The most the SNF can bill us is $471.00. Medicaid picks up the rest of my Mother's expenses. And yet the nursing home has made them the payee of my Mom's social security check, which leaves a balance of $800.00 going to them and not my Father in their joint checking account. I have a meeting with Medicaid, and the nursing home on the same day...it's not fair to my dad, somehow he signed papers making the nursing home the payee of my mom's funds. I hope we can reverse this...is it possible???
Are you or is your father in day-to-day charge of his finances? Do you have power of attorney for him? If you do, or at least if you have had de facto control for some time, then you have a valid argument that your father should not have been presented with these papers to sign in the first place, and you can reasonably request that the whole scenario gets wound back to before they were signed.
Think of them as kinda like alimony for the non NH spouse.
Mom is required to do a copay or SOC ( share of cost) of her monthly income to the facility unless there is in place paperwork to have all/some of it diverted to the CS or other factors (like a dependent or mortgage for a limited period of time).
To me the issues will be if Dad needed to submit paperwork for CSRA or MMNA and what he can show as documented costs of living that makes him need her SS$$. Stuff like this is kinda up to the applicant to look into and apply for. Each state has a maximum amount too. Like for TX it’s $2800, so in theory if the CS needs NH spouses income it can be diverted to the CS up to $2800. The max isn’t going to work for most elderly couples but for a 2nd or 3rd much much younger wife with dependents and mortgage, other debt, I can totally see the max going to the CS.
Can you DIY this??? ..... to me, couples Medicaid planning is complicated and I’d really suggest an elder law atty to work with you all. Couples have stickies that an individual Medicaid application never ever do... like if dad dies before her and he has her as his life insurance beneficiary.... bad bad idea as it gives her $$ and kicks her off Medicaid. They both need to change beneficiary to somebody else. Often couples do not have a dutiful son or daughter who can deal with this, then what!
When my Mom went into the nursing home mid December, she was in really bad shape.And My dad was asked to sign all kinds of papers without reading them. and one of these papers was making the NH the payee of her social security..My Dad was in such a state then, he just signed whatever they asked him too!! She has improved 200% and I am looking into having my Bathroom rehabbed, and bringing her home...I contacted SS and they cannot change the payee without your consent. if the NH doesn't work with me on this, we will just go to the Social Security Office, and change the payee ourselves. My parents had a life, a good life, before this last decline, and the laws protect a spouse. This is their money. My Dad has all of his faculties, he is 86 yrs, old, I am helping him thru this the best way i know how...So again thank you or all of your advice...i am taking all of this into accont!!!
If no diversion done then all her SS must go to NH.
If there’s a diversion then the NH as payee will take the copay or SOC from SS and then send a check to the CS for the difference, usually 2-3 weeks after SS payment date. So $1000 SS with $650 CSRA means a $350 check from NH business office later that month. I’d allow 4-6 weeks after Medicaid approved to get the pattern going.
It could well be that your fathers own SS$ is considered high enough for his living expenses so that he does not qualify for a diversion. This is what PamS is getting at. If he’s living with family, rent free with no personal care contract, then he has no expenses to justify his need of CSRA. So all of mom’s income must go to the NH less whatever her state has as the smallish personal needs allowance ($60 a mo avg PNA and set aside in a separate fund at the NH if the NH is the payee for her SS). Your Mom did not have to apply for Medicaid but she did; so Medicaid's strict rules on “at need” and compliance have to be done first and foremost irregardless of you or dad viewing her SS $ as “...it’s is their money”.
Dad signed paperwork to allow for NH to become direct payee for his wife’s SS so that mom’s required copay or SOC was easily dealt with.
Neither he or mom or you as her dpoa had to do that.
A NH cannot force a resident to have the NH become rep payee for SS as a requirement for admission. HOWEVER the NH has to do whatever business practices it can to be assured of getting paid for a residents stay. Which can mean that a NH won’t admit mom as “Medicaid Pending” but only as private pay till Medicaid application process and eligibility is done, which could mean month$$$ of private pay and deposit. OR the DPOA or spouse is required to sign a legally binding admissions contract that IF a resident does not pay the SOC as required by Medicaid, or becomes Medicaid ineligible, then the facility will place a 30 Day Notice & bill whomever signed contract for all past due at private pay rate & with penalty.
Realistically having NH become payee for SS can be viewed as simplest way for all (family, facility, Medicaid) to deal with billing. If dad / mom want to change it, it can be done. But NH may ask for a financial responsibility document signed.
If mom is moving back home in the next few weeks, personally I’d leave things as they are (& not go to SSA office) as once she moves back home the NH being her SS payee will stop. SSA should send out a letter as to where now for direct deposit. Also please keep in mind that SSA does not recognize DPOAs. You may find that SSA will require you to become “representative payee” for each of them. The fact exists that dad didn’t cognitively understand what he was signing at the NH & could red flag SSA, so a “rep payee” may have to be done for you.
Also please please do not have your folks pay in any way for the renovation to the bathroom you plan to do at your house. As it will cause a transfer penalty inquiry from Medicaid should they need to apply in future years. Your folks can meet with an elder law atty to perhaps do a totally legit personal care contract between you and them that is Medicaid compliant and review their situation so there are less issues if Medicaid is needed later on. Caregiving at home a set of parents - both backside of their 80’s & 1 which already has had a SNF stay - will be a daunting task. Moving to a NH could be needed and you don’t want any Medicaid eligibility issues arising.