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Hello! A patient (over the age of 65) was admitted into a psych facility (nervous breakdown, dementia, depression, anxiety) and stayed for approximately two months. He was financially approved for Medicaid long term care while there and then was transferred into a skilled nursing facility for rehab therapy. Since he hasn't been home (he can't live alone anymore), his POA is paying all of his bills through his bank account. Now there's extra money since he hasn't been using any of it for living expenses (food, clothing, gas, entertainment, etc.,). Should the POA make sure that the bank account is down to $2000 before he's admitted for long term stay (by spending money on the patient & keeping receipts) so he can stay Medicaid approved or does it matter since he's already approved financially?


Also, does Medicaid recoup that extra money or is the money available for the patient once he's admitted into the nursing home for long term care? The patient could use hearing aids now that he'll have help to operate them in the nursing home w/ CNA's. I appreciate any advice, thanks!

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Just want to add to Igloo. Yes, once on Medicaid secondary insurances can be dropped. He won't be able to pay for them anyway. I kept Moms supplimental for a month or two to make sure previous bills were paid for. ( former employer paid for supplimental) In that time the NH billed Moms supplimental. I called and asked why. They said that if a supplimental was still in force that Medicare was billed first, then supplimental and then Medicaid. This is the law. I stopped the supplimental shortly after.
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Medicaid will ask you to spend down to $2k. However, be prepared after a Medicaid person is deceased and there is money in the bank, in any amount, they will ask for that too.
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JoAnn29 Mar 14, 2019
I was not asked for what way left in Moms account. That 2k is theirs for anything personal they may need. Actually, she only had $184 left. Medicaid allowed me to close the account before her death. I also received her PNA. This was her money and the NH had no problem giving it to me. All money went to her estate. All I may owe is the 3 months (6k) that Medicaid paid towards Moms care. They will get this when and if Moms house sells.
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Yes as worriedin Cali wrote get hearing aids. Also buy eyeglasses, maybe 2 pairs as they flat go mia in a facility.

The 100 day rehab isn’t guaranteed. Rehab totally based on on if he is “progressing”. The PO, OT, ST are doing daily notes. Speak clearly with them as to where he is in rehab. I’ve been on this site over 5 years, maybe just maybe 2 or 3 or 4 posters who ever had their elder get the full 100. The daily or every other day notes into his health chart have specific measuring milestones as to “progressing”. Either it’s there or it’s not for rehab.

Really buy him him extra shoes, easy care clothing, toiletries if need be.
If he reads, get him a subscription to large print magazines. He has got to, GOT TO, begin & end his bank statements showing under 2k and once on Medicaid his monthly income going as the SOC to the facility.

Also there may may be another glitch to deal with as to his secondary insurance. If he can be on Medicaid, a secondary insurer may suspend his coverage as Medicaid can be billed instead. Like if it’s BlueCross, they can & will do a clawback of payments to vendors paid as Medicaid was available to pay as he was eligible for Medicaid. So you or dpoa need to look at whatever statements he gets from his other secondary policies as to this (clawback) happening. If so the vendors - like an independent PT who sees patients in rehab - will have to rebill to medicaid. They may not be happy as Medicaid rates seriously lower than what BCBS pays..... also clawback could be a few weeks or months later.
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Not sure how he could have been approved for Medicaid if he has money over the 2k allowed in an acct. You have to be down to 2k or under before Medicaid will pay for care. The POA can pay bills to spend down I think. But once the spend down is reached and he is on Medicaid then his SS and any pension goes towards his care Medicaid picking up the balance. The 2k can only be used for him personally. Once on Medicaid, none of his money can be used for upkeep on the house. If POA pays out of pocket, there is no guarantee that Medicaid will except him being reimbursed when the house sells. House needs to sell at Market Value. Those proceeds go for his care. Medicaid stops, spend down again, then reapply for Medicaid.

I applied for Medicaid in April. I was given to July to cash in all insurance policies and set up prefuneral arrangements. Mom paid privately for May and June which brought her under the 2k allowed. At that time, her SS and pension were handed over to the NH, they became Moms payee. Once this was done, I sent Medicaid all the info they needed and they started paying July 1, 90 days from application. If, I hadn't spent down in 90 days I would have had to reapply.
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worriedinCali Mar 13, 2019
He didn’t have over $2k when he applied and was approved. He now has over $2k because he’s been hospitalized and unable to spend his money.
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You mention “his home”, so does he actually have a home?
If so, that imo that opens up a whole other set of issues to deal with.
So is there a home that he owns? or has a Mortgage on?

in my experience Medicaid fully expects once they move into a LTC facility & become a LTC resident & apply for LTC Medicaid is that all monthly income needs to go towards paying for their care. What usually happens is that the NH is to be paid whatever is his monthly income less whatever his state has as It’s personal needs allowance (avg PNA is $50) So say he gets $1200 SS AND $600 pension, the NH must be paid $1750.00. The $1750 is his copay or SOC (share of cost). He gets to only keep the PNA $50 which is considered income for the month paid.

However, and this is important, under LTC Medicaid by & large they are allowed to have a max of 2k in assets. So say month 1 in LTC when he filed for LTC Medicaid, he had $1500 in a savings account that $ then becomes considered an asset by Medicaid. If each month, the $50 PNA is not spent but stays in his bank account it becomes an asset. Then in 7 months he will have $2050 in assets and be ineligible for Medicaid. He / POA has to make sure to spend $ so that he always begins and ends each month under 2k in his bank statements. The $ that’s assets is supposed to only be spent on their care and needs related to being in a LTC facility. Like new eyeglasses, hearing aids, dental care, clothing replacement are ok spends. The vibe I got from my mom’s Medicaid caseworker was that none of her asset or PNA $ was to be used for property costs, or to pay on any old debts like credit cards, or anything other than cate related stuff at the NH. Paying an existing premium on a funeral policy with the PNA seemed to be allowed.

If they insist or want to keep their home, they can by & large under Medicaid rules. But family will have to pay all property costs from day 1 of LTC Medicaid till beyond death and then deal with however Estate Recovery runs in your state. Whether or not it makes sense to do or is feasible depends on your specific situation. So if he has a home, decisions regarding the home need to be decided ASAP.

Also if he was on MediCARE, the hospitalization and the post hospitalization discharge for rehab in the NH rehab sector are both MediCARE benefits. First 20/21 days at 100% Medicare coverage. Rehab past initial goes 80% Medicare and 20% secondary insurance or private pay. The DPOA really needs to find out where he is/was for when rehab stopped. Cause after that is when the required income copay or SOC (share of cost) is to be paid. It should be Prorated to date of the switch over.
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onlychild43 Mar 13, 2019
Thanks for your response. The patient doesn't own his own home so that's not an issue. When the application for LTC Medicaid was put in, the patient did not have over $2000 in his checking account. Medicaid LTC ended up being approved since he was hospitalized but it hasn't gone into effect yet since he's undergoing rehabilitation therapy in a SNF. He has other insurance for healthcare that's covering all of his medical expenses (Medicare & two others). Now though, since not being in his residence, the checking account has grown but he's still paying for power, water, cable. Once after the 100 days of rehab, will medicaid not approve him anymore since the checking account has grown (it's not that much money but over $2000)? Should the POA spend the money on hearing aids, clothing, and whatever else he can for the patient before the medicaid should kick in for long term care? Again, he needs 24/7 care.... Thanks!
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