Hi! I have a call into an attorney, but figured I'd pick the hivemind as well in case something comes out that could be useful when I speak to them.
We are dealing with a parent who loaned a child around $120K about a year ago. She has about $30K in other assets. The cost per month for care in our state is about $12K - or about 10 months.
What I'm trying to understand is: if we spend down the 30K on things we can - like funeral arrangements, medical supplies, etc. and apply for Medicaid - I realize they will say she has this $120K she needs to claw back. Can we then just accept the penalty, try to take care of her as a family for 10 months, and then get accepted, at which point she'd move to a memory care facility? She's been diagnosed with dementia, but is still fairly young and we feel that we can manage for 10 months, particularly if the child doesn't need to pay back the $120K.
Unless your family dynamics is the rarity w/sibling returning all the $.
If there is no legit paperwork - like notarized with witnesses & signatures - and a set pattern of repayment happening, then your sibling can consider it an outright gift. They don’t owe mom squat. Lots of posts on this in this forum. Often it’s the siblings spouse that makes it clear that $ isn’t going to be repaid or returned.
120K, so could there be more? Did this sibling do anything else to place mom in financial crosshairs? If you haven’t gotten a big 3 credit report on mom, do it….. like today! If you are her POA, doing this is part of your required fiduciary responsibility. And another part of the duty would have been to make sure that “loan” was done correctly, if it was done while you were/are moms POA. You want an atty dealing with this so that they become your buffer should APS get involved.
brianraymor, did this family member sign any paperwork to the effect that it's a loan?
If not, I would consult with an elder law attorney about maybe proving that your Mom had dementia at the time she made this "transaction" and attempt to get it clawed back, as your Mom's PoA, in her best interest.
Heres why… say unbeknownst to you, mom gave your Sister 120k last year. This month on 5/1 she enters a NH and you as her POA file for LTC Medicaid. 5/1 starts her lookback. NH private pay 12K a mo. Now mom is considered “Medicaid Pending” so only has to do a copay of almost all her monthly income as her copay / Share of Cost to the NH. She does starting with May SSA check; let’s say she gets 2K. All good. Then 4 months, mid August, that 120K “gifting” surfaces via Medicaid review on her application. Mom gets hit with a 10 month transfer penalty that Guest aptly described and it is retro placed to start the date of her application filing (May 1)
Now the NH also gets the penalty Notice from Medicaid. NH has her owing 4 mos private pay rate of 48K less the SSA she paid of 8K. She owes 40K due in full and ASAP in order for her to continue to reside at the NH. Mom has no $ so all this becomes your as her POA problem. If you signed off to be financially responsible for her, the NH can & will come after you for payment. If you didn’t, they still will attempt this. Either way NH will not let her stay there indefinitely.
Sissy has no legal responsibility to repay 120K gift.
If you cannot pay 40K & cannot get Sissy to pay and neither sign off on a contract for mom’s future stay, either you move her into your or Sissys home and cobble together caregiving* as best u can do till past the lookback; OR the NH usually will find a reason for her to go to the ER/ED, then will refuse to take her back. Making her now a problem for the discharge planner at the hospital, whose 1st call will be to you to come and get your mom.
* mom might be able to apply for a Community based Medicaid program, like InHomeHealth or PACE as community based does not look at assets like LTC Medicaid does.
"Medicaid may help pay for memory care in a memory care facility or in an assisted living community. However, Medicaid doesn’t cover the cost of room and board in these settings."
Source: https://www.aplaceformom.com/caregiver-resources/articles/medicaid-and-memory-care
"In general, Medicaid does cover memory care in Texas, but the specifics of coverage can vary depending on the individual's specific circumstances."
Source: https://www.moradaseniorliving.com/senior-living-blog/does-medicaid-cover-memory-care-in-texas/#:~:text=In%20general%2C%20Medicaid%20does%20cover,care%20for%20your%20loved%20one.
On TX paying for AL or MC, my 90+ mom entered a TX IL private pay in a tiered facility, so went from IL, AL, NH and a hospice wing (AL had a sector that was locked so pretty much MC but not touted as such). We were told that they did have Medicaid eligible beds in the AL sector as TX had this via waivers which they participated in. So we thought this is fabulous as mom could go along as her needs and her pocketbook changed and not move; could segueway to Medicaid and seamlessly. ROTFLMAO in retrospect! So mom goes along couple of years all fine in IL. Then started having issues and LSS needed higher level of care. And those AL beds payable by Medicaid I thought would happen….. didn’t.
They were a few and facility had those AL beds only for pretty much non-ambulatory residents, because….. what this place did (& apparently common for AL & MC) is have those sm # of Medicaid beds as a placeholder for current residents who medically needed a Medicaid bed in the NH/SNF sector but there wasn’t an open bed in the NH for them yet. So they were SNF ready non or minimally ambulatory residents waiting for someone in the NH to die. The NH staff would come over to help the AL staff with their care. My mom would be in the AL queue for who knows how long OR I could attempt to get her into a different NH bypassing AL phase. And that is exactly what was done and without a hospitalization 2 rehab path. At the time I had no idea how unusual this was.
No the 120,000 won't be clawback. In fact, it will be that she cannot get care until that amount is returned to her to spend on her care. OR until four more years have passed if she gave the money 1 year ago (unless you are in Calfornia with it's 2 1/2 year lookback rules.
After that she could apply for Medicaid. Not before.
I am hoping Igloo is around; she likely can give you the exact numbers.
But so can your attorney.
She gifted 120,000 and cannot now is expect the taxpayer to pick up expenses through Medicaid.
You would have to manage home care for four more years if that gift was made one year ago and you are in a state that has a lookback of 5 years. If in California, then only 2 1/2 years lookback, so you would have to care for her another one and one half years.
I am glad that you have the attorney appointment as you will learn any option open to you at that time.