My mom was recently admitted to a nursing home. She has Medicaid and Medicare and contributes her pension and Social Security checks as per her Medicaid budget letter. She has a pending personal injury settlement that should be resolved within the next six months. I would expect it to be over $40,000. I have POA and am not sure what to do with the settlement to protect her Medicaid. My understanding is that when she passes Medicaid and Medicare will recoup their expenses. Is there a way to find out what that present balance is? Are her monthly pension and social security credited in that balance? I am in New York.
Couple of items to be aware of:
- 40K may not be what is actually paid, as could be fees, court costs etc that come off the top of the payout. You need exact $ amount.
AND
- MediCARE has Secondary Payor Act requirement for any tort actions. So if costs paid by Medicare were included in the lawsuit and lawsuit paid those costs as listed in the settlement to you, MediCARE wants their $ reimbursed.
A good personal injury (tort) attorney know this and have this $ set aside to repay Medicare and do that. But if that didn’t happen, it is on you to make sure it happens. So ask the attorney. VERY important; clearly get information from the attorney on this.
- LTC Medicaid application had a notice or paragraph as to having to let Medicaid know of any changes in income &/or assets within 30/60/90 days. Find her paperwork, it should have how that is supposed to be done. It should hopefully also be on your states website. Once you find out a better idea of precisely what the $ amount that is when I’d suggest that you contact the caseworker. Eventually they will need a xerox of the check by certified mail or via fax.
What happens??? some States suspend eligibility and have them use the $ exclusively to private pay the NH if amount is smallish. Others removed eligibility entirely and they go back to square 1 & into spend down mode, then have to reapply for LTC Medicaid completely (yeah, horrors!). Others do a reimbursement of room&board day rate costs paid to date. A lot depends on what your State laws allow for.
Keep in mind, until deposited into her bank account, it is not an asset. Yet. Also ask atty if the settlement will be taxable income; I bet they issue her a 1099 but whether it’s taxable is a ? for that attorney to clearly answer.
What you’re dealing with is common as POAs deal with selling their parents home, OR parents inherit $ from a well-off & well-intentioned sibling OR assets get discovered, etc all happening after entering a NH. So Voila! over the 2K in assets most States LTC Medicaid allow.
If you don’t let caseworker know, it will surface either when annual renewal is done OR selected for a random review OR when your State does its electronic asset verification aka PARIS matching process. FWIW when they filed for LTC Medicaid, that allowed for State to access and cross reference any database for their or their spouses personal info. Just let caseworker know so that it’s all good and they know something is coming…
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For anyone reading’s this, I’ve got to tell you, PARIS - Public Assistance Reporting Information System is quite sophisticated. Last match was earlier this month & done quietly by eligibility programs across the US pretty much simultaneously. You do not want to deal with a PARIS Notice (of irregularity). Fraud in the system is minuscule and is found. States can cross reference IRS filings, Dept of Insurance and courthouse filings. Hiding assets, fraud, submitting stuff beyond allowed by spend down rules, squishy transfers, etc all eventually are found. It flat surfaces e..v..e..n..t..u..a..l..y. Penalty placed.
Whomever got elder to give/loan/invest/buy, or convinced them something 100% ok for Medicaid but wasn’t, has no obligation in all this. It’s the elder who gets penalty and their POA who deals with the fallout left behind.
If your spidey senses feel something is off, it probably is.
Medicare is her health insurance which she pays for with her SS payment. They recoup nothing when she passes.
Medicaid will TRY to recoup but if no assets left, they can't do a recovery. After death the person most involved in Moms care, usually the POA, will get a letter from recovery. I was told this info is given by the NH to Medicaid. You then tell them what assets Mom has. If none, no worries you tell them that. For me I still had Moms house for sale. So a lien was placed only for what Medicaid put out. When the house sold, the lien was satisfied. Family is not responsible for a LOs bills.