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redhair44 Asked September 2019

Is there a way to get around the 5 year look back with Medicaid?

My father in law has Parkinson's and is also in the final stages of dementia, we kept him with us however it has started to take a toll on my husbands health.. he ruptured a disc in his back and is in need of surgery, I have to work full time while he takes care of his father. We decided to make the very difficult decision to move his father to a NH in the process we discovered Medicaid looks back 5 years. We thought no problem.. that was a mistake! There were a lot of poor financial decisions made in a very short period of time which caused us to loose the opportunity of a NH and unfortunately in home nursing is not an option either.
The family member involved will not communicate. Is there anything we can do or any way to get around the situation? The family left do not have the means to cover the expense of a $10,000 a month NH bill.

igloo572 Sep 2019
Red, well it’s quite the unwanted undeserved wedding gift for you.

As others have posted, the exact timeframe on $ is critical.
So exactly what month & year was the last time Scott’s folks gave $ to your BIL or any other family member.
Thats the drop date plus 1 month to work back from.
And find the paperwork on the RM.
If the 250k was from a lump sum payment from the RM, that probably was on a home 400-550k. I’m guessing MIL didn’t pay taxes or insurance, so RM called in loan within couple of months of those not being done. I bet his folks didn’t at all understand the compliance requirements of the RM. How they went about getting this RM may be something for an attorney to look at. RMs require consumer counseling & exit interviews; if these were done on-line, who did them?

Personally, really I’d suggest you & hubs contact an NAELA or CELA level of elder law attorney to see what the options are - if any - for the predicament you all are in. All of us can give you ideas & things to mull over....... we’re an opinionated group on this forum ....
But it’s going to be how Medicaid eligibility review & elder endangering laws are done for your state that will matter. And that needs an experienced atty to discuss this with. Good luck.

Rainmom Sep 2019
redhair44 - Again, how old is FIL and what is his condition as far as expected time left among the living?

How far into the five year lookback did the $250 large gift occur? As it is now apparent that MIL is living with you as well - what is the plan for her as she declines?

Since MIL AND FIL are both living with you and assuming their expenses are low and they are both receiving Social Security - yes? - is there enough money to bring in a paid caregiver for even a few hours a few times a week to help with some respite for you and your husband?

Im sorry - but I can’t help but think you are leaving out some bits of information. That there’s a bit more to this situation than you’re telling. I truly don’t mean to be accusatory and/or mean but if anyone here can give you any real workable advice or potential solutions - you’re gonna have to be completely forthcoming.

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needtowashhair Sep 2019
You can move him to California. The look back for medicaid in California is 2.5 years, half of the rest of the country.

Have you looked into a care home instead of a nursing home. They are like little mini nursing homes. They are about half the cost. I know, still not cheap.

I've brought this up before, consider Mexico as an option. There are plenty of nursing homes along the border that cater to Americans. They are about 1/5th the cost of an equivalent US nursing home. And, due to culture, they will get more caring care. Being so close to the border, if needed for insurance reasons, they can be in a US hospital faster than many people living in rural America can.
AlvaDeer Sep 2019
Need to Wash Hair, Thanks for that information. I never thought to look, but am so surprised to hear my state has a 2.5 look back instead of the 5 in most States. Knew we were enlightened in some things, but not THAT enlightened. Of course, dependent on where you are we are also quite expensive.
Guestshopadmin Sep 2019
As Rain asked WHEN did this happen? How long til the 5 year is up?

CTTN55 Sep 2019
Why did the son and his wife move out of FIL's home? Looks like they dumped him on you when the going got tough?

(Why did you agree to take him? Did they lie about how difficult it was going to be?)
redhair44 Sep 2019
Everyone had to leave the home(MIL/FIL and the son/wife) which had been in the family for over 100 years because my MIL took out a reverse mortgage on the property and unfortunately did not manage the finances well. Apparently the balance of the family didn't know or took it for granted that mom was still able to manage things appropriately.. they found out too late this was not true. The property was sold to pay off the debt created, the brother was given $ because he no longer had a place to live.
My husband and I were not married at the time so I am learning new things about the family and the situation every day. It is so frustrating again I want to support my husband and make sure my FIL is in a nice place where he is well cared for. My MIL is 80, she is also living with us her health is not good from mental to physical challenges which are a result of her poor decisions and frustrations with her current life status.
Life is interesting from day to day!!

Scott (my husband) agreed to take in his parents before we met. He was living alone in a 3 bedroom home and the balance of the family did not want to take them. At the time his father, mother and himself were relatively healthy as Bills diseases progressed and his needs intensified everyone's health began to decline. I don't believe Scott really knew what to expect as things progressed.
Rainmom Sep 2019
redhair44 - if you’re still in the building, can you answer a few questions that I have?

What happened to the wife - your MIL?

Just how old is FIL? You say he has Parkinson and late stage dementia- any idea on how much longer he’ll live? Sorry if that’s a morbid and insensitive question, but I’m very much a realist and a workable plan might need the “devil in the details”.

At what point is FIL in the five year lookback? Exactly when was your husband’s brother given the $250 grand?

... just trying to see a larger pic with a few facts that would make a difference in a workable plan.

Karsten Sep 2019
I guess I am not sure of the question. If you have no money, Medicaid should provide for the NH. If there was money transferred during the five years prior, it should be returned to the government. Why do people want to "get around" things?
worriedinCali Sep 2019
How can something that was never given to the government be returned to them? The whole issue here is the 5 year lookback has rendered her FIL ineligible for Medicaid even though he needs it for long term care. She’s not trying to “get around things” in a bad way. And FWIW, what is wrong with tax payers wanting to utilize the very entitlement programs THEY have funded for years? The OP has done nothing wrong. She’s one of the people suffering because of someone else’s poor financial decisions.
Katiekate Sep 2019
What happens is that until the five years has passed and the gift is no longer in the look back window, until then, someone must either pay the nursing home costs or keep her in their home.

my aunt paid the tuition bills for her son.. ($75k+). He died in an auto crash two years later, At 2 years my aunt had a massive stroke. She quickly ran through the money she had and the no money for nursing home and she was denied Medicaid until the $75k was paid for her care first. (Or the look back period no longer included the gift)
the cousins wanted to borrow the money from my Mom....but..as her POA I could not allow it because it might just be transferring the problem from my aunt to my Mom.

since no one could afford the nursing home, she was discharged to a niece and the whole family pitches in to help make that work.

in the longer term, the next issue is that unless she has been self pay for a while, some of the nicest NH will not accept a Medicaid only patient, When my aunt does get past the look back, she will have no money for self pay and they will have to choose from the Medicaid homes...most of which are poor choices.
mstrbill Sep 2019
Katie, how did the discharge of your Aunt go? How able were the niece and family to take care of Aunt (financially and otherwise)?
mstrbill Sep 2019
redhair, I'm sorry you're in this situation. It stinks. You won't be able to place FIL in NH by yourself, the only option I see is have someone else do it if you can't care for him properly. That means either ER dump or another thought might be to call APS, but I'm not sure about that. The other option would be to pay for an attorney which probably will cost you quite a bit and I'm not sure if that's the right route either. But I do know you can get him the proper care he needs by getting him into the local hospital and let them and the state take over. Wishing you well, keep us updated if possible.

igloo572 Sep 2019
So a son was gifted 25OK?
the 25OK was viewed as compensation for his caregiving but there was no caregiver agreement or other paperwork done to help establish that it was not gifting?
& parents did a RM on their home so essentially have no property that could ever be sold to create income / assets.
& home has been tuned back to RM.
That the backstory, right?

The biggest hurdles imho is that IF the son that was gifted 250k will not from the get-go be willing to provide details & be totally responsive to any requests for information or bank deposits, then you & your hubs are kinda left with 2 options:
- you 2 cobble together whatever time & $ to augment his folks SS$ to pay fir caregiving that’s done in your home. Really if your hubs has his own heath concerns you need to shift as much as possible to getting paid caregiving done all above board for the folks. & folks pay for this from their own $.
- you go nuclear option. 2 choices here:
hubs as DPOA for his parents meet with a NAELA or CELA level of elder law attorney to discuss filing a police report against bro & his wife for “exploitation of a vulnerable adult”. Often the threat of this being on the horizon will spur a recalcitrant sibling to suddenly be all cooperative. It’s a serious felony & in the process of filing a charge the atty pulls background reports on them & can call in APS to run a parallel investigation. 250k is serious $, its not grandaughter took MawMaws old pearls. If they work at any type of government or teaching job or other job that needs clearance, it could cause them to loose their job or be suspended...... not a DIY gotta have a pit bulky of an atty
or if $ move fairly recent, and folks did not do some sort of tax filing with IRS, then talk with atty ably folks doing an amended return with the $ as income paid to them for caregiving. $250k tax bill is like 75k hit.
Theses are both nuclear options but either establishes it was not gifting as you have a police report and charges brought so $$$ was stolen from them & ok for Medicaid OR it was paid for caregiving and they have irs filing to establish that. But folks have to. E willing to cause serious repercussions for 250k home owner brother. Really it’s something to clearly discuss with an atty & it will get ugly
worriedinCali Sep 2019
Wouldn’t the OP herself be guilty of a seriously felony herself, if she followed a nuclear option and filed a false police report? This was gifted money in exchange for caregiving.
Kimber166 Sep 2019
This happened with a friend of mine. Here is what happened - the mother (in this case) went to the hospital and no one took her home (she had been living on her own). She became a ward of state who went after the two daughters who were gifted the money in a mistaken understanding that they could get the money and mom could get "free" nursing home care. Grand daughter had to sell the house she bought with the money.  The other sister had a repayment plan. The authorities have no bones about going after repayments of "gifted" money. Of course this all caused WWIII between the family members - but so be it. Mom got the care she needed in a Medicaid nursing home.
mstrbill Sep 2019
This is exactly what happens. They go after the people who were gifted the money that could have been used to pay for care of the gifter. They don't go after (and can't legally) family members who had nothing to do with the patient's money.
mstrbill Sep 2019
Redhair, you need to get FIL into hospital somehow and refuse to let them release back to you. You tell them you are unable to provide for his needs. I'm not familiar with Florida but I'm fairly certain they will go after Son to reimburse any costs that Medicaid won't cover due to lookback.

gladimhere Sep 2019
Who has POA for the folks? 250K?! I would not waste time getting to an elder law attorney to discuss Florida options. 250K could very easily be a penalty of two years of nursing home care, possibly longer, that will be penalty for gifting.

How long did son provide care for folks? Was it medically necessary? If longer than two years there may be an option there, if son was able to keep them at home when a nursing home would have been required without him. Medicaid waivers are available in some states for caregiving child to remain in the home. How this would work if the home was sold and reverse mortgage besides, I have no idea. Was there some sort of written agreement between folks and son?
redhair44 Sep 2019
The son was in the home for 10yrs, it was during the beginning to the early middle stages of the disease so no nursing home was needed at the time.(I was not a part of the situation at that time so I am guessing). The sons wife is an elderly medical provider which makes the situation more sad. The only thing I can say with certainty is that we are keeping them from a nursing home now by taking very good care of them at home but it is hurting us. I hate to say those words but what do you do we need help. No written agreement unfortunately they assumed their child would love them and care for their well being.
AlvaDeer Sep 2019
Wow. So they gifted their money to their son and he bought a home with it. Does anyone know what medicaid does in a situation such as this?
Have you BEEN to an Elder Law Attorney with this problem? It could be a good place to start to get some answers as I think the one in your state would be familiar with your medicaid laws. But honestly I do not have a clue. Your parents made themselves virtually indigent with this gift. Yikes.
worriedinCali Sep 2019
Medicaid penalizes in this duration. They will deny eligibility until the penalty period is over.
redhair44 Sep 2019
Thank you for responding. I apologize for being vague... my husband and I have been married for a very short period of time so I am discovering new things regarding the situation daily as we try to figure out how to handle things the best we can.
My mother in law took out a reverse mortgage several years ago after my FIL became ill.. their 2nd son and his wife moved to Fla to help with care. Long story short they had to sell their home/property due to mounting bills and a lack of care for FIL. In order to keep the peace (what I am being told) the son was given $250,000 to purchase a house to live in because he no longer had a home. MIL and FIL after settling their debt have SS to live on for the balance of their lives. We went to the son with the situation he wants nothing to do with it.. is not concerned. Because the son was gifted the money we have no leg to stand on.
katiekat2009 Sep 2019
Elder fraud. Doesn't sound like FIL was in his right mind to sign over any funds.
worriedinCali Sep 2019
Is your FIL or his spouse (if he has one) a veteran by any chance? If yes, there is financial assistance for nursing home care. My FIL was a veteran and the VA paid for his nursing home. There is also aid & attendance but there are financial eligibility requirements (no lookback period though).

Theres no mention of what state you are in. If your state enforces filial law then they do have to prove that you can actually afford to pay for his care. It sounds like your husband isn’t working so he has no income. Should the nursing home sue, there’s no income for them to attach.

Countrymouse Sep 2019
😮

I tried Medicaid in Idaho, www.medicaid.idaho.gov, just to see if there were any examples, and this is what happened in bold red typeface:

Access Denied
You are attempting to access a forbidden site.

So not as helpful as I'd been hoping, then...
gladimhere Sep 2019
Maybe because you are across the pond?

I can access it here.
https://medicaid-guide.org/state/idaho/?utm_source=google&utm_medium=cpc&utm_campaign=Search_ID_Kwd_Medicaid&utm_content=Medicaid_BM&utm_term=%2Bmedicaid%20%2Bidaho&gclid=EAIaIQobChMIxd7oj6mw5AIVgP_jBx0OogkeEAAYAiAAEgJiIfD_BwE

There are across the pond pages I would sometimes like to read that I am denied access to.
gladimhere Sep 2019
Different states, different rules and laws and policies. None of us know for certain what is required and practiced in all locations. That is why elder law attorneys are so often recommended.

Countrymouse Sep 2019
What does "the family member involved will not communicate" mean?

What does "poor financial decisions made" mean?

What you can't do is shrug your shoulders and leave the uncommunicative family member in possession of your father's funds. So: what efforts have been made to outline the situation to the family member? How long has this been going on? Is the family member in hiding, preoccupied with a different crisis, failing to understand the problem, or what?

And looking at the circumstances in which your father gave him/her unwise amounts of money - were they cooking up a "clever" scheme, digging the f.m. out of a financial hole, or what?

The thing is. Whichever you slice it, the money your father gave to this person now has to be pursued. The end of the pursuit, depending on what happened, could be: the return of some or all of the money, the prosecution of the family member for financial abuse, the sale or remortgage of the family member's home in order to return the money, potentially (I guess) the bankruptcy of the family member. But you can't reasonably expect the state to pick up the tab for your father's care when it isn't that he doesn't have the money for his own care, it's that someone else has pinched it - so that has to be followed to its conclusion first.

What does Medicaid in the various states actually advise families to do in this sort of situation, does anyone know?

PS - father-in-law, I mean; I beg your pardon.
mstrbill Sep 2019
There seems to be some misunderstanding, the state doesn't seek to recover the money, the money has to be paid to the NH or hospital before Medicaid will be approved. in other words, if FIL lands in NH via discharge from the hospital, bills will start to accrue. If Medicaid is delayed or assigned a penalty, the money needs to be paid to the NH, not the state.
mstrbill Sep 2019
The way to do it is to get your father in law into hospital and then they discharge him to the nursing home. What happens if there is a penalty involved in Medicaid is the Nursing home has a right to go after the family member who was gifted the money from your father in law for the amount that Medicaid is not going to cover due to the penalty period. So the uncommunicative family member will eventually get sued. For your part, you do not let the hospital or NH discharge to you (unsafe discharge) and do not sign any admission paperwork stating you will be financially responsible. So your father in law will get proper care, you just have to let the hospital take over, you won't be able to place him yourself into a NH. Just don't sign anything or pay out of your own funds, the person who was gifted will eventually be taken to court, likely given a judgement and have wages attached if he/she doesn't pay.
worriedinCali Sep 2019
It’s actually not true that the nursing home has the right to go after the family member that was gifted money. The nursing home won’t be suing anyone. The exception being, if the OP is in PA and the state determines that the children are financially able to pay the nursing home bill.
JoAnn29 Sep 2019
There is no way to bypass the five year look back. If FIL gave someone 10k within the 5 years, it either has to be paid back. A NH usually cost about 10k so the penalty would be one month probably. You can call your local Medicaid and see what their look back is. Some States are 3 yrs. I would ask a caseworker at Medicaid that question. There have been posts were members have gone to Elder care attorneys and gotten second opinions only to find they get different answers.
gladimhere Sep 2019
We do not know the gift amount, only that nursing home care is 10k a month.

How much was gifted?
NYDaughterInLaw Sep 2019
I agree with Alva. At this point, rather than worrying about the family member who will not communicate, focus on reality which is that you and your husband can no longer care for his father in your home. Period.

As for using the ER to help you and your husband get out of your present situation, it's called Granny Dumping and it's done by families and nursing homes alike when they no longer can provide the care needed for whatever reason. Social workers in the emergency department are used to dealing with it.

You will not feel good about abandoning him - you are between a rock and a hard place - and you have no good solutions to your difficult situation. Keep telling the social worker or discharge planner at the hospital "No, he cannot come back to my home". This is the sad reality of health care in the USA.
AlvaDeer Sep 2019
Yes, agree. It is CRUCIAL to tell the Social Worker at the hospital that he cannot come back to their home. They will try everything. All the platitudes of "We will get you help; we can make this work". They cannot get you help and it will not work.Tell them that you will not be taking him into your home again. That you are sorry but are physically unable and it is not an option.
AlvaDeer Sep 2019
I don't know what you mean by "The family member involved will not communicate".
Are you saying that Medicare will give no coverage to a Senior with no assets? Are there assets? Have you spoken with Medicare about what you can do next? Are you the POA for your father in law?
At some point, with you working and your husband with a disc out, it is going to come to the point of taking your FIL to an emergency room and saying that there is no one to care for him and he cannot remain alone. At that point you need to ask for a Social Worker. This is the only way I know to get fast movement into what CAN be done. We all know that there are many with no funds at all for whatever reasons, who have ALSO no family at all, yet do receive care.
You are faced now with your own physical limitations, and your own need to work to sustain your life. I honestly cannot think of another thing to do in a situation where you tell me that Medicare will not help at all, and you both are currently unable to. What a terrible dilemma. I hope others have some clue what to tell you. Wishing you luck and hoping you will update us if you learn anything to help, because you cannot be the only one in this situation.
rovana Sep 2019
Alva, please keep in mind that this is NOT about Medicare, but about Medicaid. And it sounds like some kind of gifting was involved with the family member.   If senior's assets were hidden or given away in order to "protect" them, then there will be a transfer penalty. Then the family's problem will be how to get the assets returned so that they can be used to pay for care - or the family will have to manage the care until the penalty period is over.  Harsh, but ya know? entirely fair.
lealonnie1 Sep 2019
You should contact an Elder Care Attorney to see what options you may have. As far as I know, there is no way to avoid the 5 year look back period Medicaid employs to determine eligibility for benefits.
Good luck!

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