Medicaid 5-year look back - what is looked at, and to what level of detail, as far as determining penalties?

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My mother-in-law has been in a nursing home for over 2 years and is depleting her assets. Her home is on the market and when it sells we expect her to have enough assets to cover her nursing home and related costs for about 20 months. For the past 2 years her expenses have been managed by a relative living nearby but I am not sure how accurate the record keeping has been, nor if detailed records attest to the actual expenses. Just wondering how her income and assets will be evaluated when it comes time to request Medicaid pay for her nursing home care.

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Now is the time to talk to an elder law attorney who serves people in your area, to protect your mother in law's remaining assets, and prepare for the sale of her house.

Medicaid is the government program that covers custodial care provided by nursing homes. In order to qualify for Medicaid Long Term Care, an applicant must be financially eligible. The person who needs care must fie a detailed application which discloses to the government all of the applicant's assets and financial resources.

If the applicant owns assets worth more than the government allows ($2,000 for a single individual), the applicant's assets must be used to pay the nursing home, before the government will provide Medicaid benefits to pay the nursing home. Asset transfers must be listed on a Medicaid application, unless 5 years have passed since date of transfer.

But, if proper steps are taken, your mother in law does not have to continue spending down her assets before filing the Medicaid application, and qualifying for Medicaid benefits.

A pooled trust account can be opened to hold your mother in law's excess assets. Money saved in a Pooled Trust account can be used for Quality of Life enhancements for a nursing home resident. Ask the elder law attorney to provide you with a list of Pooled Trust administrators in your state. Pooled Trusts, also known as (d)(4)(C) Trusts, are sponsored by charitable agencies for the benefit of disabled people.

Also, there may be other Medicaid regulations in your state that could help your mother in law. For example, money that is transferred to a properly prepared trust that benefits a disabled family member will not be counted against your mother in law.

Hiring an elder law attorney now will benefit your mother in law, and your entire family. The detailed work required to plan for and obtain Medicaid eligibility can be handled by the attorney, allowing you and other family members to spend more time visiting and caring for your loved one.
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Medicaid wants to see all financial records for 5 years, including asset transfers, bank accounts, investments, tax returns and- here's the stickler- receipts for all things bought with cash.
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Well the good part is that by selling the house, it does give you time to either find or get paperwork & documentation to resolve any transfer penalty inquiries for that eventual medicaid application.

When the house finally sells & it's bring cleared out, be sure to keep receipts, paperwork, documents on all house and care expenses. Buy some plastic flip top bins for this and set aside. You may never need them but it could be tedious to impossible to get 2years from now.

It sound like you have some concerns that the records keeping to date is somewhat too casual. If that is the situation perhaps now is the time to restructure MILs banking situation, maybe have the account done to be POD to whomever is going to deal with funeral & burial of MIL (im assuming thus wouod be your wife?) and have them added as a signature on the account too. Both the existing family member who has been dealing with management & the new signature can each get a debit card tied to the account & both have online access. So that there will never be a need to write checks to others to reinburse for expenses. (like your wife buys eyeglasses for her mom, pays the $ 350 for them and then gets it reinbursed from moms account, so looks like mom gifted $350...& you have to go and reconstruct the past to get around this if medicaid needs clarification 2 or more years from now). I'd suggest that you try to get this done now so that when the house sells & the $ proceeds of the house goes into the account, the oversight as to every dime spent down is transparent.

Each state administers its medicaid program uniquely. For my mom in TX the look back was 3years & 6 mos of bank statements & an on bank letterhead document as to the disposition of all accounts (CDs p, Tbills, savings accounts, tutmas. Mom was in IL and still had her home so her path to impoverishment was pretty obvious.
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Continued....so I'd suggest that you ask MILs NH what documents they need to have submitted for the Medicaid process in your state. For my mom, her NH had a 1page list of items needed, which they reviewed to determine it they would accept mom as a Medicaid pending resident. Then in turn these items and moms NH medicaid application (done at NH) was forwarded to the state caseworker for this NH by the NH along with their bill to the state. I'd try to clearly find out what this NH needs to have her stay as a Medicaid Pending resident too.
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Oh and for more fun in this, states can do an annual recertification for Medicaid. For my mom, the last 4 months of bank statements (all pages with cancelled checks details) was needed to be submitted along with some items submitted in the initial application. Like insurance info, citizenship info, funeral & burial policies. So keep things organized for recertification submission if need be. My moms initial application ran bout 130 pages (mainly due to her old school style life insurance policy) and the renewal varied between 25 -30 pages. Renewal required all submitted with 14 days too.

Also as it gets closer to Medicaid application, give some thought as to what works best for managing her payment to the NH. MIL does not have to have her income go to the NH once on Medicaid. She can continue to get SS, etc direct deposit and your wife or whomever is MILs DPOA pays to the NH MILs required by medicaid copay from MILs bank account. If you go this route, her bank account will build each month by her states personal needs allowance.

Keeping all this in mind and you can see that having a easily accessible financials on MIL in place is going to make everybody's life easier.
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What happens if you file for medicaid AFTER the 5 year look-back period? I had siblings that waited until 2 weeks after the five year look-back period after spending Mom's money on themselves for vacations and weddings.
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