In my opinion, if Mom has died its all irrelevant.
We really do need more info.
Was Mom in rehab and transferred to LTC? If so, was Mom paying privately and you applied for Medicaid? How long was she in LTC?
Not sure either why it took 8 months to tell you she had too much in assets to receive Medicaid. My question would be how did she pay for her care in the NH? Do you owe them money? If not, then that letter means nothing. But if you waited for Medicaid to pay and weren't paying the NH, you now owe them. Your Mom needed to spend down that 57k to pay for her care.
Penalties only come into play if Mom had given away large sums of money within the 5 yr lookback. If she gave away 50k lets say, then someone would either have to pay for her care in a NH to make up that 50k, or she would need to be cared for in her or someones home till the penalty amount is offset.
So, the way I am looking at this, if Mom paid her own way then that letter means nothing now she has passed.
I'm wondering if mom was admitted to the nursing home as Medicaid pending, accrued a balance owed while waiting for Medicaid, and ultimately Medicaid assessed a penalty because $57+K was given away within the 5 year lookback. So NH won't get paid completely by Medicaid. If that's the case, how does NH get paid?
I'm a little confused. Spend down is the amount of money that has to be spent from the applicant's account before she's considered poor enough to qualify for Medicaid. If on the other hand, applicant had given away $57,504.21 within the 5 year lookback period, then Medicaid will not pay that amount that should have been paid for her care. That would be the penalty period. So if that's the case, the NH may not get paid that amount from the State. If that's the case, the NH may try to collect from whoever was gifted that amount. You may want to consult a lawyer/bankruptcy lawyer if you can't afford that and if the NH tries to collect from you.
Angel, you wrote that your mother died 8 mo ago in April. So is it that she applied for NH Medicaid & a determination made that she had $57k in assets that needed to be spent down? OR is it that Medicaid reviewed her finances and found issues so placed a $57k transfer penalty? You mention both “spend down” & “penalty”. Her health insurance- like Medicare or Blue Cross - does not pay for room & board for Long term care residents. But Medicaid does.
8 mos is a pretty long period of time. Your just getting this letter??? You mention a “final decision notice”, so was her initial Medicaid application denied / ineligible when she was alive & she filed an appeal? If so, any idea why denied? How was her Medicaid application done? by her? or by you? the NH? Did mom do a copay of almost all her mo income (like her Social Security) to the NH for each month she was there? Like the NH got her SS $ directly or DPOA wrote a ck for the copay each mo from mom’s checking account. If not, where did her SS income go?
If she died last April, how many months was she in a NH? Has NH contacted you or another family member about her bill? (They would have received a copy of the Final Decision Notice.) Has the NH billed you or another family member? The NH is going to cast a wide net for someone to pay her bill or turn it over to collections. Anything so far? Did you sign off in her admissions paperwork that you were financially responsible? You have your copy of the paperwork?
Do you have any idea if Medicaid paid the NH but then found issues with her application, so Medicaid did a “claw back” of $57,604.21?
Medicaid would not have been paying if she had that much money in a bank account. Were you writing checks to the facility she's in during the time they're saying was the spend down period? If you were, then the facility was double-dipping and collecting it from both you and Medicaid. They do this all the time.
Well how much money does she have in the bank? Because she could have a penalty period for money already given away, plus $57k in the bank to spend down.
That's true if she already gave away money. The post says $57K is her spend down so that refers to how much over the Medicaid limit she is. Spend down only refers to the amt over limit. Penalty period refers to assets given away. If determination letter only refers to spend down, they are talking about 'spending down her money' to the limit.
It means that she has $57K too much money to qualify for Medicaid right now. That money has to be used for her needs until gone - either by spending it to pay for facility care or to pay for inhome care, meds, living expenses etc. You need to keep good records on the spending.
Once the money is gone, they will look at the spending. If they see she gave away money out of what they already figured out she has to spend, then there would be a penalty period equal to what she gave away. That's the reason for really good record keeping. A large expense, like her house needs a new roof, would need documents to verify the expense.
You have to pay or keep your loved one home for the 9 months and take care of her.
This is why we are always telling people not to take any money from their parents. I hope that you guys can care for her until the penalty period is over.
If this is for your mom that has died, it depends on who signed the paperwork and what it said. That will determine how the nursing home deals with the bill.
We really do need more info.
Was Mom in rehab and transferred to LTC? If so, was Mom paying privately and you applied for Medicaid? How long was she in LTC?
Not sure either why it took 8 months to tell you she had too much in assets to receive Medicaid. My question would be how did she pay for her care in the NH? Do you owe them money? If not, then that letter means nothing. But if you waited for Medicaid to pay and weren't paying the NH, you now owe them. Your Mom needed to spend down that 57k to pay for her care.
Penalties only come into play if Mom had given away large sums of money within the 5 yr lookback. If she gave away 50k lets say, then someone would either have to pay for her care in a NH to make up that 50k, or she would need to be cared for in her or someones home till the penalty amount is offset.
So, the way I am looking at this, if Mom paid her own way then that letter means nothing now she has passed.
So is it that she applied for NH Medicaid & a determination made that she had $57k in assets that needed to be spent down?
OR
is it that Medicaid reviewed her finances and found issues so placed a $57k transfer penalty? You mention both “spend down” & “penalty”.
Her health insurance- like Medicare or Blue Cross - does not pay for room & board for Long term care residents. But Medicaid does.
8 mos is a pretty long period of time. Your just getting this letter???
You mention a “final decision notice”, so was her initial Medicaid application denied / ineligible when she was alive & she filed an appeal? If so, any idea why denied?
How was her Medicaid application done? by her? or by you? the NH?
Did mom do a copay of almost all her mo income (like her Social Security) to the NH for each month she was there? Like the NH got her SS $ directly or DPOA wrote a ck for the copay each mo from mom’s checking account. If not, where did her SS income go?
If she died last April, how many months was she in a NH?
Has NH contacted you or another family member about her bill? (They would have received a copy of the Final Decision Notice.)
Has the NH billed you or another family member?
The NH is going to cast a wide net for someone to pay her bill or turn it over to collections. Anything so far?
Did you sign off in her admissions paperwork that you were financially responsible? You have your copy of the paperwork?
Do you have any idea if Medicaid paid the NH but then found issues with her application, so Medicaid did a “claw back” of $57,604.21?
Once the money is gone, they will look at the spending. If they see she gave away money out of what they already figured out she has to spend, then there would be a penalty period equal to what she gave away. That's the reason for really good record keeping. A large expense, like her house needs a new roof, would need documents to verify the expense.
This is why we are always telling people not to take any money from their parents. I hope that you guys can care for her until the penalty period is over.
If this is for your mom that has died, it depends on who signed the paperwork and what it said. That will determine how the nursing home deals with the bill.