How deeply do you really think that Medicaid looks into assets when determining if a person qualifies for Medicaid for AL/NH purposes?

igloo, I want to commend you. You CLEARLY know your stuff. You are so good, perhaps you work in the industry, or should?!! All of the answers everyone has given on this thread have been wonderful and I could give a "gold star" to one of them - it would be yours!! Thanks so much everyone.

Thank you very much, Igloo, for that interesting information.

If you had asked this ? in 2003/2004 when the new Medicaid rules came about, I would have said it would be hard to find out as the govt was doing it. But not now.
There is a difference in how the review for regular Medicaid (food stamps, TANF) is done vs. the eligibility review for NH/LTC & Medicaid. NH can be done and enforced easier as for almost all there is SS income & retirement income that can be attached and the elderly don't get up and move often so can be found.

But the BIG game changer in Medicaid compliance/fraud is HMS. HMS is a huge company with many divisions - they do all the financials, compliance, eligibility audits, co-ordination of benefits, fraud, abuse, etc for CMS (Center for Medicare & Medicaid Services). They also do more than quite a few BCBS and larger hospital systems.As you can imagine their database is vast and it's very sophisticated. So every cent that is paid for via Medicare, Medicaid or health insurance or other insurance that has a health related claim is likely known by HMS.

HMS (publicly traded) got into doing Medicaid eligibility and Medicaid recovery programs for states about 3 years ago in addition to their existing insurance business. Up until then most states did a feeble attempt at Medicaid recoup as it was true state workers who get their salary no matter what. Now that HMS has it, recovery is viewed from the vantage of a collection agency.With the data they have from the insurance side of HMS, the detail on who you are is just keystrokes away. HMS is big on tight deadlines on challenging things. But that is the job they are given to do under the state's contract with them to recover Medicaid $ and make sure the eligibility is right. About 1/2 the states use HMS and more will do so

if you want to see HMS at work google Randy Drewett TX MERP to see examples of how the state of TX is going after Medicaid recoup via HMS. Drewett is a great solid elder care attorney who has a great website with all kinda info on estate planning for elders. And NO I don't know him or are even close to Beaumont.

Most states have also gotten better on X reference on ownership too with central database on home and any property ownership (cars, boats, etc). So eventually they will find out what those assets are and when they are transferred and the amount. So if you get a penalty for asset transfer it will be done with hard data by the state that determined the amount. Will be hard to refute.

Probate is public document and often on-line, so anyone including the state can find out who inherited what pretty easy if you have the time or reason to dig.

Remember when you do a Medicaid application, you sign off full access to the state system to get data on you wherever.... IRS, retirement, banks, etc. You also have to provide all information on life insurance, so they will know if mom has a term 100K policy and who is the beneficiary.

The brokerage houses send 1099's on all accounts so that will show up too.

The only thing I can think of that is private is if there is a living trust - a real living trust and not those chicken dinner "trusts" marketed to the gullible elderly. LT doesn't go to probate but every single asset must be changed to trust ownership. Anything left out and that part has to go to probate. Imho, LT needs a significant amt of assets to be funded to be worthwhile. If you mom has an LT then you are likely not on this site .....LOL.

Every week in the paper in my area there is yet another person who is getting jail time or a huge financial hit or assets seized for fraud related to $ gotten from FEMA or their insurance company related to Hurricane Katrina. That was in 2005. Six years ago. My point is that likely & eventually it will surface and the penalty will be quite nasty. Some of these were small amounts like 15K but balloon to 40K with penalties. Just not worth it.

I think that the govt is messed up and probably won't check all that well. I know it is that way with unemployment matters and workers taking money under the table. But a good conscience is like money in the bank. You know no police etc will be knocking at the door with papers for your arrest. An arrest and court battle would cost you far more than you would make with fraud. Better to be cold and hungry than be in jail/or with a record.

I think that like the IRS, the various federal, state, and county agencies involved in administering Medicaid, make concerted efforts to catch fraud (or mistakes). One state may pursue that more diligently than another; one year it may be a bigger priority than at other times. I have no way of knowing or even guessing what percentage of hiding assets, etc. get caught. Is that what you are asking?

I do know someone on disability who wasn't complying with the rules for working/reporting income (I think inadvertently). This was discovered and he has to repay the money he wouldn't have been entitled to if he had reported correctly, plus significant financial penalties. I know several other people on various government programs, but I have no idea whether they are reporting their financial status in good faith or are hiding some things.

I think the evidence is antecdotal, and since this is not something many people would talk about casually, I think guesses about percentage of fraud detected are just that -- guesses.

You are not expecting a lot of input along the lines of "Well, I've been cheating Medicaid for 4 years and I haven't gotten caught yet" are you? :)

Don't take offense, but I have paid MORE than my fair share to our beloved broken system. I was only asking for others input on how far Medicaid reaches, not a morality point of view on what I should and shouldn't do and what's right and what isn't! Doesn't make me guilty to ask does it??

I think a lot of people cheat on their taxes and don't get caught. But that is no defense if one is caught.

I suspect that increasing computerization is making assets (other than old jewelry hidden under a mattress) easier to find. Corporations are required to report dividends; banks interest, etc. etc. Wherever these is a paper trail, it can be followed. Of course, it can take a very long time before someone gets interested and follows the paper. But keep in mind, that government agencies are very hungry these days and motivated to find hidden assets. Also, I've worked in security for years and can tell you lots of stories, some of them worthy of I Love Lucy, about fall out from what would seem to be a simple scheme to hide money. Think a long time about risking prosecution for fraud. I guess it could boil down to "do you want to eat well, or sleep at night?"