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Will the current nursing home put her out on the curb? Are they legally obligated to find her some type of community care? Her family is not able to pay for her care, nor bring her home. She can not walk, nor get around on her own, and needs care.
Why not Medicaid approved? Read about what bryort posts. Schizophrenic Parent was evicted from facility and state would not step in when parent ran out of money, Medicaid was denied, and no options. Pretty stark. Nursing home has to get paid for care and Medicaid is the option.
Not sure why the NH cannot help u with a Medicaid application. Lots of people transition from private pay to Medicaid. You need to talk to the Social Worker at the facility.
Are you saying that Medicaid approval is "pending" or has it been denied? If the NH accepts Medicaid patients, they will in all likelihood allow patient to stay "Medicaid Pending" as long as the application contained no red flags.
Medicaid is asking for 5 years of bank statements and verification of receipts/invoices/deposits/withdrawals of anything over $200.
How on earth does someone obtain ALL those statements from the bank? How much paper will that take to print ALL those statement? Plus I don't have all the receipts or invoices for anything over $200.
I'm at a total loss and have been very overwhelmed by this to where it's almost making me sick.
Care, banks are very used to getting multiple years of bank statements for government entities like IRS, Medicaid, Social Security for Disability -- the main thing is that the account holder or power of attorney gives permission and pays for the printing. They will tell you the cost up front before they do the work. That is the easiest part of the process. If you have more than 1 bank, you ask each bank to provide the info. You can use your mother's assets to pay for this - Medicaid understands that expense is related to her qualifying. If she has investments (hah for many of us), you can request copies from the investment company. Prior tax returns that Mom filed will show what companies she reported income from. Credit card companies can also give you the copies of prior years' statements. If bank transactions included payment of credit cards, then you will have transactions to support part of the expenses. Withdrawals of cash? Trickier to support, I agree. This is what Medicaid is looking for. Mom makes $2000 per month in social security, pension, etc.-in 5 years she made $120,000. Mom owned a house for $100,000; maybe sold it. So in 5 years Medicaid is looking to see how that $220,000 was spent. There should be expenses by check or debit that follow house or apartment expenses, utilities, groceries, medications, etc. If there are patterns of regular withdrawals, Medicaid wants to make sure that Mom was not gifting away assets that could have been used for her care to family and friends. It's not uncommon on this board to have folks who want to get Medicaid for family member and keep parent's money for family. If Mom was paying folks for care, then there should be supporting documents for the caregiving through tax returns etc. The same way the IRS looks for support of tax deductions for charitable giving or business expenses, medicaid is looking to make sure that legitimate expenses reduced parent assets.
A good elder attorney would easily be able to sort through this and let you know your options. I know it will cost to get an attorney but this will save you a lot of grief. Yes a NH can dismiss you for failure to pay. 42 U.S. Code § 1396r - Requirements for nursing facilities.
I know the 5 year lookback can seem overwhelming. It will be time-consuming and perhaps paying for an Elder Law attorney to help would be worth it. I suggest contacting the Area Agency on Aging for your state to inquire about resources to help with the process.
The checks made out to her mortgage company or landlord shouldn't need much explanation, nor those made to a grocery store, or a clinic, etc. If Mom made frequent cash withdrawals over $200 each, that may be more of a challenge to account for. Apparently Medicaid thinks that pocket money should be under that limit. This is the part where professional help could come in handy.
Does the NH Mom is in accept payments from Medicaid? Then they most liking will continue with her on a "Medicaid Pending" status when your submit the application. (If they do not accept Medicaid, that is another problem entirely. But you still need to get that app submitted in order for her to go to another NH.
Alone or with help, do the best you can and get the application submitted. A health care facility can evict someone for non-payment so going through the hoops to get this application done is extremely important. Distasteful and time-consuming, but important.
Caregiverhelp11 - I’ve got to ask just what is the time-line / backstory on the situation?? You posted abt 2 1/2 yrs ago regarding your mom & the NH she was in and the issues with her falling. So over 2 yrs ago there was a clear pattern of her spending & where her $$ went; it should be relatively simple spreadsheet to show where spent if she was private pay.
Now IF she applied for and went onto Medicaid 2+ yrs ago and now Winter, 2017, and now Medicaid has issues with her eligibility, there has got to be something dramatically different regarding her assets that has surfaced. If that’s it what changed..... inheritance?, assets not disclosed?, citizenship?
If I’m recollecting right, SW at the NH in TX from 2 yrs ago told you something along the lines that full 24/7 oversight (for fall risk) realistically wasn’t possible & that mom would need a specialized facility if that’s what you wanted. So what happened between then & now?
You can pay for copies of old bank statements. When you get them, review them as they often list the payee. If I look at my current bank statement it tells me who was paid if it’s a checking acct. Savings might be more difficult and will be scrutinized more if the accounts were in both your names but if your mom was private pay the withdrawals should be easy to track. As for the other receipts, it is what it is. You have to give Medicaid the paperwork they require. If you don’t have the receipts tell them that- you probably will have to private pay those amounts or a penalty but in the long run your mom won’t get evicted.
Or hire an attorney.
But there is no way around it, and Medicaid will continue to deny her claims. Medicaid is state/federal funded, they don’t play.
Thank you to all of you that have responded. Yes my Mom has been private paying for health care, part-time help at her home 3 years ago, and private pay at the previous nursing home for a year, and then this current nursing home, she had enough money left to pay for about another 5 months.
The first app went through smoothly. Around August of this year her checking account went over the $2K limit by about $200, I took care of that and got it back down to $2K. Then her renewal was due and has been requesting a ton of the information I mentioned earlier.
I guess one of my main problems with getting this resolved is I can NOT find anyone caseworker that I can sit down and talk to that will actually help me through this. When I call the Medicaid office, I wait forever for them to answer the phone and if they do, I get a young person on the other end, that basically reads the notice that was mailed to me.
I have been unable to talk to anyone that is helpful and that can give me more detailed information, etc. It is so frustrating. Someone I talked to said, it looks like she had some money. Yes, she had some, but it all went to pay for her health care, aside from having the roof on her house replaced and her old electrical wiring replaced. She still owns the home, and it's only worth very little. We did file a Lady Bird Deed on the house, but was told by a Nursing Home Financial Mgr. that that is allowed. My brother has been living there with my mother for years prior to her going into the nursing home and he still lives there, rent free, and takes care of the property.
This is the backstory: daughter didn't realize you had to reapply for Medicaid each year. She inadvertently let mom's account go over $2000. Now Medicaid wants another 5 year lookback.
Care; is the NH business manager helping you at all?
What questions do you want to ask Medicaid? Wouldn't it be better just to gather all of mom's bank statements (you must have gotten them for the first application, yes?) and bills from her medical expenses and home repairs and submit them?
I'm sure it must seem like a daunting task, but try to break it down into small pieces. Call the banks first. Call the old NH second. Find the home repair bills next. And like that.
Calling local caseworker probably of no use as, application has timed out. Speaking with whomever answers also useless, as they are answering ?’s from how do I get SNAP card replaced to where do I pick up a breast pump. You need to get this into the hands of someone within regional office. If any of the letters have a contact address in Lubbock, that where your next correspondence goes to as I think it’s still the appeals HQ address.
Here’s my suggestions and it’s going to be involved but do-able. Breakdown all financials & paperwork by year into income and debts starting 2012. Ziploc ‘12,’13,’14 for each stack by income, debts and bank statements. Set those puppies aside. Get Excell or Quicken/quickbooks and enter income and where spent for ‘15,’16,’17. Print it out by month and attach a copy of that months bank statements (all pages) and a copy of that years tax assessor bill to that years report. If a ck is over $200 and written to a person but for services, if you can’t get a dupe receipt, then get thier business card or down load biz contact info from thier FB or other online presence to show why $ paid to them. My mom had an issue with mechanic as cks written to his name but I found receipts with his shops name & address. All ok if it makes logical sense. For house stuff, I’d put those into 4 categories: taxes, insurance, repairs, upkeep (utilities, yard). Then do a brief cover letter asking if moms situation can be viewed as a renewal and NOT a new application and if the attached accounting for 15,16,17 can suffice to get mom back on track & eligible for 2018. Time is of the essence. Like by next week at the latest. Letters get sent certified with the return register card both from USPO to local caseworker in SA, regional office in Lubbock (or wherever past correspondence from Medicaid show appeals done) and main hhs office in Austin. Each will cost under $10!
I didn’t realize your mom has continued to own her home. If you or bro are paying on any house costs, track that into quick books too, although that info does NOT go to Medicaid. As an aside on this, although you hate this now, you’ll be oh so glad you have this done when you have to deal with Estate Recovery and the status on moms hoUse. Why? Cause although there’s a LBD on it, the TX legislature could change rules. Plus even with a LBD, MERP is still going to send you as the old dpoa a NOI & questionnaire which either you or the atty will need to deal with. If legislators change their rules on LBDs, you are going to file for exclusions for every penny spent on property as only bro can file to get caregiver exemption. You can file those costs to MERP and also in probate if need be. You never know... good luck & get organized!
Also I’d be concerned that if not dealt with soon, that the NH (who also gets a notification of the situation from Medicaid) will do a “30 day notice” to mom. Basically it’s 30 day payment plan done for the future or evicted. Now mom isn’t put on the curb but rather the facility will contact APS and ask for mom to be made an emergency ward of the state with a court appointed guardian. This is serious as they take over. That house is still owed by your mom, the guardian can sell it to provide for income for her care. The LBD only comes into play after mom dies. Whether you or your brother live in the house doesn’t matter. It’s an asset that can be sold.
At my moms first NH there was a lady across hall from mom. Her son got her on Medicaid but she continued to own her very modest home. He sold it and kept the $. She became ineligible for Medicaid. Apparently this drama going on for a few months, 30 day notice sent, bills sent, he ignored all. APS contacted; Guardian appointed who moved her to another NH. Sonny found out when he came to visit her. Huge commotion. Cops called to escort him out. What I was told was that APS would look to file charges against him for taking advantage of a vulnerable adult. NH would turn acct over in his nameto collections Things like this can snowball. Really make the time to get information gathered, put into document form &. get to the state ASAP to get it resolved soon. If you can’t do it, please then hire a NAELA level elder law atty to deal with this.
You need to consult an elder care lawyer ASAP. It will be worth every penny.....I applied for Medicaid for MY mother, and the visiting nurse came to the house and helped me with the application. (we had already had all our paperwork in order, the will, the quit-claim deed on the house, the poa, etc.) I went to the bank and they handed over - without a peep- the last five years of Mom's bank statements and copies of cancelled checks. NO. CHARGE. Medicaid definitely looked at those checks with an eagle eye, anything over a certain amount was flagged, and they would send me letters saying, 'In 2016 there was a check written to ___ for ____' and what was that...If it was for home repair, I would send in a copy of the invoice. If it was a loan and paid back, I would make a note of when, who, how. The people at our Medicaid office were very nice and acommodating, can't say they are everywhere....Everyone reading this, please get with the program and don't delay. In the years to come, Republicans will make us all destitute while they buy yachts and stillettoes for their expensive mail order wh*ores. We will all be dying in the hospital parking lots. Just so you know. If not us, your children and your grandchildren. Some already working 2 or 3 part time jobs, as does my own bright and beautiful college graduate.
Oh my gosh, after reading all your replies, I'm even more stressed about all this. I agree with Lassie. The near future looks pretty scary for Seniors.
Caregiver11 - on reading some of your old posts and prior issues, really to me, you should speak with a NAELA certified elder law atty and have atty review all. Atty ASAP.
That Lady Bird Deed was done after mom went onto Medicaid wasn’t it? I don’t think that’s ok as it’s paperwork done for an asset transfer after moms applied for Medicaid. There’s been a couple of folks on this site who have successfully gotten through post death LBD transferred homes but all had the LBD done in advance of their elder ever having Medicaid on the horizon. Btw they all had Attys. (either elder law or probate) who dealt with courthouse filing and dealing with the outside contractor for TX MERP / Estate Recovery to clear what was needed to move house title to heirs. Things like this really imo not diy projects. The atty who works with your mom / you now can also deal with post death items. Luckily for you there are several certified NAELA atty in Central TX area.
To Igloo, the Lady bird deed was done about 6 months before she applied for Medicaid.
Today I went to the bank to order ALL the statements they are asking for, but once I get them, I am not sure I will be able to show a receipt/invoice for EVERYTHING over $200. That's going to be hard. And I am guessing if I can't show a receipt/invoice for EVERYTHING, even if I show the requested info for 70% of the expenditures over $200, I will probably still be denied.
So, I wonder, if I am wasting my time paying the bank for 5 years worth of statements on two accounts. I'm very upset and scared. Because I do recall my Mom writing checks to my brother when she was still at home to go buy groceries, lunch, etc. for at least $200 or maybe $250 and we certainly will not have receipts for the groceries, etc. that he bought for her. So, then will something as trivial as this keep us from getting approved? My mother used to give all of us money for Christmas since she couldn't get out to shop for us. That was her right, but will something like that also disqualify us getting approval? Years ago she gave me and my brothers around $lK, then after that, it was less, then even less the past couple of years.
If this does not get approved, what the heck are we going to do? I have NO clue and am feeling pretty sick over this whole ordeal.
CG11 - good for getting on the financials! For follow up..... 1. send a fax to Medicaid with detailed info as to the request you made to mom’s bank for last 5 years statements AND ask for information on the appeals process. I’d fax local caseworker as well as appeals / regional office. Make sure you get a transmission report. ASAP. 2. Contact her NH in writing (certified w/return receipt) that you are in the process of submitting info requested by Medicaid and will be going through the appeals process for your mom’s Medicaid denial. Then - to me with your mom’s prior Medicaid app issues, the LBD, caregiver exemption possibly - it’s time to.... 3. Get an elder law atty to take over the appeals process and get atty a copy of all bank statements and whatever other details attys office needs. If you’ve been lackluster on record keeping or if there was gifting done by mom, tell your atty...... Let atty deal with all from this point on.
You asked what can happen, well IF need be your mom’s house can be sold by her, with the $$$ from the sale used to pay for her care. That Lady Bird Deed, although done, only comes into play after she dies. Till then it’s her asset and she can sell it. As an aside on this, LBD get touted as a way around Medicaid MERP Estate Recovery. “Do a LBD so gov’mint can’t take maws house.” It can be but heirs have to be able to have the funds to pay on all property costs from day 1 of Medicaid till beyond death and property legally transferred. What seems to happen based on posts on this site is that if multiple heirs that all costs fall to 1 family member to pay. All falls to the responsible son or daughter who can be committed to paying on a property & spending time dealing with an old house likely with decade of delayed maintenance that eventually benefits all. And their spouse is very very unhappy about it.... house gets sold. In a way, you are fortunate that the house can be sold, as so often transfer penalty involves gifting of $$ to a family member who cannot ever repay the $$ gifted.
If Medicaid appeals upholds the denial, the NH will get a copy of the denial. What to do next, well imho kinda depends on your moms atty ability to negotiate. Mom will have an existing bill from her current NH. Ideally the past due bill will be at the states daily room & board reimbursment rate (abt $170 day) rather than whatever this NH has as it’s private pay rate (which could be 2 or 3 times state rate). This figure is up for negotiation. But to me a factor in this is that the NH can decide if working with you is their better path. If mom is a nice, participating, easier care resident and NH has lower occupancy, they should be willing to work with you. If mom needs to be in a facility as at home care not possible, you don’t have a lot of options as once she’s Medicaid ineligible no other facility will take her without family doing an enforceable private pay contract. You want it as kum-ba-ya with this NH as possible. Personally I’d step back and let atty deal with it and if it ends up house needs to be sold, it is what it is. Mom will be able to have $ needed to private pay for her care.
Hopefully the bank statements show minimal checks that are of reasonable sums attributable for cost of living. So she become re-eligible & retroactively. But if not, house can be sold or mom moves back into her home & you / brother caregive. If mom could qualify for hospice, MediCARE could provide at-home Hospice benefits. Please let us know what happens.
To Igloo: This particular app is not in appeal yet. The last one was denied and I told by both Medicaid rep and NH instead of an appeal, I should just reapply because it's faster than sending in a new app. This is the app that is currently looking for 5 year of statements, etc. I just picked those up from the bank this afternoon. We are talking about 5 years of statements!
My sister-in-law is going to go through one batch and highlight the amounts $200 and over and I am going through the other account doing the same thing. Then I told her I guess we should make a summary sheet for each year and make note of anything over $200 and write an explanation. This is going to take a long time. The statements with the checks already have who the check was written to.
I told her I just don't have receipts for 5 years for everything that is required. So, I wonder even if we kill ourselves doing this, will we still be denied if some of the receipts and invoices are missing? It really seems impossible to me.
I tried calling a couple of law offices and was pretty much told that we need to send what Medicaid is requesting and that they really couldn't do anything for me!?
So, I'm stuck. This is the biggest headache I've ever had in relation to dealing with Mom's stuff. If we sell the house, it is not worth that much at all and will most likely not last for but about 5-6 months of nursing home payments. So I kind of wonder if that is even worth doing.
Unfortunately we can not bring her home to care for her, she is bed ridden, needs to be transferred, bathe, dressed, etc., etc. And we still work. My one brother that lives in her house does not work, but is not going to change her depends, etc. I'm sure she would feel very uncomfortable about that too.
I really don't know what else to do anymore. If I turn in the tons of statements and don't have all the receipts and invoices, I just don't see how this will work out to our advantage. If I knew they had a problem with the Lady Bird Deed and would be content if we sold the house, I would do that, but no one will tell give e any details.
The first time I applied, I enclosed a copy of the Lady Bird Deed, so it's not like I was hiding it. I'm feeling so overwhelmed and not optimistic at all at this point. I appreciate your feedback.
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How on earth does someone obtain ALL those statements from the bank?
How much paper will that take to print ALL those statement?
Plus I don't have all the receipts or invoices for anything over $200.
I'm at a total loss and have been very overwhelmed by this to where it's almost
making me sick.
If she has investments (hah for many of us), you can request copies from the investment company. Prior tax returns that Mom filed will show what companies she reported income from.
Credit card companies can also give you the copies of prior years' statements. If bank transactions included payment of credit cards, then you will have transactions to support part of the expenses.
Withdrawals of cash? Trickier to support, I agree.
This is what Medicaid is looking for. Mom makes $2000 per month in social security, pension, etc.-in 5 years she made $120,000. Mom owned a house for $100,000; maybe sold it. So in 5 years Medicaid is looking to see how that $220,000 was spent. There should be expenses by check or debit that follow house or apartment expenses, utilities, groceries, medications, etc. If there are patterns of regular withdrawals, Medicaid wants to make sure that Mom was not gifting away assets that could have been used for her care to family and friends. It's not uncommon on this board to have folks who want to get Medicaid for family member and keep parent's money for family. If Mom was paying folks for care, then there should be supporting documents for the caregiving through tax returns etc. The same way the IRS looks for support of tax deductions for charitable giving or business expenses, medicaid is looking to make sure that legitimate expenses reduced parent assets.
The checks made out to her mortgage company or landlord shouldn't need much explanation, nor those made to a grocery store, or a clinic, etc. If Mom made frequent cash withdrawals over $200 each, that may be more of a challenge to account for. Apparently Medicaid thinks that pocket money should be under that limit. This is the part where professional help could come in handy.
Does the NH Mom is in accept payments from Medicaid? Then they most liking will continue with her on a "Medicaid Pending" status when your submit the application. (If they do not accept Medicaid, that is another problem entirely. But you still need to get that app submitted in order for her to go to another NH.
Alone or with help, do the best you can and get the application submitted. A health care facility can evict someone for non-payment so going through the hoops to get this application done is extremely important. Distasteful and time-consuming, but important.
Now IF she applied for and went onto Medicaid 2+ yrs ago and now Winter, 2017, and now Medicaid has issues with her eligibility, there has got to be something dramatically different regarding her assets that has surfaced. If that’s it what changed..... inheritance?, assets not disclosed?, citizenship?
If I’m recollecting right, SW at the NH in TX from 2 yrs ago told you something along the lines that full 24/7 oversight (for fall risk) realistically wasn’t possible & that mom would need a specialized facility if that’s what you wanted. So what happened between then & now?
Or hire an attorney.
But there is no way around it, and Medicaid will continue to deny her claims.
Medicaid is state/federal funded, they don’t play.
private paying for health care, part-time help at her home 3 years
ago, and private pay at the previous nursing home for a year, and then this current nursing home, she had enough money left to pay for about another 5 months.
The first app went through smoothly. Around August of this year her checking account went over the $2K limit by about $200, I took care of that and got it back down to $2K. Then her renewal was
due and has been requesting a ton of the information I mentioned earlier.
I guess one of my main problems with getting this resolved is I can NOT find anyone caseworker that I can sit down and talk to that will actually help me through this. When I call the Medicaid office, I wait forever for them to answer the phone and if they do, I get a young
person on the other end, that basically reads the notice that was mailed to me.
I have been unable to talk to anyone that is helpful and that can give me more detailed information, etc. It is so frustrating. Someone I talked to said, it looks like she had some money. Yes,
she had some, but it all went to pay for her health care, aside from
having the roof on her house replaced and her old electrical wiring replaced. She still owns the home, and it's only worth very little.
We did file a Lady Bird Deed on the house, but was told by a Nursing Home Financial Mgr. that that is allowed. My brother has
been living there with my mother for years prior to her going into the nursing home and he still lives there, rent free, and takes care of the property.
This is the backstory: daughter didn't realize you had to reapply for Medicaid each year. She inadvertently let mom's account go over $2000. Now Medicaid wants another 5 year lookback.
What questions do you want to ask Medicaid? Wouldn't it be better just to gather all of mom's bank statements (you must have gotten them for the first application, yes?) and bills from her medical expenses and home repairs and submit them?
I'm sure it must seem like a daunting task, but try to break it down into small pieces. Call the banks first. Call the old NH second. Find the home repair bills next. And like that.
Here’s my suggestions and it’s going to be involved but do-able. Breakdown all financials & paperwork by year into income and debts starting 2012. Ziploc ‘12,’13,’14 for each stack by income, debts and bank statements. Set those puppies aside. Get Excell or Quicken/quickbooks and enter income and where spent for ‘15,’16,’17. Print it out by month and attach a copy of that months bank statements (all pages) and a copy of that years tax assessor bill to that years report. If a ck is over $200 and written to a person but for services, if you can’t get a dupe receipt, then get thier business card or down load biz contact info from thier FB or other online presence to show why $ paid to them. My mom had an issue with mechanic as cks written to his name but I found receipts with his shops name & address. All ok if it makes logical sense. For house stuff, I’d put those into 4 categories: taxes, insurance, repairs, upkeep (utilities, yard). Then do a brief cover letter asking if moms situation can be viewed as a renewal and NOT a new application and if the attached accounting for 15,16,17 can suffice to get mom back on track & eligible for 2018. Time is of the essence. Like by next week at the latest. Letters get sent certified with the return register card both from USPO to local caseworker in SA, regional office in Lubbock (or wherever past correspondence from Medicaid show appeals done) and main hhs office in Austin. Each will cost under $10!
I didn’t realize your mom has continued to own her home. If you or bro are paying on any house costs, track that into quick books too, although that info does NOT go to Medicaid. As an aside on this, although you hate this now, you’ll be oh so glad you have this done when you have to deal with Estate Recovery and the status on moms hoUse. Why? Cause although there’s a LBD on it, the TX legislature could change rules. Plus even with a LBD, MERP is still going to send you as the old dpoa a NOI & questionnaire which either you or the atty will need to deal with. If legislators change their rules on LBDs, you are going to file for exclusions for every penny spent on property as only bro can file to get caregiver exemption. You can file those costs to MERP and also in probate if need be. You never know... good luck & get organized!
At my moms first NH there was a lady across hall from mom. Her son got her on Medicaid but she continued to own her very modest home. He sold it and kept the $. She became ineligible for Medicaid. Apparently this drama going on for a few months, 30 day notice sent, bills sent, he ignored all. APS contacted; Guardian appointed who moved her to another NH. Sonny found out when he came to visit her. Huge commotion. Cops called to escort him out. What I was told was that APS would look to file charges against him for taking advantage of a vulnerable adult. NH would turn acct over in his nameto collections Things like this can snowball. Really make the time to get information gathered, put into document form &. get to the state ASAP to get it resolved soon. If you can’t do it, please then hire a NAELA level elder law atty to deal with this.
about all this. I agree with Lassie. The near future looks pretty scary
for Seniors.
That Lady Bird Deed was done after mom went onto Medicaid wasn’t it? I don’t think that’s ok as it’s paperwork done for an asset transfer after moms applied for Medicaid. There’s been a couple of folks on this site who have successfully gotten through post death LBD transferred homes but all had the LBD done in advance of their elder ever having Medicaid on the horizon. Btw they all had Attys. (either elder law or probate) who dealt with courthouse filing and dealing with the outside contractor for TX MERP / Estate Recovery to clear what was needed to move house title to heirs. Things like this really imo not diy projects. The atty who works with your mom / you now can also deal with post death items. Luckily for you there are several certified NAELA atty in Central TX area.
Today I went to the bank to order ALL the statements they are asking for, but once I get them, I am not sure I will be able to show a receipt/invoice for EVERYTHING over $200. That's going to be hard.
And I am guessing if I can't show a receipt/invoice for EVERYTHING, even if I show the requested info for 70% of the expenditures over $200, I will probably still be denied.
So, I wonder, if I am wasting my time paying the bank for 5 years worth of statements on two accounts. I'm very upset and scared. Because I do recall my Mom writing checks to my brother when she was still at home to go buy groceries, lunch, etc. for at least $200 or maybe $250 and we certainly will not have receipts for the groceries, etc. that he bought for her. So, then will something as trivial as this keep us from getting approved? My mother used to give all of us money for Christmas since she couldn't get out to shop for us. That was her right, but will something like that also disqualify us getting approval? Years ago she gave me and my brothers around $lK, then after that, it was less, then
even less the past couple of years.
If this does not get approved, what the heck are we going to do? I have NO clue and am feeling pretty sick over this whole ordeal.
1. send a fax to Medicaid with detailed info as to the request you made to mom’s bank for last 5 years statements AND ask for information on the appeals process. I’d fax local caseworker as well as appeals / regional office. Make sure you get a transmission report. ASAP.
2. Contact her NH in writing (certified w/return receipt) that you are in the process of submitting info requested by Medicaid and will be going through the appeals process for your mom’s Medicaid denial.
Then - to me with your mom’s prior Medicaid app issues, the LBD, caregiver exemption possibly - it’s time to....
3. Get an elder law atty to take over the appeals process and get atty a copy of all bank statements and whatever other details attys office needs. If you’ve been lackluster on record keeping or if there was gifting done by mom, tell your atty...... Let atty deal with all from this point on.
You asked what can happen, well IF need be your mom’s house can be sold by her, with the $$$ from the sale used to pay for her care. That Lady Bird Deed, although done, only comes into play after she dies. Till then it’s her asset and she can sell it.
As an aside on this, LBD get touted as a way around Medicaid MERP Estate Recovery. “Do a LBD so gov’mint can’t take maws house.” It can be but heirs have to be able to have the funds to pay on all property costs from day 1 of Medicaid till beyond death and property legally transferred. What seems to happen based on posts on this site is that if multiple heirs that all costs fall to 1 family member to pay. All falls to the responsible son or daughter who can be committed to paying on a property & spending time dealing with an old house likely with decade of delayed maintenance that eventually benefits all. And their spouse is very very unhappy about it.... house gets sold. In a way, you are fortunate that the house can be sold, as so often transfer penalty involves gifting of $$ to a family member who cannot ever repay the $$ gifted.
If Medicaid appeals upholds the denial, the NH will get a copy of the denial. What to do next, well imho kinda depends on your moms atty ability to negotiate. Mom will have an existing bill from her current NH. Ideally the past due bill will be at the states daily room & board reimbursment rate (abt $170 day) rather than whatever this NH has as it’s private pay rate (which could be 2 or 3 times state rate). This figure is up for negotiation. But to me a factor in this is that the NH can decide if working with you is their better path. If mom is a nice, participating, easier care resident and NH has lower occupancy, they should be willing to work with you. If mom needs to be in a facility as at home care not possible, you don’t have a lot of options as once she’s Medicaid ineligible no other facility will take her without family doing an enforceable private pay contract. You want it as kum-ba-ya with this NH as possible. Personally I’d step back and let atty deal with it and if it ends up house needs to be sold, it is what it is. Mom will be able to have $ needed to private pay for her care.
Hopefully the bank statements show minimal checks that are of reasonable sums attributable for cost of living. So she become re-eligible & retroactively. But if not, house can be sold or mom moves back into her home & you / brother caregive. If mom could qualify for hospice, MediCARE could provide at-home Hospice benefits. Please let us know what happens.
My sister-in-law is going to go through one batch and highlight the amounts $200 and over and I am going through the other account doing the same thing. Then I told her I guess we should make a summary sheet for each year and make note of anything over $200 and write an explanation. This is going to take a long time. The statements with the checks already have who the check was written to.
I told her I just don't have receipts for 5 years for everything that is required. So, I wonder even if we kill ourselves doing this, will we still be denied if some of the receipts and invoices are missing? It really seems impossible to me.
I tried calling a couple of law offices and was pretty much told that we need to send what Medicaid is requesting and that they really couldn't do anything for me!?
So, I'm stuck. This is the biggest headache I've ever had in relation to dealing with Mom's stuff. If we sell the house, it is not worth that much at all and will most likely not last for but about 5-6 months of nursing home payments. So I kind of wonder
if that is even worth doing.
Unfortunately we can not bring her home to care for her, she is bed ridden, needs to be transferred, bathe, dressed, etc., etc. And we still work. My one brother that lives in her house does not work, but is not going to change her depends, etc. I'm sure she would feel very uncomfortable about that too.
I really don't know what else to do anymore. If I turn in the tons of statements and
don't have all the receipts and invoices, I just don't see how this will work out to our advantage. If I knew they had a problem with the Lady Bird Deed and would be content if we sold the house, I would do that, but no one will tell give e any details.
The first time I applied, I enclosed a copy of the Lady Bird Deed, so it's not like I was hiding it. I'm feeling so overwhelmed and not optimistic at all at this point. I appreciate your feedback.