Tag Archives: MEDICAID

Can a POA be a paid caregiver?

Q: If a daughter has a power attorney over her parents and has been told that the parents need a caregiver to live at home by a government official and the parents want the daughter to be the paid caregiver instead of a stranger, can the daughter pay herself from their money?   Can she pay a little less than what the agencies charge for 8-16 hours a day? If that is what the parents requested in writing? She also handles all their finances, groceries transportation everything it takes to live because they can’t do any of I on their own. Mother has Alzheimer’s disease and father had a stroke and is paralyzed on one side. Neither drives a car, cook nor can bath themselves, and they smoke cigarettes. (Blawnox, PA)

A: You should really consult with an elder law attorney who is versed in Medicaid law. He or she can review the paperwork and all the details. Generally, if the POA document allows the agent to be a paid caretaker, then such care is authorized. However, I am unsure of who the “government official” is and what specific directives this government person has given. If they feel you personally are qualified to provide this care, and do not need specialized nursing, I assume it is OK. I would highly recommend that you have your care authorized by a written caretaker contract which specifies the scope of your duties, hours and wages. This should be drafted with the help of an elder law attorney in the event your mother eventually becomes eligible for Medicaid so you can be paid and reimbursed by Medicaid.

Will Medicare, if requested, give us a detailed list of money spent on mother-in-law?

Q: We are trying to get a range of money Medicare is going to try and recoup after her death. This will also help us decide on decisions we need to make regarding her assets that she has. Thank you

A: Generally, Medicare does not initiate recovery of monies paid unless the payee collected the payments under some type of fraud, or if the payee was awarded money from an injury lawsuit while receiving Medicare payments and thus, double dipped. I think perhaps you mean Medicaid. Medicaid does have a recovery program administered through the PA Department of Public Welfare. When a person enters a nursing home with insufficient funds to pay for care or their funds become depleted while in care, they may have to apply for Medicaid funding. Medicaid can have a lien on all personal and real property of the applicant and expect the financial contribution of the market value of those assets in order for the person to be eligible for Medicaid. Medicaid liens most commonly can be enforced against a home when there is no spouse or disabled or minor child living in the home. If a person feels a loved one may need Medicaid funding in the future it is very wise to consult with an attorney regarding careful financial planning so at least a portion of the person’s assets can be sheltered from Medicaid. You have the legal right to get information from Medicare or Medicaid as long as you are authorized to do so. If a Power of Attorney or a standard Release is needed for you to obtain this information, Medicare or Medicaid will let you know which you need.

Should my parents sell their house to me and my siblings?

Q: To prevent disputes after my parents pass away, my parents want to sell the house to my sister. How is the easiest way to do this? I have a sister that is crazy and we do not want her to cause chaos over the house when my parents are gone. I am hoping that a straight out sell will supersede any property rights that said sister may have. My younger sister has agreed to purchase the home and take control of my parents’ living expenses. (Pittsburgh, PA)

A: f it is the desire of your parents to sell the house to your sister, and they are not doing this under any stress or pressure from other family members, then here is what I can say. First, if it is even remotely possible that either parent may need to apply for Medicaid to fund their nursing care within the next five years, then they cannot sell the house under fair market value. If sold under fair market value, your parent could be disqualified from receiving Medicaid benefits. Your parents need to consider that if this house is their most significant asset, or one of the more significant assets that they possess, the proceeds of it can never be used to fund their nursing home care. I strongly suggest that your parents consult with a local lawyer versed in Medicaid regulations. The money you spend on the consultation may be well worth the advice you receive on preserving at least some of your parent’s money. Additionally, be aware that at least in Allegheny County, they may lose any applicable senior citizen’s taxes. Your parents should also be aware that if your sister is ever sued and would have a judgment placed against her, it would act as a lien on the home. Transferring the family home to a child or children for financial or estate planning reasons, should be done with the advice of counsel and must take a multitude of facts into consideration, including but not limited to the parents entire estate value and income, their health and their intentions on equitable

Mom is 94. If she sells her house for $50,000, Can she gift some to her children?

 

Q: If she goes on Medicaid what will estate owe? Mom lives on her $1100 monthly Social security check. The house is paid off. She is on an Elder Care program repaying her up to $200 per month for home expenses. This is a Medicaid program. After selling the house she could rent an apartment for $350 a month. She is concerned that the money gifted to the children four of them will be required to be paid back to Medicaid if she were to go into a long-term care center.

A:  I urge you to consult with a local attorney who is versed in Medicaid law. Generally, gifts, which are transfers for no consideration (something received in return less than fair market value), within 5 years of an application for Medicaid benefits, will disqualify the applicant from benefits. Therefore, your mother’s concerns are valid. If she gifts sums of money to children either while she is collecting Medicaid benefits or within 5 years of applying, she could be disqualified from receiving Medicaid. Your best bet is to have her hold off on making gifts and consult with a local elder law attorney. He or she can advise you as to how mom can legally “spend down” a portion of her wealth without running into Medicaid complications. It will be well worth the consultation fee.

Can Medicaid view my mother’s home as an asset for step-father’s eligibility?

Q: Can the State view my mother’s home as an asset in determining my step dad’s eligibility for Medicaid? My mom has owned her home in her own name for 40 years. She married my step father 35 years ago but left the house in her name. He is now going to require hospitalization in a nursing facility. Is her house at risk?

A:   All assets of husband and wife, regardless of how titled, are considered available assets for Medicaid eligibility. It often happens in late-in-life or second marriages that couples keep real estate or financial accounts separate in their own name. It really doesn’t matter for Medicaid. Medicaid will count assets of husband and wife, regardless of how titled. This is true even if there is a pre-nuptial agreement saying to the effect that the assets of one are separate and not available to the other spouse. These sorts of agreements are no concern to Medicaid as they count assets of both spouses regardless of the prenuptial or ante nuptial agreement. This is true even if the wife brings a million dollars into the marriage the husband brings very little and they keep their accounts separate. It would not matter to Medicaid as they would have the wife “spend down” most of her savings on his nursing home bills. This can be prevented with a skilled elder care attorney as he or she would know how to preserve the couple’s assets and savings for the at home spouse. This is true even if the rich spouse went into the nursing home. A portion of the assets may be able to be preserved for whomever they wished, including the spouse or other family member.

If my husband goes into a nursing home, will I lose my house and savings?

Q: I have power of attorney. My husband is 82 and in falling health. I cannot take care of him. My health is not good enough for me to manage his daily care.

A:  You and he will pay for his nursing care with private funds. When you run out of funds to pay his monthly costs, you will need to look for funding. You may want to look toward the VA if he is a military veteran, however, most people in this situation need to apply for Medicaid. An elder lawyer versed in Medicaid law can direct you through this process. Generally, Medicaid will allow the community spouse, you in this case, to keep the home and some amount of cash funds, depending on Medicaid regulations applicable to your specific case. Once you die, or leave the home, Medicaid may have a recovery interest in the home or the proceeds of the sale. Again, a legal opinion would be helpful as there may be ways to spend down or shelter a portion of this money. It would be worth the price of a legal consultation where your entire situation can be reviewed including income, assets your health, your husband’s health, other resources for medical funding, etc.

 

Should we gift mom’s home to ourselves?

Q: Mom lives with us instead of nursing home. She had several strokes and wants to move back to her home which needs major repairs. How do we this sell her home and not lose it all if she would have need more care. She is 89, she has health insurance. We heard if she gifts it to us we could lose it if there were medical bills. How can we safeguard our investment to the home to make it livable? She has a daughter with power of attorney who also would like this to happen.

A: A gift of the home or transfer of any of her assets without fair consideration (like for a dollar) would likely result in the imposition of a penalty if your mother needs to apply for Medicaid at anytime during the five years following the date of the gift. That does not mean she is without options. It may be possible for her to pay for a caretaker, which could be you, but it should be done carefully, under a contract drafted by an experience elder law attorney, who is versed in Medicaid law. You may also want to consider being her live-in caretaker. To provide an answer to this question, an attorney would need much more consideration including details on her financial estate, her medical condition and health and life expectancy. It would be wise to consult with a local elder law attorney, before you do anything.

Can Medicaid make a claim against an estate if the estate has been closed?

Q: The estate of my mother, who passed away, was opened in 2012 and closed in 2014. The estate was closed Sept 2014 and Medicaid made an estate recovery claim in Feb 2015.

A: Much more information is needed regarding the type of Medicaid received by your mother and much more information on her estate. For example, was her estate closed formally, by an Account filed with the court? If it was, was the PA Department of Public Welfare put on notice of the Audit date and presentation of the Account to a judge for signing pursuant to the PA Probate Estates and Fiduciary Code? Generally, Medicaid can recover against the property of a deceased person through the PA Department of Public Welfare Estate Recovery Program. However, regulations and rules dictate if this can be done and to what extent. In addition, if the estate followed certain procedures, estate assets may be protected. You need to review this entire situation with an estate elder law attorney who is versed in Medicaid law.

Transfers of Assets Regarding Nursing Homes

Q: I am purchasing land from my mom so that she can have some cash to spend for living expenses. My mom is 78 and in fairly good health but if she needs to go into a nursing home within the five year “look back?” After the transaction can the nursing home take back that property if it was not a gift?

A: GENERALLY, if the transfer is for fair consideration, it should not exclude her from Medicaid eligibility. This means fair market value as documented or appraised. If you do this, you need to document everything henceforth, so if called upon down the road in the Medicaid application process, you have your proof.

Can I be paid for my POA services?

Q: I am a power of attorney for my wife’s Aunt. I do everything from pay bills for nursing home, do income tax, get health ins.etc. I take care of her house, clean, sprinklers on and off, buy things she needs, check medical bills, and a whole lot more. My question is, how much can I charge her monthly. I drive 45 minutes, 2 days a week to make sure house is ok. Is $300 a month ok!, or, is it too much or not enough. Thank you for your input! (West Newton, PA)

A: You can charge a fee for your services as an Agent on the Power of Attorney (POA) if authorized by the language contained in the POA. If the POA does not mention a specific dollar amount, it probably says a “reasonable fee”. If so, the fee must be reasonable compared to the normal fee charged by elderly caretakers. You may want to investigate. It may be in the $20 to $30 per hour range. Beware however, if she ever needs to apply for Medicaid in the near future, these payments could be considered a transfer without fair consideration and could disqualify her from receiving Medicaid benefits. If you fell she may need Medicaid in the future, you need to meet with an Elder Law attorney who is versed in Medicaid law, to review the entire situation.