When on Medicaid, what happens if bank account goes over 2k?

This post interested me because my mother has been in a NH in NY state for the last 6 months. As her POA, I've made sure she has less than $2K in her checking account (the only account she has) at all times (after her NAMI is paid).

But I was just told and I read that in NY, she can have assets amounting to $16,800! So I think my worries about what's in her account weren't necessary.

To be clear, she was recently approved for nursing home Medicaid in NY after being on community Medicaid and getting in-home care for over 8 months. She's been in the NH for 6 months and during that time, I'd been sending in her NAMI and making sure her acct stayed under $2K, but now I've been told the acct can have as much as $16,800 to still be eligible for her NH care.

This freaked me out, because all I'd ever heard (from an estate attorney I used a couple of years ago) was to keep her money at a low level, even down to 0 if I could. Can anyone shed some light on this if you know about NYS Medicaid law?

JS, this might help clarify...

Think of income and assets as having two bowls that your Dad puts cherries into. Each bowl can hold EXACTLY 20 cherries and no more! On the 25th of each month, the grocery store delivers a bag with 20 cherries. On the first of the next month, any cherries that are left in bowl one are automatically poured into bowl two so that fresh cherries can be held in bowl one on the 25th when they get delivered.

It doesn't really matter how many cherries are in the bowls UNTIL there is no more room in bowl one, bowl two, or both bowls at the same time. If the second bowl is ALWAYS full of cherries, then the first bowl will exceed capacity the first time cherries get delivered and then moved. If the first bowl is always eaten before the next delivery, there is room for the new cherries without having cherries all over the floor from exceeding what it is allowed to hold.

Depending on your tolerance for hassles and worries, you get to choose whether you always want the bowls almost full, one full and the other empty, or both empty at the same time.

I have a high patience and time tolerance for tracking these things so for my MIL we keep the bowls (assets and income) evenly balanced at half full. Only for a very limited time do the assets and income COMBINED exceed the limits, and individually, neither ever exceeds the limits placed by Medicaid. Since Medicaid is a month-to-month privilege, it has worked so far because we haven't had to report any considerable changes to income or assets.

Decreasing any non-exempt assets to a minimal level is something to consider if the assets are so high to cause concern and assets are the ones you have the most control over.

Just note!! that assets (and/or income) have to be transferred according to Medicaid rules. You cannot just "get rid of them" in any old way. That's where an attorney can be really helpful.

Because your mileage will vary. :-)

PS -- though if his monthly income is supposed to only be twenty cherries and 25 are getting delivered, he doesn't qualify for Medicaid and an attorney is definitely needed to figure out how to get him back down to 20 cherries and 5 peaches instead. ;-)

There shouldn't be any issues as long as the money is gone each month to LO expenses.

The way it was explained to us, is the monthly money is income until it passes the thirty day mark and then it becomes an asset. Assets have a 2000 limit (in MIL's state) whereas income is even less. It is her income and assets combined that requires careful watching every month because each individually are okay, but when combined right after her Social Security payment comes in would make it look like she has more than she actually does.

By the end of each month, your dad should be within the limits on income and assets for his state. Every single day isn't a worry.

Why are Dads medical bills not being paid when he is on Medicaid? There should be no balances as long as he is using a medicaid providers and approved pharmacy. Medicare pays 80% of what they consider reasonable. The 20% left Medicaid takes care of.

Are you talking about Medical bills prior to Medicaid? I would check that out with Dads caseworker if u can pay these out of the 2k left. With Dads Medicare and previous suppliment, most of the bills should have been paid. It depends on the contract Dad had with the suppliment. Moms and mine have a share clause so we pay the other 10% that our suppliment don't pay, they only pay 10% of the 20% Medicare doesn't pay.

What I would do (and did) is call the billing office of each provider and tell them Dad is now on Medicaid and they may "forgive" the balances. When my Mom was in the NH she paid privately for 2 months. In those 2 months I received no billings from Moms doctors. From her insurance statements there were small amts she needed to pay. I called the doctors office and was told since Mom was in a home, those balances were forgiven even though she was not on Medicaid yet.

You should be withholding the Personal Needs money allowed in your state. Be aware though, it will effect that 2k so it needs to be spent. That, lets say $50, yes, can be spent on Dads depends. Not sure about the 2k, that is something to ask the caseworker. I really don't see why not, its a spend down cap. What u are allowed in the bank. Like I said after spend down my Mom had $186.

1. I would call the providers who are billing Dad and make sure balances are left on his acct. If there are, explain he is now on Medicaid and see what they say.

2. Call Dads caseworker and see what you can use the 2k for. Medical bills prior to Medicaid and his personal needs.

3. Just a thought, has Medicare been made aware that Medicaid is now Dads secondary? I would make sure by calling Medicare. If these billings are post-medicaid Medicare not knowing would be the reason the balances are not being paid.

An Elder Law Attorney can help you strategize Medicaid and other related funds.

Imo You need to get a system going to regularly spend down on things for him. Even if it means you store items on a shelf in a closet in your home.
LTC Medicaid rules on non exempt assets are strict but it isn’t - at least in my experience- checked every month. But ya gotta plan or you’ll be stressed out.

This is what happened for my mom who was in a NH and mind you I live in another state and mom did NOT let the facility become her representative payee so her 2 retirements continued to go direct deposit into her old checking account. I wrote a check to the penny to the NH on 3rd of the month. So moms $60 a mo PNA aka the personal needs amount for TX (like JoAnns mom was $50 up in NJ) stayed in her bank account and built $ up ea month.
And I opened a personal trust acct at the NH for mom so it could be drawn from for twice a mo beauty shoppe and any sort of extra charge event or canteen buys she did (candy & hair scrunchees); kept it at abt $200/250 & the a in the NH trust acct should send you every 90 days a statement with teeny interest so you’ll know when you need to top it up again. Dad should imo have one so he can get a shave and a haircut plus it’s a social center for a facility… like all the old roosters go over when the barber comes in & they sit & chat. Medicaid does not pay for beauty or barber shoppe stuff. This is AL so they may not have barber come in, if so ask at the office as I bet they have a van doing a run couple of times a mo for the menfolk; he can use the NH trust $ for this and quietly tip the driver.

On the fear of going over…. When my mom went onto LTC Medicaid I packed up all her paperwork, like years of stuff and put it in storage. Well I did NOT know that Medicaid will require a recertification & yes those sealed in a box items I needed once again. And for more fun, the letter required all in like 15 days of date of letter and it was mailed a week + after date on letter. Nothing but FUN! Weekend. Anyways mom applied in Jan, got approved in May but the recertification letter came in April following year. It required the most recent month (April for her) bank statement and the prior 3 months (Jan - March) and several of the items submitted initially or that years updated document (like that years tax assessor bill as my mom kept her home). That’s imo what they look at…. Medicaid is looking to see that mom started the 4 months at 2k or under & ended the months at 2K or under and that any exempt assets (home, car, burial preneed, life insurance) has not been sold or transferred ownership. And that all deposits correspond to the awards letters from SSA and other retirements for income paid. For my mom, the recertification was abt 30 pages. Once I realized a recert. was going 2 happen every year & to keep $ from building up, I just did a bigger spend on clothes, shoes, large print magazines & books for her to get her bank account to under $1500 & had a binder going for that years bank statements etc. So that if it built up couple of months $60 PNA, it easily stayed under 2K. No worries. There were times when it was 3 months between visits.

If it goes over 2k what seems to happen is that dad will have to use the $ to buy something allowed under LTC Medicaid rules & asap so clears bank acct that month. Tends to be buying a DME aka durable medical equipment. Like a fancy walker or wheelchair. So in a single spend, it’s $1987.65 priced DME and takes dad almost to zero. Done in an instant, whether or not best use of $; it’s easy quick solution. You don’t want to have that happen if you can help it as dad will need clothing, shoes, eyeglasses, new reading lamp, mini frig, etc. If he’s ambulatory & can get dental done that’s a great spend. All are better use of his limited funds. Spends for his person is legit. NHs will do a 2K DME spend in a heartbeat. Your dad is in AL so they may not as most folks are private pay….so I bet it’s more on family (you) to deal with.
Enjoy shopping!

You keep the account. You can prove that you write a check or have it transferred to the AL for his care. Are you keeping out the allowed amount by Medicaid for Dads personal needs? In my state its $50. If so, this is considered part of that 2k. That 2k can be used for Dads needs, only for Dad. My Mom only had $186 in her acct after spend down.

When Dad passes anything left in that acct is part of his estate.