Question about Medicaid pending

Peg, I’d be concerned over 2 issues:
1. if I’m recalling correctly wasn’t there gifting in MIL past?
Like BIL got 80k within 5 yr look back based on June 2020 post. BIL spent all $ too, he’s quite the fun guy…. Mom did it (80k) to your hubs too, but y’all have held onto $ so had it if need be to use to private pay towards care, right? Still have it?
& overriding issue for BIL has been to keep mom from applying till beyond 5 yr point? That instead of Mil staying at NH after MediCARE rehab patient benefit stopped & becoming a NH Medicaid resident that MIL came home?
So now 2021 & MIL now in a NH & applied for LTC Medicaid and BIL is the point person on this, right?

heres what I’d be concerned about… federal legislation allows lookback to go 10 years from date Medicaid application filed. Not 5 but 10. Now most do not do this as it’s too cumbersome. But if fraud is suspected or something seems hinky, caseworker can go for full 10.

Pls do not let hubs sign off personally on any contracts for mom ever.

(Btw my post assumes MIL does not still own a home)

2. LTC Medicaid requires applicant to do copay of basically almost all monthly income to NH. All they get to keep is a smallish PNA aka personal needs allowance that varies by state but tend to be $50/60 mo. Say PNA is $60 & mom gets $1234.56 SSA & retirement $678.90; total $1913.46 then less $60 PNA = required copay to NH $ 1,853.46.
BUT & here’s the rub….
until her Medicaid application actually clears & Medicaid sends out eligibility letter w specific $ amount, she cannot be forced to pay the copay. It’s an interim period, a grey area.

Now to get around this, what NH will do heavily is lean on applicant & or their family / POA to have the NH become representative payee for elders SS & other retirements. My moms first NH had paperwork for this in packet given to me during initial tour & along with another form to open a beauty shoppe account. Very matter of fact. NH will imply that rep payee must be done or that is just so much simpler… that it’s just like an ACH or direct deposit. & just 2b done in initial paperwork.

It does NOT have to happen.
Elder can continue to have mo income go into old checking account & they or POA sends a check or online payment for copay. This is what I did for my mom; wrote a prorated check to the penny for mo she entered (abt 10 days). & told biz office a check would be mailed 2nd of each mo thereafter & did it. I’m a pretty deliberate personality so biz office wasn’t happy but knew they couldn’t force my mom or me to have them become rep payees. On retrospect was excellent as I moved my mom from NH #1 to eons better NH #2 around mo 10. Made it simpler as ea NH got paid to the penny the mo of the move with no issues. NH#1 had beyond clusterF biz office plus home office in another city. Major foot dragging on everything. Would have been a nightmare to get them to resign SSA representative payee & difficult to get my mom to stay lucid enough to speak on her own with SSA. So was a good thing for us. I did as her DPOA sign off on admissions contract.

I’m gonna guess BIL knows NH cannot force rep payee or copay, so he’s not. HOWEVER minute she becomes eligible that copay for ea mo will be due in full to NH. If he’s spending all the $, that months of copay based on mo income still will be due in full.

If not paid, MIL will be out of compliance for Medicaid regulations. At that point NH send out a 30 Day Notice (to pay in full). It will be cc’d to state, to caseworker & probono legal clinic. It will get ugly.

Could BIL be assuming that hubs will use the 80k y’all set aside to cover this? You know BIL best, how much will he push the envelope?

Is Aesop’s ant & grasshopper kinda their relationship?

Is it possible that BIL is spending the social security on her nursing home charges?

I think when we see posts like this often the Medicaid application and rules are unfamiliar, completely foreign territory, to all in the family. Other family members have a knee jerk reaction and assume the worst when it is very possible the nursing home has to be paid.

How is her bill being paid? When admitted to a nursing home it becomes the beneficiary of the social security benefit.

O boy, what BIL is doing is a big no no, unless he is spending her money on her bills as POA. If he is stealing her money to use on himself please contact APS at once.

If I recall correctly, Medicaid approval, is retroactive to 3 months because it usually takes that long for a review and decision. In the meantime the NH facility still should be paid monthly, and the NH facility should refund the monthly payments upon Medicaid approval. A portion of your mother’s SS check will also still be due to the NH facility because Medicaid will be supplementing their payment with mom’s SS check. In your case, if Medicaid is not approved the NH facility will be due all the months of residency that were not paid.The other concern is if Medicare requires a spend down amount that your BIL may be spending away. Also, Medicare probably will require any Health Insurance Supplement that your mother may already have in force to be continued and paid from her SS check. With Medicaid it always better to wait for approval than to assume approval because it is a huge and complex bureaucracy and anything can go wrong.

Her Social Security and pension will always go towards her bill. Medicaid pays the balance. She will get lpersonal needs allowance. The amount will depend on the state she lives in. BIL should not be using her SS check. It goes to the nursing home.

I am surprised the NH did not inform BIL that they needed MILs SS and any pension. He really needs to call them. If he is paying MILs bills with her SS, he is just going to need to stop. Unless he pays out of pocket, he will just need to let the bills go. They are not his responsibility. Once my Mom was on Medicaid, I stopped paying the property taxes and eventually the water bill. We unplugged all her appliances. I set up a lamp in the living room to go on and off. I set the heater to 55 degrees. I paid out of pocket one winter. Was going to shut everything down the next winter if the house did not sell and walk away. But I got an offer that paid off the back taxes, what was owed to Medicaid and the water bill. Got my OP back too.

If your BIL is going to handle his mothers finances, he needs to understand Medicaid or he will end of with a lot of problems. And as a SIL, I would not help him get out of those problems. He needs to call Moms caseworker and find out what he can and can't do especially if there is a house involved. If he holds the POA, it doesn't mean he pays. If Mom has no money, neither the POA or the children can be held responsible for her bills.

I would say ur correct. Her SS should be going to her care. I would bet there is a balance till Medicaid kicks in.

To make this really easy, anytime a person is in a LTC facility, when they can't pay privately and the stay is permanent, the NH will always ask for SS and any pension. They need something to offset the cost of care. With my GF it was found she needed 24/7 care after a Rehab stay. Since she could not afford 24/7 care in her home and had no family to provide it, they requested her SS and pension then applied for Medicaid. Didn't matter that she had an apt and bills. She just about lived on her monthly income.

To JoAnn29: Prior to Medicaid, the insured probably had Medicare and a Medicare Supplement. After Medicaid is in-force Medicare is still primary. I believe federal guidelines allow an insured to keep their Medicare Supplement, if desired. The Medicare Supplement is payable by the insured from their SS check. If they discontinue the Medicare Supplement the cost would increase the Insured’s monthly income which would be then taken by the Nursing Home to offset its monthly residential costs, and reduce the amount the State Medicaid pays for the Insured’s NH residency. Either way the Insured is not enriched. IMHO it is better to maintain the Medicare Supplement.