If I have Power of Attorney over my elderly mother and she has guardianship of a great grandchild do I then become the child's guardian?

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No, the guardianship is not transferred to you, if you feel you want to take on that responsibility then you will have to go through the process yourself.
This is correct. Guardianship has to be taken thru the court. If child has a trust or any money the cost can be taken from there. If Mom gets Dementia/Alz she will no longer be able to make informed decisions for the child. Someone will have to take the reins. Where are the mother and grandmom?
This is not going to be a DIY project. I’d try to contact ASAP the atty who did the guardianship to evaluate situation & maybe do a petition to name you if that is needed.

Also have atty look into what grans guardianship might mean IF gran needs to apply for Medicaid. I’d bet gran has given $ to granddaughter as she’s been her ward or maybe even viewed as grans dependent. Medicaid might initially think its gifting which isn’t allowed by Medicaid, so atty will need to deal with this as it’s gonna be not simple. Also if granddaughter is viewed as grans legal dependent, grans income & assets may need to continue to go to granddaughter, which I’d bet will be complicated to have Medicaid easily work through. 

Is this substance abuse mom situation who has relinquished parental rights?

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