What happens if someone in a nursing home is denied Medicaid because they gave away money within the past 5 years?

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When our health care system became for profit...by heavens, the investor class demanded money regardless of the harm inflicted! Capitalism is a lousy way to deliver health care.
Over the last 40 years the investor class (top 10%) has devised more and more ways (thru their wholy owned subsiderary ... the government) to strip the accumulated wealth from the middle and lower classes.
And...even better...convinced voters that "yeah! Hey..you don't get any help till all your life long savings has been transferred into the pockets of the top 10%... even though taxes are no longer paid fairly by everyone...so.... Geez we have to keep those poor 10% at the top from paying for any of this!" Tax burden on 1960 was fairly shoulder by everyone, now...even the middle class is calling for the family blood ... to make up for the top 10% getting wealthier and wealthier. Who do you think owns all that stock in healthcare aproviders and service? Not you and me! How did they ever convince everyone that families have to be impoverished? But..yeah..let's all keep paying them more and more because hey..they need it..right? Hey, for profit healthcare is making the top richer every year...and everyone else...........

Ok...got that out of my system.
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A transfer penalty is placed that although they are approved for Medicaid as they are now poor, they are ineligible for Medicaid to pay till the penalty period of time has passed. The penalty starts on the day of the Medicaid application and not the date of the transfer(s).

It's all a math problem. The likely scenario is that when the NH Medicaid application and the supporting documentation is turned in, the caseworker assigned will enter the awards letters #'s (their income) in and then look to see their living situation for prior 5 years. So if they still have their home or are in IL or AL, then realistically they should have funds gone. There's probably a whole algorithm with variables that is used. But if they have been living with family with no legally done caregiver & or rental agreements and are down to $ 1,200 well in the words of the handsome & talented Ricky Richardo… Lucy you have some splaining to do. Say mom got $2K a mo income (from SS & retirement) and lived with her son. That's 120K in income plus a quick scan of real property records shows mom sold her home for $ 235K in 2013. So where did 355K go? There was gifting and it's gonna show up. Lets say it's 250k...

The math problem has a "Diversion Penalty Divisor". Each state manages its Medicaid program uniquely but within an overall federal guideline. So each state will have a set amount that it pays the NH for daily room & board. Like for my mom in 2015 it was around $ 158 a day, this is the DPD.
So 250K gifting in a state that pays $ 58 r&B is 1,582 days of ineligibility. That over 4 years.

Now mom is already in a NH when the ineligibility notice comes down. The NH gets the notice too. Family have stark choices: private pay for all the time she has been there and going forward OR move her back home. OR if family ignores all this, the NH will ask the court to place mom as an emergency ward of the state & it will be done. Court appointed guardian now determines all, pays the NH from mom's income & assets and can move her to another facility. That NH bill is still there and they will turn it over to collections.

Waivers can be done but imo you will need to hire an atty to shepherd the appeal and negotiate with the NH and the state. If a family member stole from the elder, you'd need to have a police report done. If they had dementia and didn't know what they were doing, you'd need supporting documentation on this. If they gave money to their church, it could get a waiver. In the application, it's pretty upfront about penalties. The DPOA has a required fiduciary duty to the elder and they could be held responsible.

Really applying for Medicaid means the state has an all-access pass to their entire financial life.
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They are not exactly "denied" Medicaid. Rather there is a penalty period during which they are not eligible for the program. The length of the period depends on how much they gave away. They will have to come up with a way to self-pay for the nursing home until the period is up.

If the money was given to family or close friends, they may decide to give money back for the purpose of paying for that penalty payment. However, this is no requirement that they do so.
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This is a common situation here. Unscrupulous children or grandchildren talk the elder out of money, and then the responsible person finds out that the gifts disqualify the elder from Medicaid eligibility.

And then it's all on the responsible person. So the elder usually ends up living with the responsible person. I'm sure it is very unlikely that the unscrupulous ones ever pay back the money.

So unfair!
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The money that was gifted away needs to be paid back. If it can't be paid back then the patient must be cared for at home during the penalty period.
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Medicaid is available only to people who are financially eligible. To prevent people from scamming the system and giving their money to family members so they are suddenly eligible Medicaid came up with rules about gifting. If you had enough money to care for yourself and you gave it away, don't come to us expecting tax money.

Well, all right. But in the case you describe, KatieKate, grandma was not trying to scam the system. She was just behaving as a loving grandmother, expecting to get the money back. She did not foresee the accident that would prevent grandchild from paying her back.

And in the case of my support group person, the loved one wasn't trying to scam the system, but was irrationally giving away money to charities because of her dementia.

I understand why Medicaid has the rules, but, gosh, they sure to present a hardship to lots of people who were not trying to cheat.
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ok...which is it? Does the elder need to be somewhere else during the penalty period? Or... does the elder need to be in a NH racking up debt during the penality period?

So..just say grandma helped grandson pay for education in Germany. Grandson had an unfortunate accident. Now, grandma needs to be in NH..   let us say, the amount of money was equal to one year in the NH...

Does grandma stay with grandsons parents (her son and daughter in law...or someone else) for the penality period (one year) ...or does grandma go into the NH and rack up a year of debt till medicaid takes over? OR, does grandma just live on the street for the remainder of her days? There isn't any other answer. That money is not coming back.

Is there an expert here that can enlighten us?
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The thing is that so much can change in 5 years. My dad went from traveling, to needing NH because of AD in 5 years. My mom went from using her walker to visit with family at a wedding reception, to being in a wheelchair fulltime at a NH in 5 years. Neither ever expected to need every cent of their assets for care, and I can see them giving money to the grandkids for education (had they had the financial resources to do so). So it has to be a terrible situation when their generosity comes back on them (and ultimately their adult children).
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That's at least partly because there has been a significant change in the definitions of poverty.

If you get sidetracked into believing that societal problems are the fault of fat cats pocketing everybody's money and going tee hee hee about it you ignore much more substantial issues: namely, how the expectations for individuals are going to be met by a society's resources, taken as a whole. For decades western governments have been doing it with smoke and mirrors - borrowing money so that they can pretend to their electorates that they can have all of the desiderata without being obliged to pay for them. Eventually, as one charmingly tactful economist I heard put it: "these guarantees cease to be credible."

So now, a member of our affluent societies is encouraged to expect:
good primary, secondary and tertiary education
fulfilling, well-paid employment
stable prices
home ownership or protected tenancy
employment rights protecting a healthy work-life balance
affordable comprehensive health care
a guaranteed minimum standard of living regardless of means or ability to pay for it
protected access to key utilities including clean water and heating/air conditioning
general living standards rising from generation to generation indefinitely
a long and enjoyable retirement
the right to accumulate and bequeath wealth
high quality health and social care throughout a lengthy old age.

And that's not even counting expensive stuff like national and civic security, or consumer safeguards in the finance industry, or energy and environmental policy.

These are all fine aspirations for a prosperous society with continuously improving productivity (which in our case, both sides of the Atlantic, we have not got). But expectations? Not until we can balance the books, which we can't, not even if the fat cats are hung upside in public and shaken until the money falls out of their pockets. We are in much deeper trouble than that would solve.

We have borrowed too much for too long. It is the end of the line of credit. Time to decide which really are the essentials of civilisation, and which are luxuries we would do better without.

By the way, that's not necessarily a bad thing. It won't do us any harm to have our minds concentrated on what really matters.
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" I see 25 y/o on Medicaid, wearing $200 sneakers. " Really? Honestly? You've seen this with your own eyes? And you would recognize a $200 pair of sneakers? And you are sure they aren't a pair he bought when he was 22 and had his first good-paying job, before calamity struck?

It is complicated. It is way too complicated for glib accusations of fraud without knowing the circumstances.
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