My dad is 88 & has Vascular Dementia. I moved him near me in CO. a year ago from OR., when he had his 3rd stroke but was able to live independently, until his 4th stroke in Feb of 24. He had worked very hard for a good retirement, he had saved & invested & was living a great life with my step-mom. She had died from a heart attack suddenly, right before COVID. My dad was lonely & before you know it, he is being romanced scammed & they groomed him for a year before they completely ended up getting into all his accounts & wiping him completely out. He gets SS & 3 pensions, he is very lucky, but it is just over what qualifies you for Medicaid but isn't enough to afford anywhere, so he is living with my husband & I & my 15 yr old step-daughter. We just got married in October 2023 & he had another stroke in Feb of 2024, now he has Vascular Dementia, that's why he living with us. Medicaid denied him & wants me to provide receipts or invoices from 2019, that I really am not sure I can locate. I gave them everything I could from 2018, all his bank records, the screen shots of the romance scams & everything else they asked. But now, if I can't find these items, what else can I do to help get him in an assisted living? It's just my husband & I who take care of my dad. My husband works from home & I quit a great paying job when this happened, got a job closer to home but pays so much less, & don't feel I can provide any financial assistance towards what he would need to get into AL. Does anyone have any suggestions on what other avenue can I go to finding help if Medicaid denies him again? It's becoming more difficult for many reasons, with him living with us & I can't find anything on what people do if they get denied or need to be in AL. Thank you for any advice or suggestions because my husband & I are feeling really lost & overwhelmed right now. Thank you
But bottom line I would spend the money to get a good elder law attorney involved as if anyone can figure out this hot mess, it will be them.
Best wishes.
The first thing I wanted to share with you is that it is Very, very difficult to get Medicaid to approve coverage for your LO after a denial.
This second time applying for Medicaid is critical and cannot be a do it yourself project because if you are denied again it will be virtually impossible to reverse.
This is the time to bite the bullet and get a reputable Elder Law Attorney to help you get this Medicaid application done correctly. Elder Law Attorneys specialize in getting Medicaid eligibility for elders. It will cost some money to work with an Elder Law Attorney but it's the best option for you now. Hopefully the Attorney will also lighten the burden on your shoulders that you're carrying.
Let us know how things are going and please post again for support.
I would see an elder law attorney for help. This is much too complicated for a Forum that cannot be privy to the details.
1. Gifting. So “romance” & more sophisticated “pig butchering” scam? Hang with me as it’s not straightforward:
- What seems to be issue for LTC Medicaid (Medicaid program that pays custodial care in a facility) for scams is $ involved was essentially $ that your Dad (of his own free will) “gifted” or transferred from his fully owned bank accounts to others.
- He is viewed as competent & cognitive at the time he “gifted”.
- “gifting” happened within 5 year lookback period for LTC Medicaid eligibility for your State. & gifting (if determined) causes a transfer penalty placed against his LTC eligibility.
- transfer penalty is NOT a $2$ penalty but a division problem with specific State set divisor…. so 50k gifted in a State that pays NH $280 day rate for room&board is abt 179 days of ineligiblity that will HAVE TO B PRIVATE PAY first to the NH starting date of application filing. On day 180 LTC Medicaid can pay.
- but sometimes “gifting” can be viewed as related to a crime. Dad as a vunerable adult was a crime victim.
- You as POA or Dad has to do something to establish that it was in fact a crime that happened to account for $ taken. 4 things seem to be needed to be filed: police report, FBI report, IC3 report and a identity theft complaint filed with the credit reporting agencies.
Reddit r/scam subgroup has lots of posts on this and in the detail you need to familiarize yourself with. It’s heartbreaking common.
- once done, you have paper trail on a crime w/dad as victim.
- turned over to Medicaid caseworker to establish (fingers crossed) it was a crime & not “gifting”. So no penalty.
fwiw in the past, gifting would have been more dad signed over his home to his son within 5 yr lookback. All recorded in State database, caseworker places transfer penalty against LTC Medicaid application. Like 350K tax assessor value home in $280 day rate State would be a whopping 1,250 days / 3.5 yrs of ineligiblity! Caseworker can spot gifting easily as they know what income / assets are and why it doesn’t make sense that now impoverished at 2K max in assets that most States LTC Medicaid set.
2. Over resourced. Each State sets income and asset max for LTC Medicaid. Most do $2829 income; 2K nonexempt assets.
On assets, they spend down to get below 2K.
But if over $ on income, need to do something to change its ownership. Usually Miller Trust or another type of pooled trust done on 1 income that is fully guaranteed for payment. SSA is and it’s the one that’s usually used. Sometime elder law attorney work; sometimes States have supplied DIY paperwork w/participating bank for SSA deposit.
IMPT All income less State determined personal needs allowance has to be paid to the Nh each & every mo as required Share of Cost.
So say a mom has $2,345 SSA plus 1K in a pension each mo. State income max $2829. Mom has $3,345 income so $516 over.
What mom does is have SSA $ moved to a Miller Trust as its erstwhile owner and Voila! Mom only has 1K in income and ok! Now this mom is in a State that has $60 as its personal needs allowance so Miller pays all its $ as it’s SOC and mom pays $940 from the pension as the other SOC. Mom keeps $60 of the pension but has to make sure it and any other $ does not go over 2K in non exempt assets at end of every mo.
Why? Well LTC Medicaid does renewals and part of it will be submitting maybe last 3-4 mo banks statements plus any NH allowance accounts to establish that this mom is still 2K max so impoverished for Medicaid.
Can you DIY all this? Personally I think you have to 1st attempt gifting as a DIY. The too much income, if your State does not do their own paperwork (like OH & NY does so if your organized u can do it) then it’s Medicaid experienced attorney work.
fwiw r/scams worthwhile reading. U r not alone; sadly common.
keep in mind that for the LTC Medicaid program to pay for AL (as opposed to paying for a NH/SNF), that is done only IF your State wants to do a diversion or “waiver” from the dedicated NH funding. So you do need to clearly find out if
- this is done for CO and
- if there are AL that will take him in as a LTC Medicaid Pending waiver resident from day of entry OR
- AL will have him go onto a 1-2 yr waiting list in which they will be private pay BEFORE a waiver bed happens. Done as the AL will have a sm # of waiver beds.
If he could possibly get to the “at need” medically necessary for him to need skilled nursing care, so he goes into a NH and not a AL or a PACE program, that could be a better way. As this would be he goes into a NH, files for LTC Medicaid and most NH will have an open “Pending” bed or two. If he is at all on the cusp of being medically best in a NH, try to go this route. Finding out a couple of months from now that the AL says “we oh so love your dad but he needs a higher level of care” will be quite disheartening to deal with.
A current trend for Medicare and MedicAID $ is to dial back the 1-on-1 payment to an AL or a NH and instead have the elder go onto a PACE program. It is a Medicare and community based Medicaid* program done to allow for them to continue to stay in their or a family members home but go to long day programs at the PACE center. All their health care will be coordinated by the PACE with whatever health care institutions they are a part of or contract with and once they cannot have care done btwn the center and inhome services only then will they do the placement to a SNF that is a provider in their PACE system.
If your area is doing PACE, he may have to be evaluated for it first.
We have 2 in my city and for several years; run by the health care division of Catholic Charities, so know what they are doing. Now imo it’s kinda lucrative as Medicare pays a baseline capitation rate ($5350 mo plus $850 Part D). This has led to newer companies doing PACE. Some have had serious issues…. InnovAge probably is the best example of way problematic PACE (all sorts of lawsuits & sanctions). So have to do your homework as to if the PACE seems to be what it needs to be.
*in theory PACE is a Medicare program but needs a secondary insurance policy and the centers are set up to have this best be done by being on Medicaid for health insurance & community based Medicaid to cover other costs. So between the M&Ms all is paid for. But going onto community Medicaid means Estate Recovery can be done. Which some do not ever want to be an issue and a lawsuit was filed on this. So you can opt out of the Medicaid part but have to do a monthly fee to enroll in PACE.
Now community based Medicaid does NOT have the same 5 yr lookback on assets that the LTC Medicaid program does. It pretty much financially looks only at mo income to determine if at no cost or a small copay is needed. A medical at need assessment is done similar to how it’s done for NH.
fwiw sometimes when families realize there’s a good possibility of a transfer penalty being placed, they will try to keep the elder at home and go onto only community based Medicaid In Home Health care & private pay for caregivers and do this till it’s past the lookback period. Transfer penalties happen often but most folks just dont want to talk about it….
Good luck Brandi