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My 92 year old grandfather has been saving as cash, the unspent portion of his medicaid "personal needs allowance." This money has grown over the past 4 or so years. He has SS and a Railroad Pension that together still qualified him for Medicaid, paying for his assisted living facility. He was private pay in another facility, until he spent down to the $2,000 maximum allowed. My mother, his daughter-in-law by marriage, helps do his bookkeeping, barber visits, etc, as he cannot read or write. He comes from depression era thinking, doesn't want to spend a dime on anything, thinks his money is his money! Since gifts are not to be given, he can't even give it away. My mother often would purchase things for him out of her own pocket, never charging for gas/transportation, etc... (in hind sight, should not have done this, even though it was just easier). She admits this hasn't felt right, and feels she needs to do something about it now. Where should we start (Elder Lawyer, Grandfather’s Medicaid CaseWorker,…) and what repercussions is she looking at?

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.Your mother should start having GF reimburse her for any and all purchases going forward. It should be more than his monthly allowance so that his stash of cash can be reduced gradually. She should also be reimbursed for past purchases and expenses if she still has receipts.

For mileage reimbursement, prepare a log of dates of the trips. to and from, and mileage for each trip, then multiply by the allowable rate per IRS.


I don't see a need to alarm anyone which might jeopardize his Medicaid eligibility.
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Well... it's all in cash so nobody knows it is there so IMO unless you want to adhere to the letter rather than the spirit of the law  you can spend it as you see fit, this is how the underground economy works.
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By Medicaid protocol, is there an allowable monthly "administrative fee," which can be paid from his monthly PNA, that can be justified for all the managing she does for my grandfather?
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I'm on board with not sending up red flags. I'd think this money was already spent but not reimbursed properly. Find every receipt possible and reimburse those, even credit card statement charges you know were for his benefit. I like the idea of taking some cash $50-$100 at a time and buying gas gift cards to pay back for transportation expenses. I would not want to charge an admin fee as that would be taxable income for the payee.
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Shhhh....
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Yes, I'd be careful about posting anything like that on a "public" board that can be traced back to you. Few years back, had a Lawyer find me on FB, someone working under him sent me a Friend Request, I accepted. He used everything on my page, which is Private, to "prove" I wasn't injured at a 1099 job 6 months prior! On FB, I have changed my name.
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The PNA goes against the spend down. So if you spent down to 2000 for medicaid and don't spend the PNA, lets say 500, you now have 2500. 500 too much and Medicaid will question it. The PNA can be spent on any of his personal needs. Shampoo, shave cream, soap, shoes, clothing etc.

You need to get spent down before Medicaid does their audit. Which maybe later in the year. By him some new clothes, shoes, food, toilet paper anything that he needs to live there. As long as 2000 or less is there when they audit I don't think being over at a prior point will mean anything. Just get it spent.
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