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

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?

Where was the money jettisoned too?

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.

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.

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.

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.

If the elder(s) own a house that they live in, Medicaid will file a lien on the property so that when it is sold, Medicaid will be repaid the amount that is missing. (whatever was found when Medicaid examined the financial documents that were submitted.)
If you or anyone in the family has an idea of what money was spent in years 4,5, go find it. Check bank statements, Check tax returns, See when registrations for car/boat/RV/etc were last paid. Was the item sold at that time?
Consult with an elder law attorney or care planner for ideas of how to find how money was spent 4 and 5 years ago.
Sit with siblings and construct a time line - 5 years ago, where did each person live/personal situation. Might the elder have 'helped somebody out' without a record of it or without telling anyone else.
It is a serious situation, Medicaid is likely to push hard to get all the information, and if there was 'gifting' of funds or valuable items to anyone, that person needs to pay it back to the elder.
Good luck.

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

That's a good question....if they gave their money to family members, then the family members are obligated to give it back. But what if the person took a bunch of trips not knowing that three years later they would need long term care...? I don't know what happens at that point, but I am very curious to hear what the answer is.

Oddly enough I have also heard of folks cashing in all of their assets and living on cruise ships. They go from one cruise to the other. How in the world does that work when they get to a point of needing care?

Sorry Okrad1, I wish I had suggestions for you instead of posing more questions.

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.

If they need it before & there was a $$$ transfer, it could be considered a gift & then a penalty could be assessed by Medicaid. Get Elder Atty advice. You need 5 years of bank statements. Hugs 🤗

The 5 yr look back would check where whatever amount of money they had and Whom the money went to and want that person to pay up to that amount before Medicaid will come in.
So, Looks like whomever spent mom's money will need to take care of mom for a couple years then try again.
If mom's husband was in the Military she could qualify for up to 30 hrs a week Care help.

If she ever has to be admitted in to a Hospital, then once she is ready to leave, just let the Hospital know that she doesn't have a safe place to go back to and needs to go to a Nursing Home.

But, from persinal experience. Nursing Homes are are Awful and I wouldn't wish it on my worst enemy.

They are all understaffed and ignore the help button and you can be sitting in your own urine and feeces for an hour or more.

Sad but True.

You'd think with the money they charge it would be at least an ok place.

It's a lonely, cold, scary place to have to live out the rest of your life, but you can't really call it living. More like existing til you die.

Lover ones deserve better.

Not easy at all being a Caregiver but parents devote their lives toward their children for years so when it comes down to pay back and helping your parent when the time comes, most just ship them off to a Nursing Home.

Don't let the Nursing Home fool you, they are all the same, some just look nicer on the outside.

They all tell you what you want to hear as they're making a Sale and want your business.

Prayers

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.

I was very blessed to find a live in. Your parents I hope already have a home they're living in, a car to drive?, TV service, food, utils?. Someone WITH REFERENCES, who have had it rough and may soon be on the street themselves but have experience and a bit of medical knowledge COULD solve your problem. They are paying for their cost of living. Adding 1 more may not cost as much as you think. Trust God for that person & He will drop them into your life, with your efforts to find them. I can't tell you everything, but I am living proof of that. He IS a wonderous God. Find Him and watch Him work miracles NOT RELIGION!

I would consult an elder law attorney. They will have the best information for you. Find out what paperwork you’ll need to bring to the meeting. There may also be someone at the Area Agency on Aging who can help.

Do contact an eldercare attorney to work out rules in your state. And, yes, keep all bank statements for 5 years prior to nursing home placement. No spendown on gifts or other luxuries are allowed by Medicaid, so be careful.

My Situation: Back in 2013, my mother entered a nursing home in CA following a hip injury from a fall. We living alone in CA, she could not return home to me. Fortunately, my family moved her up to OR State just before Mom went on OR Medicaid instead of CA Medicaid which would have taken our condo away from me after her death, leaving me homeless. Much more humane rules in Oregon. Only after sale of my CA property or death will Oregon Medicaid take out part of assets that were paid for my mother's care in OR State.

If there are reasons that there are no records for their income/expenses for all 5 years, try to negotiate. Or have an attorney try to negotiate for them with Medicaid?
Seniors do end up living rough or in homeless shelters, if they cannot afford to pay for their own housing. Or access reduced rate housing. (long waiting lists and lots of documentation of income/assets/spending for these, as well.)

okrad1: Imho, perhaps you should retain an elder law attorney.

I’ve wondered this too. What about when they give their life savings to a scammer?

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.

I volunteer at a NH twice a week. They have discharged three patients in the last year because they didn’t pass Medicaid look back. Effective Jan 1st they will no longer accept new Medicaid patients. They are looking for a buyer for the NH.

Thank you all who answered my question.

I did ask a lawyer about can medicaid sue to recover and they said there are very vague filial laws but they are never enforced.

However, know that all siblings are VERY engaged and feel like many of you here. I also agree that the guilt and shame a senior is supposed to carry for wanting to give their hard earned things to their kids is a unique shame only America places on their elders.

Every other 1st world country would never make a senior have to bankrupt themselves to get care. It's incredibly cruel, unspeakably so.

I hope you are all doing well today and hugs to all and again THANK YOU for all the different answers and so many things to think about.

She had assets to pay her care she should have saved those assets. Medicaid is for the truly indigent. I have worked and saved for over 40 years to pay for old age, not leave inheritances and have to leave my care to be paid by taxpayers. If you believe the government should be socialized, vote for elected officials who have those beliefs

If they put their assets into a trust, then after the 5 year look back, Medicaid can’t touch what’s in there. But, let’s say the assets have been in there for only 3 years and all of her other assets and money has been spent for her care, Medicaid will only be able to collect money for her care for 2 years and then the 5 year look back kicks in. What’s then is left in the trust will go to the beneficiaries and not to Medicaid. This is what an elder care attorney told me

Easiest way is a hospital visit and saying that there’s no care for them at home. They can’t discharge them til they’re placed. It’s easier to get the paperwork on the fast track bc they’ll assign a social worker. At least that’s how it is here in Florida.

Hi Okrad, PM sent, sorry I had missed the message earlier. (This site needs to provide a better way to notify private messages.)

I have seen "seniors out on the street" that made me wonder how they are surviving. An elder law attorney has training and experience beyond law school to specialize in the laws for your state. Just like you would never use a Family Practitioner caring for you if you need surgery.

Similar situation. I took my mother in and had no idea how we would make it, her monthly pension is just enough to cover sitters during the week while I work and that is it. I have her nights and weekends. All my bills doubled, some tripled with her here... but its 1000% better than trying to deal with medicaid and greedy nursing homes. If you can, find away to make it work in your home, you won't regret it. Every good day she has here make all the sacrifices worth it. I have had to use social programs like meals on wheels and food bank to make ends meet but once I got passed the shock of having to do that its all been ok. Also see if the person will qualify for in home hospice care due to age. That will bring a lot of help with it as well and is covered by medicare. I can be reupped every 6 months by the doctor. Good luck