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  1. #1
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    Jan 2007
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    Default Will Payments to a Relative for Home and Living Expenses Affect Medicaid Eligibility

    My question involves a person located in the state of: TX

    Very elderly parent has been living with a child cor many years (definitely over the 5 for the Medicaid lookback period). During this period, parent and now late spouse, had been giving the child a monthly check towards living expenses. Child has not documented the transfers and is placing the funds in a joint account. Child is proposing hiring in home care with the parents funds that will impoverish the parent within a 2 to 3 year period. The children cannot afford to pay for either in home or custodial care without the savings of the parent. Children cannot care for the parent in the home without help. Child with whom the parent lives does not want to institutionalize the parent no matter the cost of the part time ( actually nearly full time 110 o 120 hours per week) in home care needed. Once the parent has no more resources, the parent will need to be placed in a nursing home due to the level of care required. Medicaid will need to be utilized to pay for the expenses.

    I am trying to calculate the amount needed to be available to cover the Medicaid lookback penalty if child proceeds with plan. It is expected that worst case for the lookback would be a total of $60-70,000 all that has been used for living expenses over 5 years. I estimate this to be 13 to 15 months if all is included. Cost of preferred nursing home exceeds the state average but know this is not a factor in the penalty period.


    THE QUESTION:
    Since child is continuing to receive an amount from the parent for household expenses, what is the standard for documentation for the parent's share of the expenses paid from the shared account? Should all transfers be considered gifts to the child for the purposes of the Medicaid lookback for best planning?

    SLIGHTLY OFF TOPIC BUT
    The state income cap for Medicaid is $2199 yet nursing home care is estimated to average $5,000/mo. How are people with income over the income cap supposed to survive when they have no resources to cover the difference between the income cap and the cost of care?

  2. #2
    Join Date
    Jun 2014
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    Default Re: Elder Law

    The money the parents paid the child for living expenses has nothing to do with Medicaid Eligibility, unless the joint account the child put the money in also has the parents name.on it.

    When someone goes into a nursing facility and they receive retirement, SSDI or SSI, the facility takes but $30 to pay for the care. The quality of care is not as good in a nursing facility where Medicaid and a monthly check from SSA is all a person has as it is in a facility where a person has a supplement policy to pay for a nursing facility and/or the income and resources to pay for it.

    A person doesn't have to be in a Nursing Facility.to receive help with things like bathing, preparing
    meals and light housekeeping through Medicaid, although the income and resource.criteria are the same as it is if they entered a nursing facility.

    Also when someone has Medicaid, after their death, their estate can be sued for money spent on their care. They have to agree to this when entering a nursing facility in order for Medicaid to pay..

    For more information go to the Texas Department of Aging and Disability Services website.

  3. #3
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    Default Re: Elder Law

    Quote Quoting Mercy&Grace
    View Post
    The money the parents paid the child for living expenses has nothing to do with Medicaid Eligibility, unless the joint account the child put the money in also has the parents name.on it.
    Unfortunately, they are using a joint account but only for household expenses. Child has other account for her income and expenses. Parent also has an individual account. Parent either gives check to child to put into the joint account or does so for self. Child pays all expenses from that account because parent is now incapable of doing so.


    Quote Quoting Mercy&Grace
    View Post
    When someone goes into a nursing facility and they receive retirement, SSDI or SSI, the facility takes but $30 to pay for the care. The quality of care is not as good in a nursing facility where Medicaid and a monthly check from SSA is all a person has as it is in a facility where a person has a supplement policy to pay for a nursing facility and/or the income and resources to pay for it.
    Parent has total income just under the max allowed. It includes pension as well as SS. I interpret your statement to indicate that only SS is taken and that pension can be used for other expenses. Can it be used to pay the difference in cost between a single and a shared room at the facility to a private room because that plus contributions from children and grandchildren would make it possible? Can be used to pay for the health insurance supplemental premium and the Medicare premium rather than using Medicaid for medical care other than the nursing home or must her doctors and hospitals now be on Medicaid as well?

    Quote Quoting Mercy&Grace
    View Post
    A person doesn't have to be in a Nursing Facility.to receive help with things like bathing, preparing
    meals and light housekeeping through Medicaid, although the income and resource.criteria are the same as it is if they entered a nursing facility.
    Interesting. The medical issue is dementia and that the need is for custodial care to prevent injury. How would that affect the services available? Is the total household income or just that of the beneficiary considered? How can the custodian determine what level of assistance might be available? I am sure it would not be what they are planning on beginning next month because the cost exceeds $10K/month.

    Quote Quoting Mercy&Grace
    View Post
    Also when someone has Medicaid, after their death, their estate can be sued for money spent on their care. They have to agree to this when entering a nursing facility in order for Medicaid to pay..

    For more information go to the Texas Department of Aging and Disability Services website.
    The concern is the penalty period that would occur due to the manner in which the shared expenses were handled. These are far less than the amount that would need to be paid to the facility for the penalty period. Is it possible to pay that amount to the state in order to qualify immediately as has been proposed on some websites?

    Since she is not yet qualified to receive Medicaid services, who is the best person to talk with in person about these questions?

    The issue is not about saving the parent's assets for an inheritance but making sure that when the parent needs Medicaid assistance (anticipated age of 99), it will be available since the children cannot afford to pay for the level of care that is now needed whether at home or in a nursing facility.

    There is no significant property left. The parents sold their home and cars long ago. Furniture, etc has been merged with the child's in the shared home that the child owns alone.

    IMO . parent needs to be in a memory care assisted living facility (not a nursing facility) at this time. I realize that this does not qualify for Medicaid but the parent's assets would likely cover the expenses until death.

  4. #4
    Join Date
    Jun 2015
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    988

    Default Re: Elder Law

    Parent is asking for problems to pay for expenses by
    Transfer into a joint account that apparently is not fully spent down and a reserve is being built up...that joint account may well count against parent ..it smells bad..at very least.

  5. #5
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    Jun 2014
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    Default Re: Elder Law

    They need to have an account that is their money only. Money from.others will be counted as theirs. Medicaid will go by your parents income in bank accounts that have their names, retirement, stock's, bonds, things they own, etc. They may or may not qualify for Medicaid at some point. You need to ask about Medicaid Spend down. That is when income is too great, but nursing facility expenses will decrease them to a point where the patient may be eligible for Medicaid in the future. The facility has to accept Texas Medicaid, not all of them do.

  6. #6
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    Jan 2007
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    Default Re: Elder Law

    Joint account is being use only for household expenses. Other accounts are in the parent's name alone; child has POA only. The parent's contribution is actually less than fair share of expenses. They set this up many years ago when both parents moved in with child and now late husband. I know it is not the right way to handle things but do not have a good suggestion on how parent should contribute. Child for many years when both parents were alive had a lower work income than the parents' retirement income so it would not have been fair for her to support them. Parents moved in with child from an area that was declining and had begun to have crime issues; one of the parents refused to move into the senior community of townhomes near the child so living with the child was the only option.

    I have identified nursing homes that accept both Medicare and Medicaid in the event parent must enter from a hospital stay and transition to private pay and run out of personal funds and need Medicaid. This is the likely scenario if the parent continues to live with the child. The option we are trying to convince custodial child is the best for all is for the parent to be placed into an "aging in place" assisted living facility. The parent is more likely to be injured and require hospitalization and rehab while living in the home which is not designed for accessibility or the safety of the elderly and memory impaired. Parent is very mobile, has increasing dementia, and can be unreasonable and very demanding on the child and current in home caregivers.

  7. #7
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    Jun 2014
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    Default Re: Elder Law

    Any and all income and resources that have the parents name on it will be factored in when determining.Medicaid Eligibility
    . It doesn't matter if someone else's name is also on it and/ someone else's money is in it

  8. #8
    Join Date
    Jun 2011
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    157

    Default Re: Will Payments to a Relative for Home and Living Expenses Affect Medicaid Eligibil

    You're confused about the income cap vs cost of care. I am a Medicaid case worker in Ohio.

    There is no "difference" between the $2199 income cap and the nursing home cost of care that has to be "made up". The income cap is an income li mm it for long term care Medicaid. That's it.

    When a person goes to a nursing home, a patient liability will be determined by the Medicaid office. This is the person's gross monthly income, minus any allowable medical expenses and minus a $50 "personal needs allowance". The rest of their money goes to the nursing home as a patient liability.

    There are a few exceptions though. Persons with only SSI income have their SSI reduced to $30 a month by the SSA, which the nursing home keeps.

    And persons who are married with a spouse in the "community" or with dependent children have a monthly income allowance or family maintenance needs allowance calculated by Medicaid. This is the portion of the institutionalized person's income that the spouse or family is allowed to keep.

    - - - Updated - - -

    P.S. You really need an elder law attorney. There's such a thing doing a "reconveyance" of gifted funds to obtain long term care Medicaid eligibility. But it's complex and best done by an attorney.

  9. #9
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    Default Re: Will Payments to a Relative for Home and Living Expenses Affect Medicaid Eligibil

    There is no spouse or dependent child to consider. There is no intent to gift anything. The problem is the documentation required to prove the parent's share of the past expenses for the shared household expenses when the parent's funds are automatically transferred into a joint account maintained for that purpose.

    There will be no future shared expenses because parent is moving into a care facility with costs paid entirely from parent's accounts. It now appears that parent's resources will last 5 to 6 years at this facility but less if a move is required to a skilled nursing facility.

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