Do I need to protect my Dad's Medicaid eligibility? - AgingCare.com

Do I need to protect my Dad's Medicaid eligibility?

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My 76-yr-old father gets very little in Social Security and VA disability each month but he also doesn't pay for anything, any bills, currently, and over past several years he's accrued around $8k in his checking account. He previously qualified for and currently receives Medicaid, and that program is covering all of his substantial medical bills at this time. I don't want to do anything to jeopardize his eligibility and I know there is a cap on cash assets of $1,500 maximum. I asked an elder attorney about what to do with the overage and he gave me a short list: burial plan (which my father already has) or automobile (my father doesn't drive).

I am confused about whether or not my father *must* spend the money. He's already qualified and been approved for Medicaid. Is there a chance they will investigate him at any time and ask for his financial records? He wasn't using his Medicaid for many years but is now using it often the past year and it's so important that he keep those benefits, of course.

I suppose I could open a separate account exclusively to "hold" his extra money, but is that a legal and/or recommendable way to handle things, to put the money under someone else's name?

Please advise, thank you!

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I'm still info-gathering about how best to deal with my situation. Since Medicaid would require my father to spend down on his medical care to the allowed $2k limit (not $1.5k as previously thought), the only thing I can think of that allows him to keep and use the money is if he and I do a caregiving agreement that basically pays me most of his money every month. Please believe, I'm not in full-time caregiving so I can get my hands on $400 a month! But, since Medicaid expects that any extra amount be spent for his care, I see a caregiving agreement as best way to keep his money working, or saved, for his benefit and not having to be potentially paid out for Medicaid portion of his medical bills.

I told my dad this. He is agreeable to doing a legal caregiver document with me. Unless I hear something surprising from the IL legal advisor or social worker - that I've already spoken with, but they did both say they would get back with me with more info - I think that's how I'm going to handle this situation.

The social worker asked me today "are you siblings ok with this?" She didn't say what "this" was exactly, but I knew what she meant. I told her I believed they would be agreeable when I put all the facts in front of them. We shall see.
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A resource I've come across to help explain exactly what is exempt asset vs. non exempt asset for Medicaid: Illinois Legal Aid . If you search "Disabilities Guidebook: Medicaid (for Adults)," there are 9 pages you can print about the basics of qualifying for Medicaid, including what assets are allowed, spending down to qualify, etc.

I also found the "Financial Help for In-Home Care and Nursing Home Care for Married Couples" page helpful as well.

I am going to be speaking with someone from Illinois Legal Aid about my father's case, as well as my dad's PCP gave me contact info for social worker that is supposedly an expert on Medicaid. I'll post when I have more info to add. :-)
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Good input about springing vs durable. I'm going to think about that... thank you!
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My understanding is that my father has to have served one day during wartime for him to qualify for VA A&A. He did not serve during wartime. I have looked into it and I don't the remember the specifics off top of my head... but I believe his not serving during wartime was a disqualifying factor.
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Allie - your 40, wow, you're even younger. Yes you need to be paid something. Personally $ 200 - 250 a month is too too low. Your waaaaaay more valuable than that. What you may think about doing is contacting a couple of home health care companies and have them come to the house to do an evaluation for dad and provide you an estimate of their costs for daily care and for 3X a week care (all will have a 4 hr day minimum). This you use to bolster why you should be paid more - if the funds are there for paying you $ 500 a month, then make it $ 500 a month. Whatever you're paid, it needs to be all above board on taxes, reporting, ok? please don't fall into the under the table payment trap.

Is Dad not getting VA Aid & Attendance? If not, he needs to look into getting that application in! That would be paying maybe $ 1400 a month - I'm not familiar with A&A details- maybe someone else on this site can shed more light on the amount. But if Dad is A&A, then he can determine where & who gets paid. Imagine if he paid $ 1500 to you each month……

Dad is low functioning? So he cannot live alone now really can he? If you were not there, then what would happen?

About a springing POA. Personally to me those are fraught with problems and surface just at the time that you or whomever is named really really needs to get something done and yesterday. Why do a springing one in the first place? I'd just have legal do a durable from the get go. Has anyone explained what type of compliance will be needed to get a "springing" put into action? Very often MD's will not do the paperwork for a springing (like his COPD doc won't do it as he is not a geriatric neurologist; his internist won't for the same reason, etc) and banks won't recognize the validity without notarized verification of incompentency. Banks will just freeze out dad's accounts till either they get paperwork that they find to be just perfection-like or a guardianship court order is brought to bank. If bank requires dad to go in person to allow for a springing, and he at all seems out of it or has a big-time low-functioning day with a strict bank officer or dad refuses to go along with the plan (the bank officer will want to speak with him privately in his office while you sit outside), you are screwed from ever having the springing be done. One thing on retrospect that was good with my mom, is that we made it a point to go to her bank when I was in town to visit her - they saw mom & me and we did things that involved a bank officer so there was a pattern of both of us doing things for & on her accounts. When I had to get a letter from the bank on the disposition of all mom's accounts that were closed for the look-back years for Medicaid, they were very helpful as they remembered both of us - the relationship has continued to be valuable even today after mom has died as having a local bank account for probate just makes things easier and her's is there for me to use as a co-signature on the account. If the bank officer doesn't know you or have a relationship with you or dad, then are not going to be flexible if need be. Often with a springing, family ends up having to go the guardianship route as they are never getting out of the springing situation successfully. Some bank groups just flat will not recognize DPOA's as a general rule and want the accounts to be done with a co-signataure or joint to get anywhere on the account; or set up in a trust.

So when dad dies, who gets house? If you live at the house and are a caregiver, you want something in the personal services contract with agreement with the owner as to your being allowed to continue to live @ the home maybe 60 days post death. with or without rent - that would be a point of negotiation. Who handles grannies trust & how are they towards you? If they are in the group who views you as a free-loader, well you aren't going to get a lot of love once dad dies. Over & over on this site are stories of long-term family daughter (& occasional son) caregivers who now find themselves impoverished, older with not too many options and nephews/nieces who could care less. Family especially the in-laws can be blunt & brutal. You sound like your good with these type of challenges, thank goodness! Stay strong.
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Igloo - with regards to how my siblings/family view me... I don't think they think *that* poorly of me, although there is no shortage of negative talk and criticisms towards me. But, the criticism has more to do with standard disconnect and non-understanding that someone outside of a hands on caregiving situation has with the person who is actually doing the caregiving. We all know this can look much easier from afar, and those not in the situation just don't realize how much time and effort is put in to caregiving to an elder who has frequent medical appointments and new issues. There are accusatory questions that put me on the defensive like "Why haven't you done xyz already?" So there is this expectation that I will be a magical know-it-all when it comes to elderly care, yet they know nothing and are not involved. The dysfunction is more a standard type, is what I'm saying. I don't think that they view me as an addict or a "freeloader." I think they know, as I do, that my father has a low level of cognitive functioning, and someone needs to be here to help out. I would hope, at the end of it all, that they're grateful that I am here. I do try to remind them that we should all just keep things calm and be thankful that my father's care, and this house, is being looked after.

Also... I just turned 40. :-) I feel like there is time yet to get back into full time employment (if I do it soon). I'm keeping my fingers crossed that dad remains medically stable for year or two. The absence of medical crises opens up possibilities for me to get full time employment. What's in the way of progressing here is my father's continuing to have new medical problems, because then all plans get set aside while the issue is dealt with.
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My grandmother passed a couple of years ago. She set up her trust so that all funds are for the benefit of my father until HIS death. The house is deed-in-trust. My grandmother had the idea that she would make it possible for my father to stay in this house until his death.

I know there were things that SNAP and Medicaid didn't see - financial assets - when he was qualified for those programs. My understanding of the trust money is that it is Medicaid exempt asset, because my father cannot cash it out. It is administered by a bank for his benefit. The trust does not give any allowance to my father or me for his care, all they do is pay the utilities and taxes. But... my dad only gets very little in total gov't benefits each month. He definitely needs to keep his Medicaid coverage. He's "only" 76, but he has had multiple medical issues in past few years, he has COPD and continues to smoke. My dad could live another 5 years or he could live another 20. Hard to say.

I do have my own income but that source isn't forever and I've always planned to get back to full time work.

POAs are being done this month. I imagine I will be the MPOA since I'm already acting in that capacity. I don't care who is financial POA, and that will likely be a springing POA, not standing, and so it wouldn't be effective for years, if ever. I'm taking my father a few hours drive away to city where bros live this coming weekend, and both of my brothers will have a chance to speak to him about POA if they wish to. I do wish they would appreciate my efforts to keep everything overly fair and overly above board. My father would be happy to have me as his POAs, he has said as much, and we could do the documents and it would be completely legal. But I don't want anyone to say they didn't have the chance to be involved in this process. And honestly I don't care who my father names. I'll still be acting as MPOA with or without the title (the title would help), and he has very few assets.

I'll talk to my father and the elder attorney about a caregiving contract. Even something in the amount of $200-$250 per month would help to balance out the situation more for everyone's benefit.

Book, I wish when I stopped making sense on here, and am just doing some tired rambling, that I would actually delete and log off, too. Instead I usually default towards hitting "Post Comment" and then I go to sleep. ;-) Big (((hugs))) everybody, thank you!
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Allison - do you have DPOA & MPOA naming you for dad and does dad have a will? Do you have your own source of income? The house......does dad own it or does the trust which pays taxes & utilities own the house? What is funding the trust? What happens with trust when dad dies? Or (OMG!) grannie who set up the trust is still alive so what happens to trust when she dies?

I see several red flags in the future for both dad & yourself. At 76, dad is still very young. Dad could live another 10-15-20 years. That is a long time for you to caregiver for free. You need to give some realistic hard thought on your own future. To safeguard your & dads future, you really need to see an elder law attorney. You already know that there is family friction, if they arent supportive of dad & what you do for him now, they really wont be in the future when his needs increase and things get costly, you need a legal viable plan in place for both you & dad for that day. This site has many many posts of daughters usually who decide to take off "a little time" to help their folks, and now it's 5,10,15 years later and they are close to impoverished, did not "work" those years, so their SS is low and the other family feels no sympathy & expects the house to be sold with everbody getting their share or you getting less as you lived there for free. It's a rare family (or in-laws) who are all kum-ba-ya towards the caregiver after the elders death. The vibe I'm getting is that I'd bet your siblings view you as a gambling & other addictions looser; they don't really like that dad allows you to stay with him but put up with it as it means they don't have to deal with the old miser; your co-dependency gets a pass as long as dad is alive. Yes it's harsh but in dysfunctional families there will be 1 in-law who is going to lead that you should get zero; there is no need for you once dad dead. You know your family best, does any of this sounds accurate?

Really you need to think of both your futures. You need a personal services contract in which dad pays you for caregiving - all legal & above board for taxes & so it builds up your own SS for when you start taking SS. I'm assuming your 50ish, so you really have another 12-15 before SS. You need to understand just what the trust is and it's role for having a place to live both now and in the future.
If dad just won't pay for legal, then use your money to get the initial consultation.
Good luck in all this. You can do it just like you've done your sobriety.


I'd bet that when dad applied for SNAP & Medicaid, he didn't mention the trust. If he gets nothing direct from the trust, it probably shouldn't matter. But trust could mean a more detailed review of Medicaid eligibility. Yiu really need to know what this trust exactly is.
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ABB, if you see the elder law attorney, he can assist in making a payment contract with you. The elder law attorney has your father's best interest not yours. So, if this lawyer sees no reason why you shouldn't be paid, then that helps a lot with you and the sibs. Yes, of course the family will come down on you with accusations. But, by going through the lawyer, you know where you stand and won't be swayed by guilt from them. Remember ABB, YOU are the one who is there for your father 24/7 - not your brother, not your mother. You.

Just remember - the money can only be spent for your father.
I typed more sentences but I noticed I wasn't making sense. I deleted those sentences. I'm exhausted, and it's only 10pm. I'm signing off now...
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Good question and want to follow. Thanks!! Great above answers. My husband and myself are facing same problem with my parents and now with my husband diagnosed with Pancreatic Cancer we might be in the same boat. My Dad has the same hair cut saving money thing except he is afraid that his water bill is to high and he should save water. Cannot take too much more.
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