Medicaid Look Back not passed. How do they get care?

So often on this forum, I read where elders gave significant funds away to one or several siblings, and so are denied Medicaid because of a penalty period. And then what happens is that another sibling ends up taking the elder in. The ones who got the money don't do anything, and are often excused by the martyr caregiver.

I don't understand this. In my mind, the caregiving for the elder should be done ONLY by the ones who got the money.

There will be a penalty period. I that penalty period either someone pays for private care or she is cared for in someones home or caregivers hired to care for the person. You need to find out what the penalty period is.

Yes curious, why were assets jettisoned leaving this person with nothing. Sorry to say, this is what happens when people try to hide money from Medicaid. Medicaid is not guaranteed.

The way the laws are written (in my State at least), the facility or entity providing the care has the right to sue to recover costs related to care services that Medicaid did not cover. if Medicaid denied eligibility because assets were given away, the person(s) on the receiving end of those assets may be sued. If a judgement in court were obtained against those persons, paychecks can be attached, liens can be had, etc.. Getting care and placement in a facility for the senior is much more difficult, but not impossible. Basically you need the State to step in and take guardianship. You are right, (thankfully) we as a society are not going to let demented and vulnerable seniors die in the streets.

You can appeal the denial if their are extenuating circumstances.

Where did the money go? If it was gifted to family members, those family members should be expected to provide care, yes?

If the person needing Medicaid now got rid of their assets three years ago, the people they gave to either have to care for the person themselves until the five-year lookback period has finished, or give back the value of the assets they accepted.
If the person needs to go into a care facility they will be able to. It is true that the state can sue family members who have accepted cash and assets from the senior in the care facility. The facility the elder is in will usually be awarded conservatorship over the elder and their property.

I’m going to approach this slightly differently….. so is it
1. the elder is living in a NH with Medicaid beds AND has actually applied for LTC Medicaid AND has gotten a determination from Medicaid with a transfer penalty placed against them? So you have a set # of days of ineligiblity due to transfer penalty.
OR
2. is this theoretical, like what happens if I can’t locate documents before 2020 as you have last 2 years?

On #1, what will probably happen is, as the NH also will receive CC’d ineligiblity letter from the State, NH will require someone in the family to sign off a new financial responsibility contract & ACH or credit card payment done to have the elder continue to live there. And if elder has not signed off to have NH become representative payee for their SS $, then press elder / POA to do this as well. Hopefully while elder was Medicaid Pending they did a copay of SS or other retirements to the NH, so something has been paid. You can attempt to negotiate the amount, like get NH to accept payment under Medicaid rate rather than private pay. If elder is an easier care resident, NH might do this.

Now if family just becomes all MIA on dealing w the elder; NH can go hardball…. They send you / POA a 30 Day Notice and it’s cc’d to the State, APS and a probono legal clinic. If you still do squat, then NH contacts APS & APS in turn gets the court to do an emergency ward of the state & elder becomes a ward & gets court appointed guardian who then can get elder into whatever NH they can in the state. That guardian has alot of authority, so if the transfer penalty was that $ went to the kids or house transferred for zero or way under FMV to a kid, the guardian can work w APS to place charges on taking advantage of a vulnerable adult against whomever got the gifting. Law enforcement & the DA gets involved. It can get beyond ugly.

At my moms 1st NH, lady across the hall had son who sold his on LTC Medicaid moms house after she entered the NH. He pocketed the $. All property info on state database & Medicaid found out & she became ineligible w a penalty. Medicaid also did a clawback on payments to the NH. NH sent bills to Sonny. Sonny ignored them. Would be huddled conversations in the hallway w billing & administration when he visited. One day, I went in and there was security, police, Sonny & staff in a shouting match by the entry. LSS the lady was made a ward & moved to another NH; Sonny not told where either. I cannot imagine how beyond awful it was for the mom, she was super sweet. NH also filed a suit against him as he had signed his name on the admissions documents. Word was the guardian also filed for fraud & vulnerable adult stuff against Sonny as well.

2. if you have past 2 years of their financials and you have a good solid POA you can try to do your best Nancy Drew or you hire a forensic accountant to do a recreation back to 2016 - 2017.
The info is there… like you get your elder to contact SSA and any other retirements or pensions to get details as to income paid for the missing years; IRS gets contacted to get old taxes. Courthouse records get researched and recordings get downloaded and printed for any real property in thier name &/or thier old spouses name. Also dl old divorce decrees and any probate filing on deceased spouses. Banks keep records, you just have to know how to use your POA authority to get them to give you 5 years or one fixed month for 5 years back. Deep dive forensic accounting get done all the time by more pit bull divorce attorneys. Believe me there will be a elder law atty who knows & works with forensic CPA types.

The financial past can be recreated. But if you find that there was gifting, well personally, I’d turn over everything - even if ominous- and let the atty review to see what the options might be. I would not try to DIY dealing with Medicaid if this is more than a 2-3 mo transfer penalty period involved.

Where was the money jettisoned too?

If there were family members who received the money putting her in penalty now, I think I'd call them together and discuss her care plan. They can give her the money back so she can self pay to use it up (and then get the Medicaid) or they can start figuring out who can come on what day to care for her during the penalty period. Everyone who benefited from the money needs to be included on the in-home care plan (or send money to pay their share).

During the penalty period, the patient just has to stay in the home and get care there since there's none of her money left to self pay and spend it down.

Where do you live? There are tons of homeless seniors living on the streets in pretty much any major city.

Is the senior a Veteran? If so there may be some help from the VA.
Depending on where and when the service was the help could be a little or it could be a LOT.
If this person is a Veteran contact the local Veterans Assistance Commission and if you can find any discharge papers bring them with you so that they can help determine what and how much help the VA can offer.
There are local services that might help. Check with Area Agency on Aging. Your local Senior Center and ask if they have a Social Worker that could help.