My mother in law pays my wife (her daughter) to help with grocery shopping, doctors appointments, etc. It is likely that she will likely need LTC at some point and are concerned that Medicaid will see these payments to my wife and think they are gifts and not for the work she is doing for them. How can we be sure this is appropriately viewed from Medicaid’s perspective?
If your mother in law needs Medicaid eligibility in future years, a Caregiver Contract in put in place now can be used to document the payments to your wife.
Does the Medicaid program in your state provide hours and services for home care? That's another question to ask the Elder Law Attorney.
In my practice, we always look to keep the client in the least restrictive setting, and Medicaid paid home care can help do that.
If the client needs to transition to a nursing facility in the future, the application is converted to Long Term Care with updated records that verify the client and family have been complying with the income and asset regulations.
It cost only a small retainer, which she credited toward an updated PoA that we needed, and her guidance (including don't let Mom's funds run down too low before you initiate the Medicaid process because it takes a while) was invaluable.
Seems like a good idea to set up a company name for caregiving.
https://www.caregiver.org/personal-care-agreements
When we applied for Medicaid, they only wanted explanations for large cash withdrawals. Small cash withdrawals were not questioned. If your MIL has been paying your wife by check, total up how much she has received. If Medicaid considers them gifts, they will ask for a penalty to be imposed equal to the amount they considered to have been gifted.
You only have to worry about payments made in the five years prior to your MIL's application for Medicaid. You will save yourself a lot of trouble by learning the rules and acting as if a Medicaid application is in the future.
As it comes to receiving money to care for your mother, that's considered a gift. I have a mother in a nursing home 75 miles away, and for the year before we sold her house, I traveled there weekly to oversee the house. I paid myself $300 a month for my time and the gas, etc. The Medicaid attorney (not elder care attorney!) told me this was not allowable and to stop, so I did.
Please, please see a Medicaid attorney NOW so you know what the rules are. Best!!
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