When a patient passes on while in a NH can their ckg, savings, etc be attached to pay for Medicare?

Medicare or Medicaid? There is a big difference. MEDICAID requires the patient to spend down all their assets, including bank accounts. If her Medicare and pension covers the costs you are among the lucky who will escape any need to pay back Medicaid.

Hi jewell1954,

There are two great articles written by AgingCare.com editor’s that were already posted in our community. We thought this might answer your caregiving question.

https://www.agingcare.com/articles/10-Government-Programs-Caregivers-Can-Access-for-Their-Elderly-Parents-120513.htm

https://www.agingcare.com/articles/how-to-get-paid-for-being-a-caregiver-135476.htm

We hope this helps.

Thank you,

Ashley T.
The AgingCare.com Team

Medicare is for hospitalization, prescriptions, provider services. Medicare does NOT pay for any long term care like in a NH. Almost everybody over 65 qualifies for Medicare and have been paying towards it via your FICA. If MIL is getting SS, she is having a monthly premium taken for Medicare out of her SS too.

Medicaid for NH is for those who are impoverished & need skilled nursing care. You have to qualify both financially and medically for Medicaid. Most states have it so that you are limited to 2K in assets and about 2K in monthly income. Each state runs Medicaid so the exact # varies by state. For my mom it is $ 2,094.00 in income max each month and 2K in overall non exempt assets. She has a NCV funeral policy & small term life policy which are ok assets as they have NO CASH VALUE. For your MIL, all funds she has like her stocks, whole life insurance policy, savings, other investments have to be spent down BEFORE Medicaid will pay for the NH. Anything she gets a tax form for will be an asset that is totally reportable which Medicaid can find out about.

You mention she has stocks, I'd really suggest you speak with her broker on starting to liquidate all this now so that it minimizes any penalties for her cashing out. Please keep all the documents as if there is something that is odd, like she has margin calls or other vehicles that seize a big chunk, Medicaid will require extra documentation on these.

Medicaid requires documentation with the application. For my mom it was 3 years & 6 months of her financials. No way around it. I had to go to mom's bank and sit a morning with bank officer for them to do a letter with the details on each of her CD's and all accounts that were closed and what happened to the proceeds of each on the date they were closed. Now luckily they all went into her main drawing account so she was good there and she was in IL prior to NH & has a home so it was clear where her $ was going. What I think the caseworker is looking for is "patterns of spending" that make sense and then since the caseworker is local, I do think they also look at the zip code to see if the applicant's poverty makes sense.

If MIL sold or transferred any real property (home land cars) within 5 years prior to application, Medicaid will look to see where the proceeds went. If she didn't put the $$ into her bank account, then where did it go? Real property records are recorded by the local assessor and dovetailed into the state system and will surface eventually and to the penny. That seems to trigger a transfer penalty inquiry by Medicaid and they are declined from Medicaid till the penalty period is privately paid to NH OR the property transferred back to mom's name if it was that she gifted the property to family OR they move back in with family to get to the 5 year point. Transfer penalties are super sticky to deal with, really if you all have done something that could become a penalty, you should go with MIL to see an elder law attorney to work out the best option before she applies to Medicaid.

Medicaid is & has to be for those who are impoverished. If not, you are expected to private pay till you have spend down your assets and can document it.

Both of these comments are very informative, and I wonder if the money that is moved into cash well in advanced, 3 yrs, can be accessed? I hear stories about relatives who snitch cash knowing in advance that relative will need nursing home care. It would seem difficult to track cash that was removed and not replaced into another account. I also wonder how legal this is?

peary, Medicaid looks back five years. If it was moved in three years, they want to know where it went. They can't go into the recipients bank account and get it, but they can and will refuse to pay. There was a recent post about a woman who sold her house and gave the kids the money in 2012. Now in 2014 she needs Medicaid for a nursing home. Medicaid said NO, they imposed a dollar for dollar penalty. If the house was worth $60,000, they will not pay for the first $60,000 of care.

Medicaid lookback is 5 years & a total paperwork nightmare to have to provide when you are going by the rules much less when you are lying. You do sign off on the application that you realize that any omission or deletion or anything you find out about later and do not report is subject to penalty & fraud. Not worth it.

What I have learned is that the application is never closed per se, like I as DPOA for my mom has to do an annual recertification about 8 pages and provide the current month and 3 months prior of financials along with the details on her assets (insurance, etc). This is Texas and other states do this too.

About the "snitch cash", I just wouldn't do it as if & when they find out, your elder will be ineligible for Medicaid until the penalty is worked out. The NH will come after you & any other family to private pay for their care. As this usually happens after they are in the NH a couple or a few of months, the amount will be significant enough (at 5K - 15K a month) that it is worth the NH going to sue you or turn you to debt collection.

If you apply for Medicaid, you have to provide whatever length of time of financials that Medicaid requests whether 3 months, 3 years or 5 years. You do not have the option not to comply either. Medicaid knows what income they are getting in and what their living situation is. If they are getting $ 1,500 a month from SS and retirement and live with family and had 50K in their bank account 5 years ago and now have only 1K, then someone will have to do an accounting of just where 50K in savings and 90K in income for the last 5 years went. This is what I meant by providing a "pattern of spending" that made sense. Many states are contracting out compliance for Medicaid (just like outsourcing MERP) and they have the ability to quickly do an evaluation on your pattern of spending to discern fraud.

"The NH will come after you & any other family to private pay for their care. " I thought family was not responsible for their parents bills/debts?

keppelish, the nursing homes are using very old "filial responsibility" laws to recover costs. A Pennsylvania judge recently ordered a man to pay $93K to a nursing home because "he had the means" to do so. Too many people were hiding assets and expecting Medicaid to pick up the tab. I'm not talking about poor or middle income families. I'm talking about smart people with money who manipulated the system.

Go to a good eldercare attorney or at least an estate planner who shows evidence of understanding your state's Medicaid, and get this sorted out and all the papers done properly. It might cost you anywhere from a few hundred to over a thousand dollars if it is complicated and nothing has been done yet, but it will save you probably ten times that or more and give you some peace of mind.