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Medicaid does not expect the elder to live on air. Medicaids evaluation on their application for LTC Medicaid will reflect the cost of living for the elders state or their city. It needs to make sense based on where they were financially 5 years ago and over 5 years time to now find themselves impoverished and at the $ 2,000 maximum for non exempt assets (for most States).

How the 5 year look back is done depends on your States LTC Medicaid program management. What seems to be happening now is 12 full months of bank & all other financial statements based on date of application then every 6 months back 5 years. Medicaid is also going to want details on any property (land, home, car) owned and sold in past 5 years. Details on any life insurance and any funeral / burial policies. Plus current “awards letter”, like the document from SSA sent out in Nov that states to the penny what they will be paid for the incoming year.

Most NH will have a list of items needed for LTC Medicaid applications. For a lot of states it is the NH that takes the elders documentation and adds their own room&board bill and submits all to the caseworker assigned to their facility or zip code. Often a NH will themselves evaluate the documents to determine IF they will accept the elder as a “Medicaid Pending” admission or will require them to be private pay. If you are new to this, please please ask the places you are looking will do Medicaid Pending as many do not.

But back to look back $:
Let’s say avg cost of living in your state $1,500.00 a mo.
So if a widowed & now medically needing skilled nursing care mom back in 2017 ended her year with 20K in savings and did not have a home, is paid $1200 a mo SSA as her only income & pays you $ 1K a mo as her rent or share of cost to be a member of your household; for that mom makes sense to now be @ 2K & “impoverished”.
if a mom ended her year in 2017 with 20K then sold her home in 2018 for $320K and gets $1200 a mo SS and pays you 1K a mo as share of costs and now finds herself at 2K and impoverished, that does NOT at all make sense. This mom should have at least 200K as house sale $$$.

Caseworker has 5 years of records to take data from and use in an equation to quickly determine if #s seem amiss. Caseworker can in a few keystrokes search State database by your moms name and SS#. If something should seem amiss, then in my experience they review the last year to see if a pattern of spending that makes sense to now be impoverished. Like mom has extraordinary medication costs, lives in a higher rent apt, have in home caregivers they are private paying for, $$$ paid for dental care. If $ still doesn’t make sense, then the application is flagged for deeper review. Go through her financials before applying to see if there flat are things that look hinky and do what you can to get documentation as to why they are an ok spend down.

My mom had a car within the look back & wrote checks to mechanic not in the existing Business name but in his name. I found receipts so it matched up and not an issue.

If you flat know your mom did gifting, personally if it was me, I would not try to DIY her application but have mom hire & pay for from her $ a elder law attorney to shepherd her Medicaid application. Good luck.
Helpful Answer (4)

Medicaid will want records documenting what her money was spent on so that they can tell that it was not gifted, starting with statements from all of her accounts for the five years. I've heard of no standard amount that gets to avoid scrutiny.

Monthly $1,250 checks on the first of each month with a memo that says room and board will be more plausible than a single check for $15,000, and they will likely look closely at caregiving costs. What you'd really like to be able to show is a caregiving contract specifying hours and duties consistent with her doctor's description of her ADL or cognitive needs, along with payroll tax records.

Document what you can. Reconstruct records using her doctor appointment records, and your own credit card and banking records if necessary.
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