I have read a lot of posts on this and I am still unclear. Can someone explain exactly what will happen to the elder in this case.

Four years ago elder gives $25K to grandchild for college. Three years ago elder gives $25K to brother after they have a house fire that destroys everything. Two years ago elder donates large some of money to a religious charity. At the time of these 'gifts' elder had plenty of money. Now elder has been in assisted living for two years. At the original level of care elder would have had funds to cover them for quite a few years. However elder is now declining quickly and needing more and more assistance which comes at a higher and higher price. Yet they are not declining to the point where the end is near. They could 'exist' like this for years. Relative has taken over as POA to make sure no more large gifts are given and that the bills are paid.

Obviously the money given is no longer in the possession of the people it was given to. What really happens when the elder runs out of money and cannot recover funds previously given? I am certain the religious charity is not going to return the money he donated. And what if the brother he helped out is no longer living? The grandchild gave the money to the school.

What actually happens to the elder at this point? Do they become a ward of the state if no relative can taken them in? Who's job it is to try and recover the money?

I have seen a lot of posts about how medicaid will deny coverage for so many months but I have not heard what happens in that case. Has anyone experienced dealing with gap in coverage? How was that dealt with when no one could step up and afford to cover the gap?

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Oh I missed this.... the fire brother is deceased? Is that right? Could it be that 25k is debt that is uncollectible? It’s a ? for mom’s attorney to deal with. 

Also the 30 Day Notice in my experience is pretty standard. NH will issue them for those who have their application still “Medicaid Pending” beyond 90 days. It’s a way to ensure the caseworker has the documentation needed from the DPOA and the application is churning through the system.

My mom’s Medicaid application took 5 1/2 months. She got a 30 day at month 4 & month 5. Done routinely. Caseworker called me or I called him. All good. 

Now the transfer penalty 30days seem to take on another layer. In my mom’s first NH, lady (sweet & a easy care type of resident) across the hall continued to own her under 40-50k home. She was approved by Medicaid as home is exempt asset. Her son sold it and kept the $ and did not report sale to Medicaid. Sale surfaced and TP placed. So she was suspended by Medicaid. Therefore NH not getting paid. Every time I was there, he was approached by staff to settle bill & invariably shouting matches. He was imho a real azzhole. One day he came to visit and found that mom was gone. Moved to another NH as she as now a ward of the state with a court appointed guardian. Lots of commotion and police called. Staff told me that the NH would seek repayment from him personally. 

I cannot imagine how beyond awful for the little lady. How he could put her into such a position is unconscionable.

In the 30 Day Notice I got, the NH cc’s APS and nearby pro bono legal clinic. By doing this it enables the NH to contact APS to be aware & at the ready if the NH asks for APS to do an emergency review of an elders status. If that happens, APS will ask court to do an emergency placement of elder as a ward of the state. Judge will give temporary guardianship & this happens all the time.  If the NH wants to they can ask for their atty to be awarded guardianship in some states. But usually it’s an outside court appointed guardian from a list the court has on file. And they take over all. APS was cc’d so you were made aware that they have been notified. 

The guardian can move the elder and control all their funds. If there are improprieties with dpoa and elders $, they can ask APS to look into this. Stuff like this snowballs, as that can become an APS investigation into someone taking advantage of a vulnerable adult. Which is a crime. You really do not want to go there.....

Really use whatever last bit of $ Mom has to get her an attorney to shepherd her Medicaid application and whatever appeals needed. I’d bet a good attorney can get it to be inaccessible assets determination for some of this. 
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I’d suggest whomever is her dpoa now use whatever funds she has left to secure representation of an elder law atty who has experience with doing Medicaid appeals. Atty will need to shepherd the appeals process.

If this was what I’ll call a “hard target transfer” - like a car or home or piece of land - transferred by her, those I think a DPOA can deal with as the item has a set value. And things you can do to to make it a perhaps more accurate value. Like cars can have excess wear & tear, or be in accidents that lower value so the Kelly blue book value may not be accurate. So you get an appraisal done by a person or biz who can do valid appraisals for the car. If it comes in way under the KBB, it is what it is. And the appraisal report - if done by a person licensed and registered by the state for the item - is considered legal. Medicaid has to accept it. And if it still causes a penalty period, it is what it is...... but lower. Comprende?

BUT what your facing is lots squishier as 2 individuals & charity. Not a DIY.

Hopefully the charity has a tax ID # so it’s legit. My mom gave larger than I would have liked amounts to annual Archbishops Appeal for decades. Checks were in her banking statements turned in for Medicaid application. Caseworker basically ignore it. Why? It’s viewed as an “inaccessible asset”.

The inaccessible asset category can have lots of stuff possible.

This is going to meander a bit but I think may help you understand how inaccessible asset may work for you. I grew up in TX & lots of folks have ranches. Big spreads as need lots of land for cows as land is not lush like in other states. Ranches measured in sections not acres. 10 sec is nice lil’ spread & its 6,400 acres! Which might be super bigly for land in other states. Invariably land will have mineral leases & mineral rights & often from decades long ago. Land gets sold but very often the seller holds onto the mineral rights. Or gets passed down by inheritance. So you have Oil & Gas dividend possibilities. So there’s a value. Problem is you can’t really sell the O&G. Your O&G is part of a line, say 1/25th, that in turn is within an overall field that has hundreds of lines. So your O&G is like 1/25th of 1/64th..... & field may not even be in active production but dead / tapped out or may be in exploration. Plus every day for those actually producing, value changes as it’s a commodity. For those applying to Medicaid with O&G, it’s viewed as an inaccessible asset. If the well is actually in production, then divided is reported in the annual renewal for Medicaid. It’s common enough for TX Medicaid that there’s a question regarding O&G in the renewal. Dividend paid gets amortized for the year. It’s like if they have a paid up term life insurance policy that pays an annual dividend. My mom had this, it got reported in the renewal and amortized. My point is inaccessible asset exists and can be used by Medicaid to get past a hurdle in determining eligibility.

Niece had no control over grannies gift. Didn’t ask gran to do this. Grannie competent & cognitive did it on her own without consulting w/her DPOA . Grannie signed the check on her own. If it never went through nieces bank account (like grannie did a UTMA type of account) but directly to school, the $ was never the nieces’. She benefited from it but did not control the gift. University has the $ & it’s an inaccessible asset. & that is what the story is going to be in my not an attorney opinion.

The fire $, to me in my not an atty opinion, will be harder to get around a transfer penalty inquiry by Medicaid. We went through Hur. Katrina & lots of older parents gave $ to their 40-50-60 yr old kids (had homes with mortgages) as kids needed $ to rebuild as even though they got insurance $ due to the required mortgage payoff left them with zero or very little $. Mortgage co were heartless. I haven’t heard anyone over the years since then having Medicaid gifting issues. But it was a federal natural disaster. Your Mom may just face a 25k transfer penalty on fire $.  I’m guessing there was no loan or other repayment agreement done to offset it looking like gifting? If something was done, the atty perhaps could use this with Medicaid..... Not a DIY.

TP is basically a division problem: $ gifted is divisor / top & your states specific Medicaid daily room&board reimbursement is numerator / bottom. Avg R&B about $175 day. So 25k = 143 DAYS of ineligibility. Penalty is by DAYS. So in order to apply for Medicaid you have to be in a NH. Then once penalty placed in order to stay in the NH that means private pay for 143days /almost 5 months to the facility. It’s a panic to pay. This is where the atty can come in to negotiate with facility as to how paid. If not paid or settled by payment agreement, mom will get a 30 Day Notice (to move out). 

Use mom’s $ to get her an attorney to deal with this. Good luck. 😉 
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As I understand the posts...the elder or family will have to pay for his care during the penalty period. Medicaid will look back five years and question these gifts. I was told by NJ Medicaid that once my Mom was in an AL that all her income should have gone to her care. She still had a house I was trying to sell. I was using her SS to pay taxes and utilities. Was told I shouldn't have done that. In the end though, Moms caseworker didn't worry about that.
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