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So my mom is now in a nursing facility, and I'm told Medicaid will allow her $60 of her income per month for expenses, and the rest goes to the nursing home. Her current Medicaid has a monthly spend-down (her income is above the "allowed" income in our state).


I called the Medicaid Assistance Program and asked how that works considering she has other bills... like all of the hospital bills that will be coming down the line, her credit-card bill, etc. The person I talked to didn't really have an answer for me. If we're supposed to pay $X for the spend-down each month, but she is only given $60-- well below that spend-down amount-- how is that supposed to work? I can't exactly pay these for her.


She doesn't have that long left (a month or two), so soon enough it'll be a case of "I'm sorry, but she is deceased and has no assets to pay the debts" and in the meantime, it's not like I'm worried about her credit score if she doesn't pay, but... I'm not sure what we should do about these bills when they start coming in? Call the creditors and explain the situation? I don't fancy the conversation of "well we can maybe send you $15-$20 a month" nor "and soon you're going to be out of luck anyway"? Should I just ignore until she dies and then just let them know then that she's deceased?


I know there's nothing I can do, but there's something that bugs me about us sitting here racking up a bunch of bills we know will never get paid or just knowing her bills won't get paid. Especially things that were incurred before she was in hospice and such, like the credit card bills.

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The $60 is to be used for her expenses in the facility. My mother used her’s for the beauty salon. Why would she be responsible for her medical bills? Doesn’t she have health insurance? Medicare Part A, B, D and a Medigap policy?

You are not responsible for her credit card or other debts. The people owed can come after the estate, but if there are no assets, her bills can’t be paid. When she passes, write to the companies and tell them she is deceased. You may want to check with an Elder Law Attorney to make certain you’re doing what you need to do.
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k12144 Sep 19, 2018
She has insurance-- Medicare supplemental-- but insurance has deductibles, co-pays, things they simply don't pay, etc. It might only be a few hundred dollars, but it's still there.
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Please, fill out your profile, helps to know your situation.

I am assuming Mom is not on Medicaid yet? You are in spend down?

By the time Mom can go on Medicaid she will only be allowed 2k and this is spent only on her if needed. Her SS and any pension will go towards her care. Medicaid provides health insurance that covers what Medicare doesn't. She will have Dental and vision too. So any health bills will be paid by Medicaid. Hospital bills prior will be paid by Medicare and her supplimental at the time. I held onto Moms supplimental until I was sure that all her previous bills had been covered then I stopped since she was on Medicaid.

The $60 is a Personal Need Acct (PNA). The 60 is taken from her SS for personal needs. Like a hair cut, snacks, clothing, etc. Its not for paying any prior bills. My Mother had a house that I had up for sale. Once on Medicaid, I paid no taxes or insurances. My nephew was living there so he paid the utilities. If he wasn't there, I would have shut off the utilities. Because, there was no money. I was not guaranteed that if I paid these expenses I would be able to be reimbursed. Being retired I couldn't afford not to get my money back.

You are just going to have to let the bills go. Someone on site has said do not contact the creditors. Once they get your info you will be harassed. You are not responsible for Moms debts. If you have POA freeze her accts so no one can use them but do not use your money.
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k12144 Sep 19, 2018
She is on Medicaid, but she has a monthly spend-down (her SS check is more than our state's allowed maximum income for Medicaid), not an asset spend-down (she has no assets). So, she is responsible for her medical expenses each month up to the spend-down amount; once her bills exceed that, if they do, Medicaid takes over paying. This spend-down is well more than $60.

I don't mind letting the bills go once she is gone, but I feel bad just leaving them while she is still alive and technically could pay on them if it weren't for the nursing home thing.
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Yes, you let the bills go until she is deceased. Then you can send all the creditors a copy of her death certificate and they will take it as a loss.
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K12144 ...I have experienced the same issues with my dad. Although, he is only 73. He had a stroke/car wreck in 2016 and he was 700 miles away, so I was the only sibling willing to drive back there and stay while he rehabilitated. Unfortunately, he was never able to walk again or really talk. I had the frustrating task of figuring out his bills, Medicare, taxes, house, etc and didn’t know much about his day to day life. Bills kept pouring in and the facility helped me get him on Medicaid. His social security had a garnish on it from my stupid half brother that defaulted on a Federal Parent/Student Loan and Medicaid did not excuse that in regards to the nursing home bill. They wanted me to make up the difference and I already had to pay for his life insurance policy and storage rent from me moving him out of his rent house. It was a mess!! I finally stopped paying the garnish makeup. I just can’t do it all. So, the bill racks up at the facility....I understand your frustration! But, what do you do? My dad could live to be 100!!!
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sjdorsey Sep 23, 2018
Ive read this column since my mother was dying and has long passed. I keep reading various folks comments, etc though. I must say, I had no idea, a person's social security monies could be garnished. Nice to know for when my hubby and I get to the stage where mom was at....we have some nasty stuff to look forward too ..sheesh
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If Mom is in a facility, all her medical needs should be taken care of. I never paid for anything medical except dental care and that was only once. There should be no worry of co-pays or deductibles. Medicaid takes care of all that.

I used to withdraw money from my mom’s PNA, especially when the balance got too high to buy her things like shoes, personal care products, etc. I saved every receipt and gave it to the financial department at the facility to show it was spent on her.
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k12144 Sep 23, 2018
Her medical needs once she was in the facility were taken care of... it was everything prior. A month of hospitalization earlier this summer, other doctor visits, her hospitalization immediately prior to going into the nursing home (which I haven't started receiving bills for yet), and other expenses like her credit card bill, etc. Technically she still has bills for even earlier stuff that she hasn't paid yet because I had submitted it to Medicaid toward her spend-down or whatever.

No worries when she's gone, but I felt like it was still "her" debt while she was alive and I should make a good faith effort to pay it (from her funds, not mine).
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You have to change the way you are thinking: “I feel bad” about not paying her bills. She is on Medicaid and those other bills cannot be paid now. Let them go. I tried all that for my dad, such as paying some bills myself (then stopped), notifying companies (got harassed and even summoned to court on a credit card - I notified the judge he was on Medicaid and had no money; judge dismissed the case) and just plain ignored some collection agencies. So sorry you are going through this but the reason they didn’t really answer you is because they can’t give you this advice.
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K12144,
Tough Times with little governmental help! Been there done that! Any bill incurred under your Mom’s name is her debt alone and will be retired with her passing. This includes credit cards, hospital any. I would contact them as they come in only to explain, as is fair You will probably find most just will ignore, and the bills will arrive and feel at this point you may ignore too! You did your part in advising them. Only one creditor attempted a second go around with us after she passed and that was American Express where she had a $4,000 debt incurred after hurricane Irma came through our state. Not frivolous, but survival stuff! They have an estate recovery team, nice huh! Mom was a widow on S.S. and the 7 years I cared for her we lived on this small stipend. Estate???? Be at peace, understanding no one wishes to be a dead beat! My goodness, her payment history to the end was awesome! Just another part of the tragedy we face as AD caregivers.
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Do not start paying your mom's bills with your money! That could be interpreted as the balance is yours and your responsibility. Then the collection calls will begin and you will be harassed.
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k12144 Sep 24, 2018
Oh, I wouldn't pay with my money-- that's why I was asking: I was wondering how to pay with hers when Medicaid is taking it all.
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If your income is only Social Security it cannot be garnished for everything- just for federal taxes, child support, educational loans and an overpayment from SS itself that is being recovered.
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SSI, by the way, can't be garnished at all. SS also could be garnished for victim restitution if you owe that. Google garnishment of Social Security for more info if anyone is worried about that. The actual rules are a bit.more complicated than you'll find in an answer here.
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What is the "spend down" being spent on? When Mom applied for Medicaid, those medical debts and certain other allowable expenses were what the spend down was spent on.
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k12144 Sep 23, 2018
Medical bills and other expenses, yes (I was also told we could use it for medical equipment, incontinence supplies, etc.). But there is no more money left for the "spend down" if all we'd have is $60/month.
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Don't give the credit card companies anything. I f you only pay a portion of the monthly payment, they will just take it and put it towards the penalty for not paying the full amount and that will go on and on.
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Let all the bills go until she is deceased and then send them a copy of her death certificate. They will still try to come after her estate, including Medicaid. But as they say you can't get blood out of a stone. Obviously if she has sold everything and had to use that for her expenses prior to death, there won't be anything for them to come after. As others have said don't try to pay anything on the bills since then they will try to say you have taken on that liability and try to come after you and your estate. If she has a house or such then Medicaid and the other creditors will all get in line to get whatever they can of what is owed with Medicaid getting first dibs. Don't think that once she passes the bills go away. That only happens once the creditors are satisfied there isn't any estate.
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Social Security can be garnished for a federal debt only. Federal income tax or if a parent has co-signed on a child’s or grandchild’s federal student loan that is in default. A friend co-signed her granddaughter’s student loans totaling $65,000. She defaulted and my friend I’d now having 15% of her Social Security check garnished each month. And federal student loans cannot be discharged thru bankruptcy.
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k12144: Do NOT pay ANY of the credit card bill because once she passes, they cannot come after a deceased individual's credit card debt. Btw, the "spend down" is a function that happens when the individual applies for Medicaid, e.g. they spend down to the amount that they are allowed. In general, it is $2K. Also, I implore you to change your thought process. Do not feel badly; you're not responsible for your mother's bills.
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k12144 Sep 23, 2018
That's an asset spend-down, which she never had because she doesn't own a house, her car is old, she doesn't have stocks/bonds/retirement funds/whatever. In my state (MI) apparently you can also have a monthly spend-down, because the allowed amount to qualify for Medicaid is only $400. Anything more than that that you make (whether pension, SS, whatever; in her case SS), you have to spend on your medical bills/expenses before Medicaid will pay the rest. (And apparently, if you don't have any medical bills for three months in a row, your Medicaid is discontinued.)
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The main point to remember is the once someone enters a nursing home, the nursing home gets ALL the money, from wherever - except for the $60 a month allowance. They supersede all other bills, to take care of your Mother, rent her a room, feed her meals, etc.
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I was told by an elder law attorney that we went to about this same issue, that the bills are “in limbo” until Dad passes. The spend down would be any $$ over the $2000 dollars in assets that Ohio Medicaid allows a person to have.
This is money in our Dad’s checking or savings accounts BEFORE the nursing home began getting Dad’s SS check directly deposited to them for his care.
The other thing the spend down could be, would be if your mother gave money, valuables, real estate, etc. to someone within the last 5 years. That has to be paid back for her care by the person that received it.

The 60$ per month goes into an account at the nursing home and is only to be used for her personal use.
Dad can go to the office and take it out of his personal account to buy whatever he wants. He gets haircuts, buys things in the vending machines.
My brother is just like you state you are. He is getting Dad’s mail and seeing the bills. There is no money to pay the bills, and it is driving my brother nuts. All of us siblings pay our bills, so it is distressing to see these unpaid. Dad did this long before he had dementia, and could never be reasoned with.
I was called by an ambulance company since I had DPOA medical at the time. I told them my Dad was in the nursing home, with dementia and did not have anyone as financial power of attorney because he had no finances. They said they would turn it over to a collection agency. I said they could do that, but there still was no $$ and Dad had refused to pay those bills because of his dementia, but when he still had the right to make his own decisions.
They have not called back since.

Just think, in limbo.
But again, if you or anyone has received money, real estate, valuables within the last 5 years, that is what must be used to spend down. Or if the 60$ per month put into her personal account gets close to 2000$ that needs to be spent down.
It sounds like that will likely not happen due to your mother’s decline.
My heart goes out to you. All of this is very difficult.
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jackos Sep 24, 2018
The resource limits are too low for individuals and families - #2,000 or even 4,000 is not enough - most people have sacrificed all their lives, paid their share of local, state and federal taxes and are tagged to take all their SS income, any pensions and of course, the assets whatever they may be over the minimum amount ---

this Medicaid law should be changed/modified/expanded to at least $12,000.00 so any individual, especially those that are lifetime workers and tax-payers, can have some dignity and self-respect for the own 'asset' management as giving their monthly income to the 'state' for personal care with a more logical baseline in 2018 is enough!
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Well, she has now passed, so no more worries about the bills. New problem: I called the bank to let them know and asked what about her credit card, as it's through the bank and she won't have the funds to pay off the balance. They told me the money will be taken from her account. This could pay off much of it, but I was hoping to pay other bills from that (final electricity, car insurance until I get it switched into my name, etc.). And, I'm not sure what sort of legal precedence there might be for bills but I thought I saw mentioned in my reading that technically, there is one... my guess is that Medicaid would want to claim it before any other creditors. I hope the bank doesn't take it and then Medicaid come looking, find out the bank took it, and expect me to make it up because they somehow blame it on me. (I assume Medicaid would have cleaned out the bank account anyway, but I was counting on getting some bills paid before they came knocking. Now that I've notified the bank, even though they don't have the death certificate yet or anything, they'll probably pull the money soon.)

I need to talk to an attorney for sure on this, though I was planning on calling one anyway. I can't really afford a lawyer, but I can even less afford somehow ending up financially liable or in criminal trouble (which would also wreak havoc with my job) because I make some misstep due to ignorance. With financial power of attorney, I don't know if I can forbid the bank to take the money or not. Even if so, I don't want it on my head if they do it anyway. If Medicaid and the bank want to hash it out between themselves, that's fine, but I don't want to get stuck in the middle.
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Nancynurse Sep 26, 2018
I'm so sorry for your loss. Please check with your local Office for Aging. They may have an attorney on retainer that can help you. Usually the first appointment with any lawyer is without charge in any case. Good luck on getting this very difficult situation resolved.
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You might want to look into a pooled income trust. Basic idea is that you put excess income into the trust, and then the trust pays the bills from that money.
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Maridog4 Sep 27, 2018
This is also called a  QIT (Qualified Income Trust) and must have been done while mother was alive and by attorney. If you are talking after the fact then she is taking responsibility for those bills.
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medical bills and car or utility bills credit cards are not a concern. (unless you are Executor of her estate) POA AND MPOA are gone once she passes. By law the bank can not take money from her account until they have a death certificate, and even then it must be stated in her credit card agreement that this can be done.
As for nursing home bill medicaid /medicare will pay up to day of passing. If her ss, and pension went straight to nursing home. then I understand she did not have a QIT (Qualified Income Trust) bank account set up, which only the trustee can take money. medicare/medicaid should not ask for any money from her regular bank account.
Creditors or collections will bother you until they get a death certificate. Make sure you send these register mail asking for a signature. if you fax, keep record that it went threw ok this is the print out that come after the fax say it went threw. then call asap and check.
For her mortgage, check her home ins. Some policies pay off loan upon death. she may also have this with her bank card as well. and maybe with the mortgage company to. Do not pay any bills or collection, in some states this makes you farther responsible for remaining debt.
The 60 was only for your mother to use in nursing home, for snacks or hair cut, maybe order from McDonald for example. If you used it for your own stuff or her medical bills out side the nursing home , you broke the law.
Her pension and ss. was her payment to nursing home for room and board and any medical supply like diapers, medication, special creams ordered by doctor. Transportation to and from Dr. appointment.
Nursing homes can cost about 5,000.00 per month. not much pay check left after that if any at all.
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k12144 Sep 28, 2018
Hm, that's a very limited use. Pretty silly and shortsighted of them to do it that way. Especially since at her NH, there were no fees for activities, services like a beauty shop (not that she would have used it anyway), etc. No way would she have spent $60/mo in the vending machines.

What happens to money that isn't used? Does it build up, or just go back to the NH?
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I am sorry for the loss of your Mom.
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k12144 Sep 29, 2018
Thank you.
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K12 - sorry for the loss of your mom. Now that’s shes deceased there will be a different type of paperwork to deal with her debts, banking and Medicaid.

Here’s my take on this as one who has been Executor 3x, you need to get death certificates and not just a couple. In the past you could xerox one and attach to the credit card, doctors bill, whatever statement and write deceased across the statement and it would be accepted. My experience is that nowadays each debtor wants an original death certificate to close out a file. So get several. The more your order initially the cheaper & it’s the funeral home that do these initially and it folds into the funeral bill. If that window has passed then you’ll have to order from the state and pay in advance for them and it may take more time to get.

Check with the NH to see the status on her PNA / personal needs allowance placed in a trust fund at the NH. It’s the $60 a mo she got to keep, so 3 mos = $180. NH can hold or till her bill is zeroed out. Then they should send the balance as a check to whomever on file for it as an authorized signatory for withdrawals. The amount is considered an asset of her estate. A nicer NH writes the ck in the name of whomever is listed as signatory on file; a buttrash NH will issue a time limited check to “The Estate of Ann Jones Smith” and the only way to ever deposit these is IF you open probate and have a Estate Of account...... if resident was on Medicaid they likely died with no assets so no need to ever open probate, so check cannot get cashed ever. NH keeps the $.

On her banking, if SS was being direct deposited into it, SS might be deposited for Oct. BUT it will be clawed back by SS within 2 maybe 3 weeks as she did not live the entire month of September and so not eligible for September payment deposited in Oct. Federal / civil service retirements do the same thing but take a bit longer (for my mom it was like 10 weeks for federal civil service $ to clawback). The $ must stay in the account so they can clawback from.

The CC, well that card probably had the terms of card issuance with the banks ability to seize account assets if she defaulted on her CC. Most CC don’t. Otherwise CC write it off when you send them an original death certificate and write deceased accross the bill.

And then there’s Medicaids MERP / Estate Recovery to deal with. State is required to attempt a recovery of all costs Paid by Medicaid from the deceased estate. How it’s done depends on your state, some states do it via state employees; other states have outside contractors who do this and these run much on the traditional debt collectors playbook.
You or whomever on file for contact for your mom gets a NOI from MERP. NOI = Notice of intent (to file a lien or a claim against the estate).
Its not a warm & fuzzy letter but reads the amount Medicaid paid and kinda implies you owe state as it’s your name on the letter. That is not the case, it is your mothers estate that the state has to file a claim or lien against according to however probate laws are done in your state.
The NOI usually has a multi page questionnaire as to mom’s assets...... everything from wanting to know her bank balance as of DOD, her life insurance payouts and who as beneficiaries, property in her name, etc.
Questions all to determine IF her Estate makes sense to go after. MERP has rules..... like if Medicaid paid under 3k, no MERP; if died with under 2k in assets, no MERP; if value of assets of the estate for MERP placement under 10k, no MERP. Questionnaire will ask if you plan on opening probate as that takes MERP to another approach for Recovery. This really a factor if yours is a probate distribution by level of claim by class state. Unless your mom owed a home as she kept it as an allowed exempt asset for Medicaid, this part you’ll ever need to deal with.

If you ignore the NOI, it will keep being sent, like what debt collectors do. Yeah even in death there’s still stuff....
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This not exactly the answer to your question but helpful to those that never had a retirement account,life insurance, or a medigap...or a lesson in what can happen in real life if u do not prepare with a will or poa,dnr,NH...my brother Dads caretaker suddenly died with my dad, his dad sitting next to him at 97 yrs old...with some dementia couldn't tell his caretaker son was having a seizure...so I had to spring into action firstly cause Dad become ill,perhaps UTI or some recognition of his son being incapacitated looking for him,I lived next door,first the fact that son predeseased Father means any inheritiance goes to Father who I had to get a POA for
and DNR for ………..although if I had stated that Dad had dementia perhaps the state would have granted me rights to property,anyway dad had to go to a NH..
I could not handle him,plus I was distressed at my brothers sudden death from an infectious desease that frankly I did not know anything about ,he was in a coma and died after the Brain surgery in one day..that I had to give permission for not having a will,dnr.....also could not get his records due to Hippa from his GP
although the other docs complied..so Dad had to be put on Medicaid but there accured 10,000 due to him not having a supplement...this could wipe out a low income senior who had been in home care until 97 yrs...due to his son passing I could not handle but in hindsight I could have gotten the Veterans as he was on aid and attendance for three years thankgod!!!!to come into the home it would have been better than all the burracracy and Medicaid stuff I knew nothing..was prepared to pay from my own money mind you my brother also had debts when he died...…….I never or am in the process of becoming the executor but waited for six mos after Dad died in the NH.
Today I am waiting for a lawyer to call me as the company that did DAds poa
frankly blew me off,after charging me 400 to do the poa...as Dad never had any money in the bank,,only his one year retroactive ten thousand that was used by me for a funeral trust contract...…….I assume that they thought they did nto have any business possibilities for me or my family..however today Iam due to paying on my brothers bills...I have paid 16,000 of my won money twards his home equity before becoming an executor,I was quietly informed by the bank that the HE had a death insurance on it..so now I hope to get my money back..at least ..things can get messy with two deaths..six mos apart..also im thinking my brother had caretaker burnout that contributed to his death...this had caused me a lot of stress..caretakers go to the utmost to keep their pateints dad alive to their own overlooking of their own health, and needs....I did it for four weeks after bother died and I almost had a nervous breakdown...waking up at nite,of course I could nto address dads private needs...that's my story..
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