How does a person with dementia qualify for Medicaid if they were withdrawing money from their account and no one knows what they did with it?

Have a consult with an elder care attorney. They do go by bank statements. My mom was fond of withdrawing money from the ATM, usually in $100 amounts. Problem is she would do this maybe for several days in a row. Never could figure what she was doing with it, no new clothes, no groceries. The lawyer seemed mainly concerned with $500 or greater amounts in checks written to specific people and why. My niece had managed to get money out of mom for awhile this way.

Buying alcohol and cigarettes is acceptable, as long as she bought them for herself. Supplying friends in the NH or in the neighborhood while she was home is considered gifting and would raise red flags. A pack-a-day habit costs about $240 a month. More if she smokes more, of course. Did she buy beer or expensive wine or liquor?

Did/does she gamble? Eat out a lot? Did her groceries come out of this cash?

Has there been a change in the cash withdrawals since she has been in the NH?

Contact your Area Agency on Aging, and explain the situation. Ask if they have resources who can answer your questions, or can refer you to law firms with specialists in Elder Law.

Paying for an Elder Law attorney to help with the application is a valid use of her money.

If she was really truly spending it on alcohol & cigs, there’s going to be a obvious pattern of where it was spent. At $66 a day, that’s imo that’s venturing into functional  alcoholic and they need to have routine to manage their days, so there’s gonna be a pattern. Plus Both liquor & cigs are regulated. So there’s going to be a short list of shops, bodegas, liquor stores, whatever she could easily go to on a daily or multiple times a week basis to buy Scotch & Camels.

If she’s supposedly paying cash, she has to go to the bank or check cashing place to cash a check & there will be Records on her doing this that you can find. 

If she doesn’t have a car, there’s only so far someone will walk hauling hooch... liquor is heavy even if it’s plastic “handles”.
If she doesn’t have a car & is using a delivery service, there will be an agreement existing to have this happen. States require this as both liquor & cigs are regulated. 
If she has a car, even then she’s gonna have a store that’s her place. And someone will know her & can pull up some old receipts. So you get these so you can show a pattern of spending that makes enough sense to pass Medicaid’s concerns.

Also there’s going to be a lot of bottles, like a full recycle bin regularly. I’d ask her neighbors about her shopping habits. Someone going to know something. At 2k a mo, spent every few days, it’s a lot of hooch, a lot of bottles.

Or she was gifting $.

I have to ask how or why does this person still have the ability to access their account? If that has not yet changed it should.

I can see how it might be easy to get that total on personal items. Cigarettes, alcohol, if incontinent supplies are her responsibility to purchase you would have the pull ups, ointments, wipes, under pads. That is a good chunk of money there. A few "fancy" coffees, a meal or two out a newspaper daily or even just a few times a week adds up. Paying for a phone.

The five year look back requires 5-years of bank statements and they will question unusual withdrawals and will require explanations. Not sure how they will handle not knowing where the money went.

Was money squirreled away in the house or clothes? A friend found $40,000 his mother had hidden in various places around the house - cereal boxes, clothes, purses, etc. My uncle has money stuck in his passport, drawers, notepads, various stacks of paper. Same with postage stamps - I'm still using all the stamps he had in the house.
They forget they have it, or are too lazy to look for it. Uncle would 'lose' his wallet for weeks. I usually found it within 15 minutes of arrival - typically in same drawer.

Was there any kind of caregiver? Could they have had access to funds? I found my uncles housecleaner was making regular withdrawals from ATM. I alerted the banks and police got her picture every time! except at the casino.

Countrymouse - if “exploitation of vulnerable adult” is going to be used to get around Medicaid gifting/ transfers, then there will need to be documentation on it..... which means that a police report is filed and that APS is brought in. Police report leads to charges filed, arrest warrant put out, somebody’s getting arrested. APS does an investigation, which means employers & neighbors interviews, and APS can contact others like if their SS income is involved then SSA can go into representative payee required mode. Stuff like this snowballs.

The issue will be that elder won’t file or cooperate on filing charges. And neither will the Dpoa. So the $$ gets looked at as gifting by Medicaid.

I agree with Igloo572 and Drooney:

If no formal report of elder care financial abuse was filed, medicaid will still consider it gifting.

To do otherwise, they need documented proof that the elder person was coerced to give the money away. If there is no such proof, it is considered a gift pure and simple.

If you do a search you will find numerous cases of home health aids and hospice aids taking advantage of the elder persons good will or dementia to get them to give them money.

Sometimes it is a relative who is taking the money.

In either case, it is considered a gift, unless the elder person is proved to lack capacity or agrees to file a complaint.

Too many times, if it is a child, the elder will not file a complaint, even though one is warranted.

A neighbor hired help paying cash, paid his taxi driver cash, loaned the taxi driver money, went to the casinos with his wife (taxi), and paid a reputable driver to go to doctors visits and wait. With his pattern of spending, it was no doubt more than $2,000 per month.

In that 5 year "look back" , its not so much what was done with the money, as much as you HAD that money. They really don't care if you gifted it, wasted it on silly stuff, or gave it to charity. If you show a considerable amount of funds then you must've had a good income. The more money you had, the less likely you can qualify for Medicaid . At some point, after all funds depleted, then you can qualify for Medicaid. It is a long process. Elder Law Attorney can provide guidance.