What happens when a Medicaid applicant has always used cash for expenses during a 5-year look-back period?

michaeleric76: Perhaps Carolynn should pose her questions to an elder law attorney.

I have just recently got my BIL on Medicaid for a nursing home in Sept 2022. We didn't have to go back 5 yrs for anything. All I had to do for him was spend down what he had in finances. Going back 5yrs is for when he passes away is what I was told to prove that we spent everything correctly and that applies to a vehicle if they have one which my BIL did I have that paperwork to prove who I sold it too and how much it was and where the money went too.

Also I had to prove what he had in each bank account that he had. If she has a life insurance policy that will have to be cashed out and applied to her funeral. You would have to set that up for her if she doesn't have one. I did this for my BIL had to cash out his life insurance policy that he had for years then apply it to his prepaid funeral he had already set up.

I hope this helps you. Prayers that you get her where she needs to be and that Medicaid is approved. I was told once they are in a NH that its almost done deal with Medicaid. The NH will take all but $50 of any finances they have. My BIL had social security and a small pension so all he gets is the $50 and he was allowed to keep under $2000 of his finances for anything that he needs while he is in that nursing home. I was his rep payee for social security so he put me on all of his bank accounts so that I could get all the paperwork needed and close down the accounts after I handed everything over to the NH which I did on April 2023. They are now his rep payee which is a lot better because of his family they wanted his money and I was turned into DHS twice and once Social Security all were unfounded. Never again will I be with that side of his family.

Prayers

what will likely happen is forensic work done by the caseworker for Carolyn’s LTC Medicaid application (the program that pays for custodial care in a facility, usually a NH) to fill in what’s MIA.

Realize once she files for LTC Medicaid, that allows for an all access pass to Carolyn’s financials if needed. Now the application will have a list of documents need to accompany her application. Like 3-5 years of bank statements, her awards letters from SSA and retirements (the end of the year letter that state to the penny what $ she will be paid for the incoming year), any real property ownership info (house, autos), her health and life insurance info, funeral & burial policy info. Could also want citizenship info. In theory the POA gets all this together and has it get attached to the LTC application which in turn goes to the State caseworker. FWIW the system on this depends on your State… like for my mom it was expected that they had hit “impoverishment” with spend down done & all documentation given to the Medicaid liaison at the NH billing office who in turn sent it up with their NH bill… but others States have a system that they can apply 3 months ahead of the impoverishment.

so if the POA cannot find what is needed, then caseworker will look to federal & state info as to what SSA pays her. And do a search of the SS# to IRS and state retirement accounts. The info will be there somewhere even with gaps, but enough to get an overall idea if gifting or transfers of assets happened. The caseworker finds this info and also has a rough $ amount that is monthly living expense are for her situation. So let’s say it’s $1234 a mo for your city. Say her SS is $1200 a month but she’s rent controlled so her mo expenses are $900 & right now all she has is 18K in a savings account. Having just 18K in savings and that 18K has been consistent for 2-3 years makes sense. She has no real $, that she even has 18K is pretty fabulous. That she has no receipts on the $300 gap is fine. The $#’s work.

But a different Carolyn who sold her home 4 years ago for $350K and now with only 18K in savings, $1200 a mo SS$ and rent controlled apt at $900 a month…… well in the words of the Handsome & Talented Ricky Ricardo “Carolyn, jue got some exsplian’ 2 jue”. If this is your Carolyn’s situation, I would resign that POA as it will be extremely challenging to be able to get her LTC Medicaid eligibility. There’s too much $ that’s MIA. For this situation, APS will come in and then ask for the court to have her to be a “ward of the State” and a guardian appointed for her.

Sometimes the best help is to be a friend & an advocate for her once she’s in the NH and just let State guardianship happen as they can do things that we as individuals cannot ever do.

I agree with JoAnn, but I would caution you against doing the work that now belongs to Social Workers if this gal has no family. The 18,000 will be gone in very short order. She can then be helped to apply to Medicare. It is very unlikely that she withdrew in amounts that would ring the bell, say 5,000 here and 10,000 there. She likely took out to pay bills and etc. Whatever records she has and however she kept them, someone acting as conservator, likely court appointed Fiduciary will help her to work on all of that, gather what is needed in terms of documentation from banks.

THIS is going to be a HUGE job. Unless you are an expert with a whole lot of time and knowledge you want to steer clear of this and keep your own contact as a loving visitor.

I would say no. You are allowed to withdraw money from ur own acct. Your allowed to spend your own money. What they look for is large withdraws that maybe gifts. Like giving a child 5k. I would think she pays her bills by check or auto pay. The bank will see the money going in and going out.