Has anyone had to repay money from the 5 year look back period to get a parent into a nursing home? - AgingCare.com

Has anyone had to repay money from the 5 year look back period to get a parent into a nursing home?

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If you are referring to a Medicaid transfer penalty being imposed, just how it is done will depend on your state. Although Medicaid is a joint federal & state program, Medicaid is administered or managed uniquely by each state. So your state administrative code or Medicaid rules will make a difference in how the penalty is imposed.

For TX, it is TXDADS who is the agency for Medicaid and they send out a letter of inquiry asking for documentation as to where funds went. As a part of the Medicaid application, you or the POA has provided months of bank statements & their awards letters. If they have been living with family (so rent free) and had like 50K 3 years ago and get $ 1K a month from SS (so make 12K a year) and now they are at $ 1,500.00 there better be documentation to show just where all that money went. This is "pattern of spending" type of inquiry, & you have to show just where the $ went that was legit (usually by paying for IL or AL or having a legit caregiver contract with their kids). There also is the real property transfer inquiry - where the elder owned a home or a car and the tax assessor system shows the transfer so if the value of the real property wasnt deposited in their bank account and spent properly, you get a transfer inquiry letter - these are really hard to get around. Sometimes the caseworker will contact you, as well. You have like 30 days to get the documentation to the state otherwise the application goes into the ineligible file and then you get a penalty for the amount in question.

For most states how the transfer penalty works $-wise is based on whatever your state pays the NH for room & board. That is the Medicaid benchmark for cost. Like for TX it is about $ 155.00 a day. So say mom gifts you her home for free that has a tax assessor value of 135K. That would mean a penalty of 870 days (135K divided by $ 155) in which mom although now qualified for Medicaid is ineligible for Medicaid to pay. So for 870 days mom in order to stay at the NH, will have to private pay. Often family will take mom out of the NH and back home to live till the # of days penalty have passed.

The NH will get the ineligibility letter as well as the state will do a clawback on any payments made to NH during the Medicaid pending period of time.

The problem with transfer penalties often are that the penalty is found out AFTER mom becomes a resident @ the NH. Like it's found at month 4 @ the NH & in the Medicaid application process. So mom owes the NH for those 4 months of staying @ the NH as she is Medicaid ineligible for paying for her care due to the penalty. NH really has no choice but to go after mom or her family to pay this debt. If the penalty is small so the # of days of ineligibility is low, I'd try to work it out with the facility.

It seems the NH can choose whether to bill you for the days at either the private pay rate or the much lower Medicaid rate. If mom gets a good amount of money from her SS and retirement as monthly income, the difference between what mom does as her co-pay and what Medicaid would have paid could be manageable amount. Often a NH will want to keep mom as a resident if she is easy to work with or has minimal demands on care, so they will be OK with family paying the Medicaid reimbursement rate or maybe slightly above that (rather than the significantly more expensive private pay rate). Other NH may do no negotiations. If you face a transfer penalty, try to keep communication going clearly with the business office and get the agreement in writing if they take the lower rate.

Also about the documentation requirements, you have to really get on any request for info from the state. Usually the timeline is 30 days. If caseworker doesn't get whatever requested in 30 days, the application is toast. You kinda have to get something in - even if incomplete within the first 30 day cycle. If you do, that buys you time as when you get the decline letter you do an appeal (in writing and sent certified mail) which usually allows for 90 days or if its a hearing - this could be 3 -5 months to be held which gives you time to get your paperwork together and get an attorney.

Out of curiosity is this a house transfer?
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