Are you automatically refused Medicaid full coverage (nursing home) if you can not provide a five year look back on large bank withdrawals?

Medicaid rules/laws vary from state to state. That is why you are getting responses advising you to seek the advice of an ELDER LAW attorney. I capitalized elder law because they are the ones that know Medicaid/Probate, etc. and will be your best source of information and they look out for the client. Having said that, the way it worked in my state was Medicaid audited my Mom's bank account themselves. Yes, they did ask me but the run checks randomly quick checking with banks looking for any sums they consider large that could have been gifting to a sibling or anybody for that matter. Keep all receipts for anything spent out of your parent's accounts. Yes, it is a job and it is not an easy one. I had file folders all in a room I fixed up at my home for an office so I could keep track of everything and make sure we were doing everything right. BUT, you really need to seek help from the very start.

I agree with everyone re the elder law attorney. There may be some emergency measures for your dad's situation and they they know all the ins and outs specific to your state. One thing I have come to realize over time is that whatever the illness, circumstance or whatever...you're never the first and the experts have seen/heard it all before. PLEASE make sure you seek out a CERTIFIED elder law attorney and preferable one who charges a flat rate for the task. I'm guessing there is some way to figure out and look at records at what your dad started out with and allow for basic needs to be met like housing, utilities, food. The worst would be holding him accountable for X number of months or years to pay on his own, but there's nothing there...I mean the rule in general is GIFTING /giving large sums to others, but I think you can spend it on yourself. It's a wacky system...but I bet it might all be okay in the end. Just be very careful about assisting with your OWN funds. Try not to put any out, unless it is essential, like for the legal advice. Take it all one step at a time...things that have been going on for years are still going to be there in a month...

In the state of NJ I provided the five years because Mom had kept then. Out of that 5 years, the caseworker pulled out 4 a year. They want to see any large amounts coming out and will question it. The more info u have available and you do the footwork to get, the faster ur application will go. If u rely on the caseworker, it may go slower.

I was told that they just do random checks of the patient’s bank account looking for large amounts paid to a relative or friend. They can order this from the bank. My Mom had her five years of records but when I asked about it at the outset, that was the answer I received.

No ,,,you will not be refusing, they will ask what he haves now and what he had in the past 2 years like property, cars , stocks and bonds

wow , I been there, my father was active, and a player , clean cut , shaved and dressed to impress then I had to take him in that became over whelming fast, so I had to look into assisting living that he could afford with his social security check, they would take his whole check except $30 but they gave him 3 meals and all the utilities was included, once he fell again he ended up in the hospital again but was so serious he was in ICU then was sent into rehabilitation / Nursing home for 60 days. The social worker applied for public assistance so he is now staying here permanently, being payed by Medicare and public aid

Frogleg, how are things going? Did you get your dad placed in a facility that can meet his needs?

You may want to seek out the help of an elder law attorney just to make sure no glitches come up and Medicaid disqualifies.

I’m with the others that if it’s a regular pattern of cash withdrawals since mom died, that Medicaid will be ok with it. They are gonna want at least 3 years of financials, maybe 5 years. So pull that stack of paperwork together. If everything falls apart after her death, the pattern will be obvious.

BUT I’m more concerned about other things....
- is he likely to be discharged to be ok to live in AL or in the community? He doesn’t at all. sound like he could manage AL as he’s not ambulatory or able to actually do most ADL daily care things, like transition from bed to get dressed or toilet on his own. He sounds like he’s LTC NH needing skilled nursing care & 24/7 oversight. I’d suggest you Ask NH to do a needs assessment on him early next week. That might help you determine where he goes AND which Medicaid needs to be applied to & spent down to qualify for.
- he’s actually currently a rehab patient in a NH, right? I bet Medicaid is going to want to place him in LTC NH Medicaid program application pile rather than Community based Medicaid Program. Community Medicaid is good for those living at home that need a secondary insurance to their Medicare. He has BCBS, he has secondary. He’s right now not living at home. He’s in a grey zone for residence, he’s not living in his home anymore, had temporarily moved in with you & now in a NH & after more than 1 hospitalization on rehab. If Medicaid does this (NH LTC) that 10k CD will have him ineligible from the start for LTC NH Medicaid as it’s 2k max for assets for almost all states.
I’d suggest you asap speak with the Medicaid caseworker for his application as to which path his filing went. If this was done at the NH, caseworker is geared to all being LTC NH Medicaid type of vetting.
- BCBS & health insurance, Why isn’t his stay in rehab being paid by MediCARE post hospitalization rehab benefit with BCBS as his secondary insurer? & BCBS covering the copay? 20% copay is pretty standard to get paid by the blues. MediCARE is doing the bigger payout. Realize if he has Medicare as his primary & BCBS as his secondary or supplemental, if he should actually get onto any Medicaid, that BCBS will drop or suspend his coverage. BCBS won’t cover if they can shift costs to another secondary insurance, & that’s what Medicaid will become for him. BCBS will return his premiums paid to date Medicaid in effect. For more fun in this, if he gets onto Medicaid and they date eligibility back a few weeks, BCBS likely will do a clawback for all payments to vendors that they paid for him from that date on. The vendors will have to rebill to medicaid & if they don’t participate in Medicaid, they will come after dad or you as dpoa to get paid. This could be quite a bit of $ & flurry of bills for months as clawback can take time to happen & be realized. I went thru this for my mom as she had federal civil service retirement with BCBS coverage & she went onto LTC NH Medicaid; Blues clawed back 5 months of payments..... nothing but fun there.
- Also If he should move back to your house & his current docs do not take Medicaid, it’s likey going to be quite a hurdle to find him new docs. I’d call his 3 main MDs ASAP to see if they participate in Medicaid AND are taking any new patients in their Medicaid set aside #.
And lastly...
- does he still own his home?
You mention he had a large home but moved in with you. So is home still there in his name? If so, how are property costs getting paid? Is it empty / vacant or was there someone living there with him?

Alot of determining what’s better to do maybe be best based on his needs assessment. It can be a reality check with documentation for all.

Please note that some NH will not accept residents pending Medicaid approval

If your Dad had made the checks out to you or another family member, that would have been considered “gifting” in our state for Medicaid purposes which disqualified the patient until the money is paid back. DHHS does and will audit the bank account just looking for large amounts paid to their kids maybe. They audited my Mom’s. She had to pay a portion of her social security check to the nursing home but Medicaid paid the rest. When the parent is deceased here, Medicaid does Estate Recovery whereby they will try to recover any money or property such as land or a house,etc to reach their claim. I went through all of this. My parents’ house was deeded to my sister and me in a life estate 6 years before she entered the nursing home so it was not an asset they could claim. BUT, you go straight to an elder law attorney and gather the info. I made 3 trips to one and they usually charge about $300.00 or so for an hour of valuable advice. Worth every penny. If you Google Medicaid info, be sure to put your state in as keyword because each state has its own Medicare laws/rules that vary. Hope this helps. Good luck to you.

In Florida you can’t make above $2200 a month and my mom had to sell everything and her Whole life insurance To get eligible for Medicaid. She’s allowed a $10,000 term ins policy but that’s it. She lived with us 30 years and nothing else. So your answer is no you can’t apply for Medicaid if he has anything of worth and even if you cash it in they want to know where the money was spent. We purchased my moms burial plan and cost to fly her home to be buried by my dad. So your best plan is to call elder affairs in your city get information and talk to a social worker. They’ll get what you need to do but you’ll have to pay till his money is gone and then skilled nursing automatically takes his social, retirement, etc till exhausted then you apply for Medicaid. Hope this helps

Ask for help from Social Work. They can help you find a place he qualifies for. He needs a place that can care for all his needs since he is very unstable on his feet and very impulsive. Has anybody ever checked him for a stroke (probably frontal lobe) or for hyperthyroidism? Just my guesses as a nurse for some of his problem behavior.

Choose the Place he is able to get Into Here, dear. They will Sit you Both Down and you can Go over this. No onned to worry because it was Done, Hun, Five years ago and Not Recently, Where a RED FLAG Would Wave and you might Get...WAIVED.

All good answers...only thing I would add is to be careful signing ANYthing at rehab/nursing homes, do not spend any of your own funds for his needs, especially since the 10K will have to diminish for him to qualify for medicaid; don't forget to spend down to consider funeral plans and if you get an elder law attorney to help, try to do some research and get one of the best, certified...if you can one who works for a flat fee for a task. They will guide you through the process and relieve the burden and make sure other legal stuff is covered like will, POA etc.

As long as your dad spent his money on things he wanted, there should not be an issue. I recommend that you get five years worth of bank statements from his bank. Medicaid will first look to see if he sold anything of large value in the past five years, i.e. home, car, etc. and if so, where did that money go? The issue with only using cash is there is no paper trail to show that he spent his money on meals, gas, clothes, etc.
As for the $10,000 he has remaining, please get receipts for all things that the money is spent on. I would recommend applying for Medicaid, gather all the verification paperwork and see what they determine prior to spending down the $10,000. Medicaid will be able to determine if he will qualify once $6000 is spent. If he does not have funeral costs, burial, etc. paid for, I would recommend using the last of his money for this expense. Medicaid approves and recommends doing so with the last of funds.

Yes, that 10k will have to be used for his care before Medicaid will pay.

They question $750 a month? We spend more than that just for spending money. We eat out a lot and pay cash for somethings. If she had a car thats gas, groceries and just spending money alone. I don't see why that would be questioned, especially if it was a regular with drawl. Makes since to me.

I guess I was lucky. Our bank includes copies of checks so Medicaid saw Moms withdrawls. Her pension was a check and that she cashed and that was her spending money.

I think this might be a good place to start: https://ocgov.net//oneida/ofa

They say:

"The Office for the Aging and Continuing Care provides services to the elderly and disabled of Oneida County and their families. We assess individuals to identify unmet physical, medical, psychological, social and financial needs. Care plans are then created and implemented cooperatively between our department (case manager) and the individual and their family. Appropriate and available services are provided and referrals are made to other agencies when necessary to accommodate each individual's specific needs. After the care plan is in place; we monitor, evaluate and adjust the plan to accommodate the ever changing needs of the client."

Their contact numbers and walk-in office information is on that page.

It's especially the bit about identifying unmet needs. Your father's reckless spending, in the context of your description of him, suggests to me that there could be all kinds of mental health issues in the mix which have impacted on his financial situation. It's all going to be relevant to the Medicaid issue; and I would hope that the Area Agency will be able to guide you about how to move forward.

Don't forget that the first person who is responsible for managing your father's life is your father. Once he can't, or looking back if he could not, that STILL doesn't make you responsible, certainly not if you had no authority to take over decision-making. So while this is a mess - a) it will be sort-outable; and b) try to avoid that feeling that it's your fault and it's up to you to solve everything.

Get an elder attorney. Depending on the amount of money spent he may or may not be able to get Medicaid. My aunt in WV took out $750.00 a month to spend. Medicaid questioned the amount spent and she had some kind of penalty and did not get Medicaid immediately. He definitely would have to legitimately spent down most of that $10,000 CD

The first thing you need to do is meet with the Social Worker and case manager at the Rehab Center and address your concerns about him being able to live with you anymore. They need to know you cannot safely care for him at home. When the time comes do not let them release him to you. As far as the bank records, those are easy to get. Unless there are large transfers, there shouldn't be much to worry about. Did he sell or transfer property? If it is shown that he gifted large amounts, those that he gifted to may be on the hook to pay it back ultimately, but your first concern is Dad's proper placement. Do not let them release him to you when the time comes, you will not be able to safely take care of him.

I don't know about the Medicaid requirements, but it's good advice to call an Elder Care Attorney for guidance.

I doubt an Assisted Living Facility would take your dad, being he's constantly falling. With a caregiver to resident ratio of approx 20:1, there is no way he'd be properly cared for in an ALF. Not to mention the liability factor for them, or the fact that Medicaid doesn't usually cover ALFs, just Skilled Nursing/Long Term Care Facilities. And when in such an environment, they'd be ill equipped to prevent falls. My mother fell about 36 times in Assisted Living and had to move into Memory Care after she became wheelchair bound and her dementia progressed. The ALF wouldnt take her back after a stint in rehab. The wheelchair has been a blessing....shes only fallen 2x that we know of since June. They've wired her bed and easy chair with alarms which notify staff if she tries to get up alone. Of course, they couldn't possibly get there in time if she were to get up alone....but that's the way it goes. If she starts falling a lot again, as she did in Assisted Living, I'm sure I'll get The Call about having to move her to Skilled Nursing. Falling is REAL dilemma, especially when they're stubborn and insist they can do things on their own, when obviously they cannot. Sigh. Then throw in dementia and the whole mess is literally impossible to manage. When mother had a CT scan in the hospital recently, they saw broken ribs and sternum bones, all in various stages of healing. Coming from falls she managed to hide from staff by getting up on her own without help.

Anyway, just some food for thought for you to consider. Wishing you the best of luck with this difficult situation

Is dad competent to respond to questions? You are going to have to provide five years of his financial records. I have no idea, since he has withdrawn huge amounts of cash, what they will do with that. My only suggestion is get a elder law attorney to help with the process. Tell that attorney the absolute truth.

How did this get so out of control?

New York has so many programs, I have no idea what is available.