Medicaid; How far do they "Look Back".

[DawnCt1]

Far enough I hope. One of my friends has a mother who is 88 years old. I remember a few years ago, (can't remember exactly how long), this friend, her sister and the mother visited an "elder law attorney". When I and another friend had dinner with her, it was clear that the intention of the visit was sheltering her mother's money. She let it slip. The elderly person is also related to a relative of mine, by marriage, and it is thought on good authority that this elderly person had several million dollars at the time of her husband's death 15 years ago. The mother lived modestly since her husband's death so she hasn't spent the money frivolously. In fact, she probably lived on social security, barely touching the principle and any pension income. Now the DD is saying that the only asset her mother has is her small house. They are applying for Medicaid, and once they do, all the assets are frozen according to her. I of course, am not supposed to know about her mother's previous wealth so I pretend I don't know. HOWEVER, It does anger me that this family has more than enough assets to pay for her mother's last days in a nursing home, and yet are willing to let the taxpayers pay. Years ago, I heard that they looked back 2 years. Since then I have heard 7 years. I suppose if one has a "good lawyer" money can be made to 'disappear'. Any thoughts on this practice?

 

[freckles and boo]

It is frustrating, but there is a good chance any assets of value have already been sheltered or transfered. My mother-in-law had chronic/progressive MS and we knew that if my father-in-law died before her we would have to spend down her limited assets before applying for Medicaid. She was severely disabled and needed help with the most basic functions and we were looking at expensive care. They passed away within weeks of each other so we never had to do that, but IIRC Medicaid would have asked for statements from the past five to seven years.

 

[kellyg403]

I am not sure if it is everywhere but I know that when my dd's dh lost her job they applied for a few things. Their car could not be newer than 5 years, and they had to have bank statements, pay records for 1 year. Now, what they did in the office after they had the above I do not know. They were asked if they owned stocks and bonds etc.

I believe that there people that deserve help and there are people who do not. I do believe the elderly are among the ones who do. "IF" she had several millions and is protecting it for her children's inheritance, not so much. But, I do belive they should be able to get medicaid and still have a little money in the bank, they have worked and lived a long life for it. I am not sure how it works with having medicare and medicaid, that may make the difference.

Kelly

 

[DawnCt1]

I
I believe that there people that deserve help and there are people who do not. I do believe the elderly are among the ones who do. "IF" she had several millions and is protecting it for her children's inheritance, not so much. But, I do belive they should be able to get medicaid and still have a little money in the bank, they have worked and lived a long life for it. I am not sure how it works with having medicare and medicaid, that may make the difference.

Kelly

I don't have a problem with having some money left in the bank for needs and desires; I do have a problem with leaving "millions" for your kids when the tax payers are paying. At the time the three of us had a conversation about it, and she quickly back peddled, but it was obvious that the money was squirreled away at that time.

 

[creativeamanda]

It's 60 months. Dh's mother went through this. She lost Medicaid because she got a huge amount in back Disability. She never was able to requalify for Medicaid because she never spent all of her money.

A person CAN put $$$ in another person's name as a gift 3 years or more before they qualify for Medicaid, but it has to be counted in the other person's income.

The problem I have is you have to have less than $2000 in the bank to qulaify for Medicaid. My mil made less than $1000 a month in disability benefits, which she fought 3 years for, even though she had a terminal illness. She paid over $1000 in prescriptions. Had she gone hog wild and bought anything she wanted, she would have qulaified for Medicaid again, but she chose to be responsible and was, imo, punished for it. There are people who play the system and the government pays for them. MIL never even close to got back what she paid into the system, yet she did not qualify.

Our Medicaid/Medicare/Disability/Social Security system is in major need of an overhaul. People who purposely work less than 1/2 a year qualify because they play the system, but a woman who stood on her feet 9 hours a day, 6 days a week as a waitress for 37 years and raised 6 children by herself with no government assitance can't qualify in the last 11 months of her life? There is something wrong there.

 

[PADISFAM]

Medicaid is a State ran program- so essentially a lot different plans, Medicare is a Federal program. The two are vastly different in qualifying factors. PA Medicaid for long term care works as such: a 7 yr look back; if your 'monthly' income (pension, interest etc) is greater than ~$1700 you must 'spend down' to ~$2500. If your (the patient's) monthly income is <~$1700, you must spend down to ~$8,000. If a living spouse is in the home, (not the case for you Dawn), the house is not touched, again w/ a spouse 1 vehicle is permitted, other assets are spent down to pay for the care of the patient/resident (yep, that is what the money is for), after that in PA one can apply for Medicaid.........most states are similar, but I don't know the specifics. (the above $$ amounts are approx-I haven't done Medicaid billing in a few yrs) Medicare----whole different ballgame.

 

[minniebeth]

Creativeamanda is correct, that it is 60 months. My family is working through this situation at this very moment for my mom. My mom had her whole life's assests in her home which obviously the housing market is very poor right now. It is a shame that she will get so little and have to use it up to be eligible for Medicaid. I'm all for everyone working to take care for themselves, but you have the other side like the op posted where people take advantage of the system. It is very disheartening...

ETA: Maybe it's Medicare I'm speaking of....

 

[kellyg403]

I don't have a problem with having some money left in the bank for needs and desires; I do have a problem with leaving "millions" for your kids when the tax payers are paying. At the time the three of us had a conversation about it, and she quickly back peddled, but it was obvious that the money was squirreled away at that time.

Yeah..millions would be problem for me to. But, its hard to say if its the truth or not? You would think her children would NOT want their mother on public assistance, but have the best life possible.

Kelly

 

[minniebeth]

^^^yeah, you would think so, but I know people who would sell their parents down the river in a cardboard box for some inheritance and I'm not talking about for millions, either....

 

[creativeamanda]

Creativeamanda is correct, that it is 60 months. My family is working through this situation at this very moment for my mom. My mom had her whole life's assests in her home which obviously the housing market is very poor right now. It is a shame that she will get so little and have to use it up to be eligible for Medicaid. I'm all for everyone working to take care for themselves, but you have the other side like the op posted where people take advantage of the system. It is very disheartening...

ETA: Maybe it's Medicare I'm speaking of....

No--it's Medicaid. MIL had Medicare, which she payed monthly premiums for out of her DIsability. She also paid for prescription drug coverage out of her disability and still paid over $1000 per month for.

I don't see how a good attorney could hide anything. We went to an attorney and tried to put mil's money in an account so she could have little things she wanted that (ie--money in the canteen fund at the nursing home). No can do. Medicaid is very careful and is so to prevent people from seriously abusing the system.

Most states are similar in the way they handle Medicaid, but $2000 is a drop in the bucket and easily if MIL gained a lot of weight or wanted to take a short weekend trip, that $2000 would be gone.

People who half work and half do everything abuse the system and are able to wear name brands and buy new cars. My MIL in the last year of her life never wanted for anything, but her money was starting to run short and soon her family was going to have to start helping out. A person whose worked hard 37 years should not be paying $3000 a month for a little room with four walls to share with a roommate just so they can have access to assisted living. That's just ridiculous.

 

[PADISFAM]

No--it's Medicaid. MIL had Medicare, which she payed monthly premiums for out of her DIsability. She also paid for prescription drug coverage out of her disability and still paid over $1000 per month for.

I don't see how a good attorney could hide anything. We went to an attorney and tried to put mil's money in an account so she could have little things she wanted that (ie--money in the canteen fund at the nursing home). No can do. Medicaid is very careful and is so to prevent people from seriously abusing the system.

Most states are similar in the way they handle Medicaid, but $2000 is a drop in the bucket and easily if MIL gained a lot of weight or wanted to take a short weekend trip, that $2000 would be gone.

People who half work and half do everything abuse the system and are able to wear name brands and buy new cars. My MIL in the last year of her life never wanted for anything, but her money was starting to run short and soon her family was going to have to start helping out. A person whose worked hard 37 years should not be paying $3000 a month for a little room with four walls to share with a roommate just so they can have access to assisted living. That's just ridiculous.

$3000, that's a bargain...........average is $7000 private pay in PA, (Medicaid does not reimburse that--only a fraction--hence why PP is sooo $$$$$).........PA does a $40 a month 'allowance' to a resident in a NH to pay for things like additional 'hair dos' for the ladies (or men ) (PA Medicaid-'pays' for 1 haircut a month) & things like the canteen.

 

[creativeamanda]

$3000, that's a bargain...........average is $7000 private pay in PA, (Medicaid does not reimburse that--only a fraction--hence why PP is sooo $$$$$).........PA does a $40 a month 'allowance' to a resident in a NH to pay for things like additional 'hair dos' for the ladies (or men ) (PA Medicaid-'pays' for 1 haircut a month) & things like the canteen.

$3000 was for assisted living, not a nursing home. Meaning there were probably 1 CNA for every 10-12 people there. When she went to the nursing home for 1.5 months, Madicare paid for the first 20 days. The bill left over was $6500. That was the last bill paid out of her estate. She had over $1000 left owed to a drug company. They did not get paid.

 

[tasha99]

There are two issues with medicaid--how far they look back for eligibility and how far they look back for reimbursement. I'm pretty sure for eligibility it's 5 years. I work as a legal assistant in a practice that does old folks law (probates, trusts, elder abuse etc) and we get people all the time who are shocked that they don't qualify for medicaid because they gifted their house (or sold it for less than it's actual value) to their children recently. Often that gift was because of pushing from the children, and there's an elder abuse financial case.

The other issue is that medicaid (at least in Oregon) expects to be reimbursed when the person who received it dies. I don't know how many times I've seen families surprised to discover that the estate they thought they were inheriting is going to DHS. There is a hardship waiver for those who are poor, but I've never seen anyone actually qualify, including a family that had no income and was living in a shack of a house.

 

[PADISFAM]

$3000 was for assisted living, not a nursing home. Meaning there were probably 1 CNA for every 10-12 people there. When she went to the nursing home for 1.5 months, Madicare paid for the first 20 days. The bill left over was $6500. That was the last bill paid out of her estate. She had over $1000 left owed to a drug company. They did not get paid.

well- that's more like it! (I was getting ready to come move to NC for when I'm old )

 

[tasha99]

Also, is she sheltering assets or income? If she's gone through her assets but makes too much to qualify for medicaid, maybe she was setting up an income cap trust. That's perfectly legal, and the state would get her excess income as reimbursement later.

 

[golfgal]

Creativeamanda is correct, that it is 60 months. My family is working through this situation at this very moment for my mom. My mom had her whole life's assests in her home which obviously the housing market is very poor right now. It is a shame that she will get so little and have to use it up to be eligible for Medicaid. I'm all for everyone working to take care for themselves, but you have the other side like the op posted where people take advantage of the system. It is very disheartening...

ETA: Maybe it's Medicare I'm speaking of....

Actually she is not correct and that 5 years is the COMMON look back. Some states are more. MN is currently 3 years but phasing in the 5 year so in 2012 it will be 5 years. I think Florida is 10 years or is considering going to a 10 year look back.

Medicare is the health insurance plan-plan A, plan B, etc. Medicade is more for long term care-think nursing home care generally.

There are two issues with medicaid--how far they look back for eligibility and how far they look back for reimbursement. I'm pretty sure for eligibility it's 5 years. I work as a legal assistant in a practice that does old folks law (probates, trusts, elder abuse etc) and we get people all the time who are shocked that they don't qualify for medicaid because they gifted their house (or sold it for less than it's actual value) to their children recently. Often that gift was because of pushing from the children, and there's an elder abuse financial case.

The other issue is that medicaid (at least in Oregon) expects to be reimbursed when the person who received it dies. I don't know how many times I've seen families surprised to discover that the estate they thought they were inheriting is going to DHS. There is a hardship waiver for those who are poor, but I've never seen anyone actually qualify, including a family that had no income and was living in a shack of a house.

This is another good point, they can come collecting after mom dies and that causes issues as well. What this family SHOULD have done was buy a long term care plan for mom--and the attorney should have advised them to do so. She could protect some or all of her assets and would have had funding for her long term care AND they couldn't collect from her estate if she used up her long term care plan and then had to go to medcaid. If the attorney didn't recommend a long term care plan they could have grounds for malpractice against that attorney too. My guess is chances are the atty did recommend the plan but they didn't want to pay for it.

Sheltering your assets isn't illegal, if done correctly, however someone with millions should have been more responsible with long term planning.

 

[CPT Tripss]

The "look back" is five years. Exactly how they do the look back is very complicated to explain.

I struggle to understand how wanting to protect one's assests for ones heirs differs from being opposed to paying inheritance taxes when one passes. Particularly since inhertiance taxes don't kick in until many millions of assets and Medicaid is only for those with (roughly) less than $2,000 a month income.

If you have a million plus in assets, it should be hard to spin off enough income to private pay in a nursing facility.

No, I don't think that people should hide their assets . . . I think rich peopple should pay taxes on passing assets to their heirs.

 

[DawnCt1]

Yeah..millions would be problem for me to. But, its hard to say if its the truth or not? You would think her children would NOT want their mother on public assistance, but have the best life possible.

Kelly

I think they want both, but if they have to decide, I think they would come down on the side of enriching their bank accounts.

 

[DawnCt1]

The "look back" is five years. Exactly how they do the look back is very complicated to explain.

I struggle to understand how wanting to protect one's assests for ones heirs differs from being opposed to paying inheritance taxes when one passes. Particularly since inhertiance taxes don't kick in until many millions of assets and Medicaid is only for those with (roughly) less than $2,000 a month income.

If you have a million plus in assets, it should be hard to spin off enough income to private pay in a nursing facility.

No, I don't think that people should hide their assets . . . I think rich peopple should pay taxes on passing assets to their heirs.

Taxes have already been paid on inherited money from the person who earned and later invested it. It is double taxation. Inheritance taxes are also responsible for the loss of a lot of farming real estate, family businesses,etc. Often the properties have to be sold just to pay the taxes. Saving one's assets for one's heirs is fine, as long as one doesn't impoverish themselves and become dependent on the tax payer to do so.

 

[cruellababy]

I work for a NH that has a forensic acct on retainer; people get caught all the time and then the owner of the nursing home sues them. People receiving medicaid/medicare are "paying" a lower rate for their care, then a private pay patient. The nursing home I work at is $6500 a month for a semi-private room. The owner owns 3 small nursing homes 40 beds each. Lng term care insurance is really the only way to go; I believe a policy can be bought by anyone @ age 50 for a relatively low fee.