Spending down assets for Medicaid

cearbhaillFebruary 24, 2010

My husband and I have durable power of attorney for his mother, who has recently entered a nursing home for long term care. In order to qualify her for Medicaid we need to spend down some of her assets. Is it allowable for us to spend her money to hire an eldercare attorney to help us navigate all of this?

Or would the hiring of the attorney have to come out of our pockets?

She doesn't have all that much in the way of assets- maybe $10k. The State of Kentucky allows her $2k. We have used some on an Irrevocable Assignment for burial expenses, but are confused on what we can and cannot spend the remainder of the money on. We want it to benefit her somehow and not be spent just for the sake of spending it.

Her nursing home has promised us a list of allowable expenditures but I thought I would ask here as well.

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Sorry to follow myself-
I know I should ask my Family services agent who is helping me with the long term care application, and I will. But just for now today please understand that the woman is impossible to reach by phone and I have to drive to the county seat each morning to sign in to be given the privilege to drive back in the afternoon to actually speak to her.
It's absurd so I'm asking here too on the off chance somebody knows things.

    Bookmark   February 24, 2010 at 12:17PM
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Here's a series of articles from a California attorney who specializes in this area. There may be some difference in your state, but this is a federal program with local twists, so the info should be generally good for you.

I wouldn't touch this without a good attorney who specializes. Do not go to a general-practice attorney! There is a look-back period, several years so it's too late for that, and they will examine everything you spend right now.

I sure hope this helps you.

Here is a link that might be useful: Medi-Cal planning.

    Bookmark   February 24, 2010 at 12:22PM
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If you are having trouble contacting this person, who is her boss? There is NO reason to go to her workplace to make an appointment to talk to her on the phone. I would call and request the appointment, call again, and again. Either she will never call or she will. That is NOT doing her job. But I believe you do need an attorney specializing in medicaid/elder care.

1 Like    Bookmark   February 25, 2010 at 1:57PM
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One very efficient way to spend down her assets is to spend it on her medical care-- including the LTC facility. Sometimes I think we forget that it is appropriate to pay now, while she can, for the bills that medicaid will later pay for us.
WARNING: If she has been recently hospitalized, it is likely that the patient's responsibility part of the bills from all the doctors and the hospital will take a few months to arrive--and medicaid will NOT pay those if they were incurred before she qualifies. I would be proactive and contact the billing departments of those providers and tell them you need to pay the bills quickly. They should have an idea how much it will be, and they can and will refund you later if you overpay them while waiting for medicare to process its end.

You can buy her personal care items, clothing that she will need there, medications, take her to the dentist or eye doctor (many won't take medicaid, by the way, so might as well do it now), pay her outstanding utility bills or pay impending condo fees and property taxes while you try to sell the property. They really just have to be legit expenses for her benefit--not doing a shell game to hide money or transfer it to family members. At least, those are the rules in Ohio.

    Bookmark   February 26, 2010 at 8:43PM
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You don't need to spend down, just use it for her expenses and when you only have $2,000. left, apply for medicaid. She can not give it away, you may have to account for it if it disappears. I don't think it is worth spending money on an attorney, just talk to medicaid and see what they say.

    Bookmark   March 4, 2010 at 8:11PM
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Like Maime said, you just have to be sure to exhaust all her assets on HER. For things like the monthly LTC bills, doctor appts., cigarettes (in my MIL's case), and other personal needs. The Medicaid "look back" period is five years now, so you can't sell or have sold her home or transfer funds in that five years or it will be considered family attempts at "asset removal" and grounds for denial of Medicaid application.

We just went through all that 1 years ago with my mother-in-law here in Temple. We couldn't sell her house due to "look back" so it went into foreclosure and sold at auction in Dallas. That sale netted her back (after debt owed) $30,000. That amount in her bank account immediately bumped her out of Medicaid eligibility. We were told to pay her nursing home bills from those proceeds and when we get her bank account back down around $6,000, start the reapplication process to get her back on Medicaid.

It's called jumping through hoops and being patient with the process. Application process takes about 45 days unless there are problems.

    Bookmark   April 14, 2010 at 3:12PM
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I had to go through this same thing with my mother a few years ago. I have practically become a self educated Medicaid guru. We had taken care of my mother and supplied over 50% of her income for well over 20 years when I realized that at some point in time she would have to go on Medicaid.

The first thing we did was stop listing her as a dependent a because I discovered the 5 year look back period and never wanted that hanging over our heads if and when we might need her to be on Medicaid.

Once she was on Medicaid I kept meticulous records of all expenditures for her from our income as well as from hers.

After the initial application, you still have to fill out annual income reports but if she is already in LTC, then they will do it IF her income is going straight to them.

After approval by Medicaid, she will be allowed to keep assets of a total of $2000 max. THe LTC facility will take all of her income minus the $2000 and she will be allowed to have $50 a month stipend (at least in my state) but she can never have over $2000 in assets at any given time.

What is a nightmare is if the person comes into money once they are already on Medicaid. THen you have 30 days to spend that down adn the records/ receipts have to reflect the expenditures were for the Medicaid recipient. .

My mother was not in a LTC facility at the time she received $12000 from a pension plan we knew nothing about and I had a month to spend $10000 or go through the entire hassle of reapplying for Medicaid. I managed to spend it all on her in that time period as there were some things we needed desperately to better manage her care but it was a real headache.

Had she already been in a LTC I would have done what has been suggested to you from others here and that is to just use it for her LTC charges until it has been exhausted. Then the LTC can aid in applying for her and will make it easier for you. While you can have an irrevocable burial plan, you can not use her funds for a lawyer- at least I was told that wasn't allowed in our state (CO). You also can not prepay for anything for her save for the burial plan.

Do however, take her to the dentist if she needs dentures for instance and get those, take her to the eye dr, get her needed items to make her life easier in the LTC- a smaller easy to see TV, a DVD player, a cell phone or phone for her room, personal care items she can use there- perhaps a recliner or better walker or wheelchair, any clothing she may need, the nursing home supplies Depends and such so don't invest to heavily in those, a small dorm fridge, a stereo for her room, a laptop computer anything that will make her feel more at home in the LTC and that she needs as long as you keep receipts proving w/o a doubt it was for her and her only.

Keep in mind also that the LTC you have her in now, may not keep her once she is on Medicaid, they allot only so many beds to Medicaid residents and could tell you you'll have to find another LTC facility once she is on Medicaid.

Hopefully she did not give any great sums of money to her children, grandchildren or relatives in the past 5 years - otherwise the state may request/ require that money be returned or they can deny Medicaid coverage based on that. Applying for Medicaid for people who have any/ had any assets in the previous 5 years is a slippery slope at best.

If you or your husband were in charge of her finances, you will also be under scrutiny until they approve application and afterwards if you continue to be in charge of her finances. Once my mother went into LTC, I turned all her financial dealings over to the LTC- made life much easier for me.

I wish you all the best. as I know how difficult it is to be a caregiver. I was caregiver to both my parents for 10 years and then solely to my mother for the past 14 (total 24 years of caregiving - started when I was 32) and for a few months also cared for my MIL at the same time.

While your parent is living in a LTC is not a perfect answer, staying sane and healthy yourself and keeping your marriage stable and happy as well as having a relationship with your children is also of utmost importance. I did not realize how tired everyone was and how much I had missed with my husband and children and how much time and effort I had actually put into caring for my mother at home as long as I did until she had been in LTC for about 4 months and I realized she probably should have been in an LTC much earlier.

While I can't see her everyday any more, the fact that she was forced to go to LTC due to a health issue I wasn't equipped to deal with at home nor were the funds available for 24 hour care, I realize that may have well saved not only her life, but perhaps my health and marriage as well.
I am still her primary health care advocate and fight for her rights every day. i check up on the nursing home and her two- three times a week. They never know when I'll be there or what time. Keeps them on their toes.

Just be very very careful with her finances and assets.You don't want to get a personal bill for everything you have. Medicaid has done some terrible things to caregivers in the past. Medicaid can be ruthless when it comes to finances.

    Bookmark   May 11, 2010 at 6:05PM
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Check into irrevocable trusts. The only thing is the trust has to be started BEFORE money enters the equation. It is such a crime that money has to be spent down. it is also called "wasteful spending" but there are ways to protect future income just like the disable person on SS disability who won the lottery and was legally able to keep it because there was an "irrevocable trust" in place. There are specially trained lawyers who know all about this. Not all of them do, believe me. The trust is legal and can protect money. Money over 2000. can be "stored" there and used for certain things. Anything that increases quality of life, your lawyer can tell you about it. These trusts allow people to travel, have some things that normally are not covered by other entitlements or programs. Such as education, assistance to do something, and even technology. low income people should have a trust of this sort because who knows when or if you'll win a lottery and we certainly don't want to give it to medicare, at least not yet!They will get what ever is left eventually.

    Bookmark   November 27, 2012 at 2:07AM
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mama22doxies has supplied some very good information as have others. I did this for a couple in a nursing home (now deceased). He passed away first, & I/we were allowed to purchase a memorial arrangement for his grave and before his passing, I ordered her stone. I knew them well enough to have a good idea of what she'd want, but got her approval before having it ordered. Allow some funds for the setting of the stone as it wasn't included in the stone cost.

They had started a pre-paid burial policy & that was paid in full; purchased her a new TV. even tho she rarely had it one....it was there if she wanted it. Clothing was purchased & when we knew the time was near, I had his suit cleaned & purchased clothing for her burial. The nursing home costs quickly used what monies that had from a home sale 2 yrs prior (at that time our state used 2 years; don't know what OK uses now). When funds built to over their 2000 allowable, I, with input from family, decided what they needed or would enjoy. Our DHS worker was very helpful (for instance, when I inquired about the memorial wreath).

I so hope you can get the non-caller straightened out so you can get some answers. As someone else posted, it is ridiculous for you to have to jump through hoops to appease this aide.

    Bookmark   December 8, 2012 at 12:47PM
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Let me add another thought/suggestion. If a walker or wheelchair is used, purchase their own/new. The facility furnishes, but those quickly get "old". A resident having their own is so much better if you can manage. Medicaid doesn't help w/that purchase. Nor will they purchase a favored brand of Depends if needed...just whatever they buy in bulk. Hope this helps a bit.

    Bookmark   December 8, 2012 at 12:56PM
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CA Kate

Just a bit of correction, jayokie: Medicare does pay for the first wheelchair IF there is a doctor's prescription for one. It is easiest if you have the store put in for reimbursement.

We have a big, serious wheelchair that DH has never used but probably will in the future which was very expensive and Medicare pays the rent on for something like 13 months and then it becomes ours. I needed a smaller, lighter weight one for the car and that I had to buy.

It would really be nice if they paid or the diapers too. This is becoming a big expense.

    Bookmark   December 8, 2012 at 2:50PM
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