Medicaid rules of eligibility. Any guidance? -

Medicaid rules of eligibility. Any guidance?


I am the Durable POA for my Mom. She has dementia and resides in a Medicaid approved Nursing Home. She is currently private pay, however, within a year, she will need to apply for Medicaid. Is it alright, per Medicaid, for her to give cash, say $30-50 to her children on their birthdays? Also, if my sisters buy clothing for my Mom, is it alright per Medicaid to reimburse them. My Mom lives in Iowa.

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Every state has a few rules that are different but in all states there is a look back time period. You would have to prove any money given was for her benefit, esp. if is was a substantial amount. If your mom has any money, then contact an elder law attorney to assist. If she is running out of funds and must apply for Medicaid to help pay for her stay in the nursing home then she will get to keep a small portion of her income for personal needs and the rest will go to help pay for her stay along with the Medicaid. In MD & WV the resident gets to keep around $75 for personal needs and it can be spent however the resident wishes to spend it. Call your local Medicaid office and speak with a specialist there, they would be able to answer any question they would have. If you don't want to call locally go to which is Iowa Department of Human Services. they have a lot of info there.
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No gifting anymore. Mom needs to be doing a spend-down of her assets between now & when she finally applies for Medicaid later this year. All her funds need to clearly be for herself or her needs. Spend-down on dental work, extra eyeglasses, better hearing aid, better walker or wheelchair are all good and not covered or just minimally covered under Medicaid.

Sissy's reimbursement looks like gifting. If these amount get ?'d by Medicaid, Sissy will have to document to the penny the reinbursement by exact matching receipts from Target, etc. Otherwise, mom could have a transfer penalty on the amount. Although it may be smallish amount, the issue with transfer penalty is that the application will go to a higher level for review. You could find the 4 month average Medicaid review process s…..t…..r…..e….t…c…h….e…s into 9 months and the NH fully expects to be paid under the old private pay terms during this period of time. If that happens, who is going to have the funds to continue the private pay? I'd suggest you all stop this now and have Sissy dig through her files for those receipts.

Be proactive for the Medicaid filing. Ask the NH now for the list of documents that they want to have to accompany the Medicaid application. As Pam said, start digging. Carefully read the life insurance policies too - make sure they are NCV - no cash value. If they are, you need as DPOA to get those cashed in and spent down. This can take time too and can through a wrench into Medicaid approval as can't be approved till cash value spent down. My mom's application had over 100 pages of documents attached. Mainly due to her old-school style life insurance policies that were always dz.'s of pages.Ditto for her old FH pre-need done in the 1980's. For mom it was 3 years & 6 months of bank statements. One document had to be from her bank as to the disposition of any and all accounts under her SS for the past 5 years. Luckily as mom's CD's, Tbills, etc. expired they were all deposited into her main drawing account. So no issue as to gifting. But still I spent the better part of a morning at my mom's bank with a bank VP to do this and I had all statements, cancellation, etc.. Letter was like: CD #1234 $ 5,678.00 expired 3/03/2008 deposited checking # 4567 on 3/03/2009 for $ 5,678.00. They did it for free but some banks will charge a research fee to provide this.

Right now in January this is the best time of the year to start the Medicaid binder. Mom just got or will be getting all her awards letters: both the ones that say what she will get paid in 2015 and then the tax statement as to what she was paid 2014. NH needs those to determine what mom's co-pay or SOC is. If she has any assets that pay a dividend, then she will be getting a 1099 on all of those by the end of this month. So you can double check to make sure those are all spent down or cashed in if need be as well. If mom has an old paid up life insurance policy, it may pay a dividend. If so, post that as I have a suggestion on what to do.

About how to deal with buying clothing, what we did was I am a signature on my mom's checking account. So periodically, I do a super shopping at Target for her and stock up on bathing items, socks, lotion, sleep shirts, etc and write a check for it from her account. Stuff all gets marked with her initials. At Medicaid's, $ 60 a month allowance for personal needs items, well it will not be enough to cover the true costs of clothing replacement, beauty shoppe visits, sundries. If you have room, you may want to buy clothing in advance and store them. Both of the NH my mom has been in, have laundry that just wrecks their clothes. My mom has a pretty extensive nice wardrobe, really within a few months all her clothes had to be totally replaced as the hot water & high heat just wrecks clothes.
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no no no she gives away NOTHING. Medicaid will NOT pay for her clothing. Right now, start digging for 5 years of financial records for Mom. Make sure she has not given anything away. Oh my, if she even gave away an old car they will count that against her. Find the Life Insurance policies too.
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