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LongShot56 Asked March 2022

How to deal with multiple Medicaid denials and clearly respond to their questions?

My sister and I recently applied for Medicaid Dec 2021 for our mother (age 95) who has resided in a nursing home since Feb 2020. We are concerned about being denied Medicaid for the following reasons.


Many years ago, my mother added me to her bank accounts in case she was disabled and unable to pay home expenses. This occurred after our father went into a nursing home 2005 -2010, initially as private pay then Medicaid coverage. I know my mother was fearful and wanted peace of mind for me to access her accounts. What I didn't understand at that time was being her POA gave me / my sister that access. Since I live local, Mom picked me to put on her accounts. I don't know the setup - if it was as OR accts or AND accts with my name.

In addition, over 30 years ago I had added mom to my personal checking account when I was doing extensive out of state traveling for work. Again, it was for emergency access only to pay bills if I was detained somewhere. (Europe on 9/11). I had forgotten about Mom's access status to my checking account until my sister noticed mom's name linked to my old account. The bank could not remove my mother from my personal account, which is where my monthly social security is deposited. The Bank advised me to close my account to get my mother off it and to create a new checking account for me. So I followed these instructions June 2021.

Our mother was living independently as of July 2018 (age 91)- where upon she could no longer safely care for herself. After much stress and fighting with her we managed to convince her to sell her home and move into an assisted living apartment in Aug 2018 until Feb 2020. The sale of the home covered her rent and other living expenses. It was at this time that I accessed her bank account to make payments to the AL facility. Prior to that, my mother controlled and did her own bank transactions. My sister and I had no knowledge of her personal business as Mom was very private and independent.

Since the death of our father Aug 2010, our mother receives a part of his monthly annuity pension plus a very small social security check for herself. Upon looking at the past 5 years, my sister and I saw a trend where our mother made monthly cash withdrawals for the pension. She was very old fashioned to pay cash for living expenses, eating out, hair, car gas, etc. and only used a credit card if necessary - rarely. It appears she kept left over unspent cash at home (not smart - but this is what she appeared to have done). Then early the following year when home taxes and insurance were due - she would make a cash deposit back into her checking account. It is obvious to see tracking these cash withdrawals/deposits between her 3 bank accounts BEFORE Aug 2018. It all stops after she moved into the assisted living apartment and the home sale.

So far, Medicaid has denied our application 4 times. Twice because the nursing home social worker missed dead lines and did not include bank documents I passed her. So now my sister and I are trying to submit these bank documents to Medicaid directly. There is no more money left from the sale of the house - over $200K was already paid to the nursing home at $15K per month. There is no life insurance - only the monthly pension and social security deposit. My sister had to setup a QIT account because mom's monthly income was just over the state cutoff limit by about $75. There is less than $300 in mom's 3 bank accounts - she has outlived all her money at age 95. She is mentally and physically disabled and totally dependent on nursing home care.

The stress is unbearable for us with the multiple Medicaid denials and questions over my personal old/closed checking acct and mom's bizarre behavior moving cash money between her accounts. I do not know how else to explain these past circumstances.

LongShot56 Mar 2022
We got our Medicaid approval letter today. We are so very glad to put that stress and worry behind us now. The Medicaid Caseworker confirmed the NH social worker was missing our deadlines. I feel like now I can finally breathe again.
mstrbill Mar 2022
Great to hear! TY for updating.
JoAnn29 Mar 2022
In reply to my response. Looks like you are headed in the right direction. Just remember once you have all your info in, confirm with the caseworker that you have completed what they needed. From there its now the caseworkers job to set Mom up for Medicaid.

Please come back and tell us how everything turned out.

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Llamalover47 Mar 2022
LongShot56: Perhaps you should retain an elder law attorney.

Riley2166 Mar 2022
Two suggestions: Immediately speak with an eldercare attorney and second find a MEDICAID SPECIALIST - They exist and I would think a social worker or Adult Protective Services might be able to find one for you. Go from there. This woman has dementia and someone has to take over - far too complicated for just you.
LongShot56 Mar 2022
Thank you - we are now only communicating directly with the Medicaid caseworker to ensure they get our documents directly and before the deadline. The NH social worker was missing the Medicaid deadlines and not forwarding all of our documents - causing confusion for everyone. We are mom's POA.
geddyupgo Mar 2022
Well, you definitely made an error by have your name on her accounts and "mixing" money but that is in the past now. Going forward you need to get an appt ASAP with an good certified eldercare attorney who is familiar with Medicaid in your Mom's state. You will have to pay for this service but it is well worth the cost. Let the attorney file the Medicaid application and let him explain the mistakes made in setting up the bank accounts in the past.

Good Luck!!
LongShot56 Mar 2022
Money was never mixed or ever accessed by the 2nd person on any accounts. The only time I wrote checks from mom's accounts was when she entered Assisted Living and then needed to go to the nursing home. Also, mom never accessed my checking account from years ago. Each account was used only by the primary owner.

There is a clear paper trail of who used the accounts and who wrote checks.

https://www.agingcare.com/articles/joint-bank-accounts-affect-medicaid-168094.htm#:~:text=Medicaid%20assumes%20that%20the%20parent,adverse%20effect%20on%20Medicaid%20eligibility
Labs4me Mar 2022
Sounds like you may need a Forensic Accountant to tackle all those financial situations.

katepaints Mar 2022
Start by contacting an elder law attorney. Medicaid is a big issue for many people and they deal with it all the time.

KPWCSC Mar 2022
I am so sorry for what you are going through. The info below may give you some insights if you consult an attorney as so many are suggesting. What I’m sharing is only FYI for everyone because I am in SC and each state has their own laws for Medicaid and other estate issues. Go to the link below for our attorney’s blog, then go down to see several entries for Medicaid. Your state may be similar so use it to make a list of questions to ask an ESTATE attorney in your area. Any attorney can help but they may not be as experienced as an estate attorney. Call several to get their fee policy… I learned the hard way by paying a lot to a general attorney with a straight hourly charge not understanding and nothing was accomplished… a couple years later I tried again and almost used one with a $400 consultation fee but very blessed when a friend referred me to this one with free consultation. After the consultation she told me what the costs would be IF I hired her to prepare the documents she recommended specifically for our needs... which we did. It wouldn’t hurt to ask an attorney if some benefits can be retroactive if it is shown that your mom should have been approved earlier. That could help pay the fees.

https://www.strattonreynolds.com/blog/

Anyone reading this without an estate plan of your own needs to consider the info shared in the blog… no matter how young you are. Had we known about this attorney and used her instead of the first one we consulted, we could be receiving VA benefits right now and have everything in place for Medicaid had we needed it. As it is, we only have two years down and another year to go to be more prepared for the three year look back the VA requires and another three years to go for Medicaid. We hope to never need either assistance, but it will be less stressful if we do because we took the advice of our attorney.

Taarna Mar 2022
Talk to your banker or a financial planner that is licensed/certified in your state. They should be able to advise you on financial matters.

Flowerhouse1952 Mar 2022
Hire a medicaid estate attorney. They can help you slog through that swamp.

mstrbill Mar 2022
If you were denied you there should be an appeal process. Attend the appeal hearing and present all your documents and explain everything and leave it in their hands. Did you sign paperwork at the facility stating you personally would be held financially responsible? If you did not, you don't need to worry that much, let the social workers take over. If you did sign in a way that would cause you personally to be billed, then you would want to strongly consider getting legal assistance if you can't succeed yourself with the Medicaid appeal.
DrLokvig Mar 2022
You bring up a point about financial responsibility. My (strong) advice to all: DON'T SIGN ANYTHING THAT HOLDS YOU RESPONSIBLE for anyone, except yourself and underage children. -
JoAnn29 Mar 2022
I live in NJ. I did my Moms Medicaid application with the help of a Medicaid caseworker. She had her house but that is a an exempt asset. At the time she was in an Assist. Living being transferred to LTC. Mom had 20k left. That was used to pay 2 months of her LTC. I started the application in April, Mom was placed May 1st. She paid May and June privately. This gave me time to get the info Medicaid needed. (NJ only gives 90days to apply, spend down and find a place) Mom was under the monthly income cap of just over $2300. I needed to provide all the information that Medicaid required and spend Mom down within 90days of my initial application. By June Moms money was down to $186 well under the 2000k asset requirement. Her insurance was cashed in and used to prepay her funeral. I called the caseworker and asked if he had everything needed, he said yes and Medicaid started July 1st. Moms SS and pension went toward her care and I allowed the NH to become her payee on those accts.

TG Mom kept all her Statements. I had the 5 yrs needed. I was then given a list of things I needed to provide. Any accounts with Moms name on them are considered hers unless you can prove otherwise. I was on my Moms accts and had no problem with Medicaid, because I never co-mingled our money. Moms bank statement showed all her transactions. Money going in and going out. Her name on your acct may not matter because you should be able to prove its your money, she was only on it to help you. The house, as long as she received Market Value and the money was put aside for her care, that also should not have been a problem. If you sold it way under, then there maybe a penalty that needs to be satisfied. Meaning you care for Mom or pay for her care.

Did your sister use a lawyer to set the UIT account up? To me sounds like you know whats what. Maybe you should sit down with a Medicaid caseworker to explain how Moms money was spent in last 5 yrs. When I gave the caseworker the 5 yrs of statements, he took only 4 a year. If the caseworker feels this is all too much for them, then maybe a lawyer. But, I understand the transferring of money. You may need to provide 5 years of statements from all 3 accts so the caseworker can see what you mean with transferring money.

I know, this is hindsight, but you should have never relied on a NH clerk to make sure an application is done correctly and on time. I told my Cousin this when he started the Medicaid application for his Mom. The Office of Aging told him the same thing. Maybe the O if Aging can help u in some way.

Make the caseworkers job as easy as possible by finding a way of showing the money being transferred. Its now 2022 and you say these transfers stopped in 2018. That means you have less than 2 years of statements showing transfers.
LongShot56 Mar 2022
Thank you so much for your detailed reply and personal experience with the NJ Medicaid process. There are several similarities to our situation with bank accounts where my name was added (years ago) but all moms accounts were very clearly used only by her - until I needed to sign checks for assisted living care and then the move to the nursing home (private pay covered for 3 years). Likewise, mom never accessed my personal checking account either. Never any co-mingle of funds.

Looking back, we had very poor direction and communications from the nursing home social worker who supposedly only does Medicaid applications. (She was very bad replying to emails or returning phone calls and tracking documents I passed her. HUGE RED FLAG) My sister did consult with an elder attorney (he helped our mom years ago when our father went into a nursing home then needed Medicaid too). He directed us to setup the QIT at the bank and it really was an easy process. Our mom's monthly income amount was slightly over the cutoff limit which is why the QIT was required.

Also, it was easy for me to provide the printed bank documents. The problems occurred when we realized the nursing home social worker was missing Medicaid deadlines. The denial letters were asking for documents and information that we had previously passed to the social worker. She certainly made this a nightmare for us. We are done with her after contacting Medicaid directly which we should have done from the start after a very hard lesson learned.
LongShot56 Mar 2022
Also regarding all bank records - I am able to clearly show detailed payments for written checks for all amounts over $1000 as required by Medicaid. These included home taxes, insurance, all trades jobs done to repair the home and prep it for sale. All rent checks to Assisted Living and Nursing Home in recent years. I am able to provide mom's 3 bank acct printouts going back 5 years. I have spent HOURS printing and sorting out this information.

Plus, I had ask the bank to printout a detailed document of my closed checking account which I can no longer access online. This printout clearly shows my former employer check deposits and written checks by me to pay personal living expenses. My mother never touched this account - except her name is linked to it.

LongShot56 Mar 2022
We are located in NJ. We used an elder attorney years ago 2005 - 2010 when our father had an inheritance tied up in bank CDs with POD. Our father had no will and did not give our mother access to his savings. We had to get legal guardianship to release those funds to pay his nursing home. Our mother was allowed to remain in the house with allowed funds per the state law. When our father's funds ran out after 3 years - we contacted an elder attorney again to apply for Medicaid. So he was on Medicaid for 2 years before he died. The attorney kept raking us for more money by missing the Medicaid deadlines. Back then we spent over $15K between those 2 elder attorneys. This is why my sister is distrustful of these elder attorneys after that very negative and costly experience. She is trying to work now directly with Medicaid again after the recent bad experience with the nursing home social worker.

Fast forward to the present where we have run out of funds after home sale and liquidating all bank accounts.

AlvaDeer Mar 2022
Take all your documentation and everything you have told us to an elder law attorney. This sounds all very convoluted and it going to take some serious ironing out, as it was so wrongly done when it was done. Unfortunately, without very complete records and diaries I cannot imagine how it can be ironed out, so I don't think you will get many expert enough on this Forum for your question. You now badly need professional help. Unfortunately when things descend into this kind of chaos it is going to be very hard to fix, and the awful truth is that not everything can be fixed. Was just talking to someone else doing the beginning journey as POA to go to a lawyer at once, as doing things wrong is catastrophic. See an attorney. I wish you the best. Dig out and organize all the records you are able. Sure do wish you good luck.
LongShot56 Mar 2022
We have all the records and documentation. Our huge mistake was to use the nursing home social worker to submit our Medicaid application. We contacted and confirmed with Medicaid that this social worker was missing our deadlines and not forwarding our documents to the Medicaid office. She caused excessive confusion for us and the Medicaid office. We are now submitting documents directly to Medicaid ourselves because they already have the initial submission file. Now it needs to be completed with the information that NH social worker never passed on.
Geaton777 Mar 2022
You don't say what state your mother resides in, and this matters since Medicaid is run by each state, therefore the rules can vary. Even the look-back period can vary between 2.5 to 5 years. We can't really advise you without more information.

I would suggest you consult with a Medicaid Planner for her home state. You'll be able to give this person all the history and they will know all the rules for your mom's home state -- and it will be accurate info that is actionable.
AlvaDeer Mar 2022
This is all sounding so confused to me that there may be no answers that will suffice. I am wondering if there might not need to be state guardianship and at least then the state is responsible to placement and payment and trying to dig out this information that seems not to exist. I hope our OP starts with an attorney. So few states do only the 2.5 lookback (tho my California does that); in most cases it will be five years, but this sounds like pure confusion to me, things without answers, and I have to wonder what in the world could be done other than checking in with an attorney, or putting others in charge of Mom's care, since she needs it, and seems unable now to access any funding. Yikes.

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