Nursing Home Legal Questions - Please help!

[AliVal]

What is the name of your state?I am in PA, my father in law is in a nursing home at this time and I was wondering the following things. . .
*How long will Medicare pay?
*What if he "comes into money" very soon? Can we keep it safe from the state legally?
*Can the Nursing home take my mother-in-law's home or put a lien on it?
Thank you - I look forward to hearing from someone.

 

[ellencee]

How long will Medicare pay?

Usually, Medicare pays for the first 30 days of admission to a skilled facility, following a hospital stay.

What if he "comes into money" very soon? Can we keep it safe from the state legally?

If he comes into money, it will not affect Medicare. Is he receiving state-funded care, Medicaid, instead of Medicare? If he is receiving Medicaid, then his share of the new money will be subject to being spent on his care in the facility. If the money is substantial, it could end his qualification for Medicaid until such time as the income has been spent on his care and he again qualifies for Medicaid. He can give a certain amount of his assets to another person; the amount he can give away depends on his state's laws.

Can the Nursing home take my mother-in-law's home or put a lien on it?

Your mother-in-law will not lose her home; her interest is protected by law. The nursing home can not take anything. Medicaid can place a lien on his estate in certain circumstances.
Example: In NC, Medicaid will pay for the first six months of nursing home placement; after that time, a lien will be placed on the person's assets and Medicaid will collect as much as possible after the person dies. So, in NC, if your in-law's home has no mortgage and is fully paid-for, then one-half of the value of the house would be considered your father-in-law's share and after six months of Medicaid-paid nursing home placement, Medicaid would place a lien on your father-in-law's interests in the house/land. After your father-in-law's death, Medicaid would act to collect on their lien; however, if your mother-in-law is still living and still residing in the home, then Medicaid would not be able to collect until after her death and then, could only collect from your father-in-law's portion of the value. In NC, each year (until his death), your father-in-law could give away $10,000 interests in his portion of the house, which would lessen the amount Medicaid could obtain for reimbursement.

If your father-in-law stands to 'come into some money', someone should put a stop to that, if possible.

I strongly suggest that your mother-in-law and your father-in-law (if he is able) meet with an estate attorney as soon as possible. Because of his change in health, his estate will be affected by his medical expenses and nursing home expenses. It may be that his will and/or your mother-in-law's will needs to be changed to address these issues. Also, an estate attorney should be able to not only help your in-laws protect their assets, but enable them to gift their heirs now, according to allowable limits, rather than after their (your in-laws') deaths.

I hope that answered your questions; those issues get kind of confusing!
EC

 

[AliVal]

Thank you EC

I hope you don't mind a few more questions. . .

Fyi, He is on Medicare at the present time.

What if the "money" in question comes in, she cashes it, and she pays off all her debt? Will the nursing home know? Will the state know? Can the state come after that money for payment for time in the nursing home?

Also, forgive me, but all this is new to me. . .is Medicaid the same as Medical assistance?? Because my mother-in-lay filled out the paperwork for that prior to knowing about this settlement coming to my father-in-law. Should we stop that request (for medical assistance) from going through??

Finally, is there any good websites you could suggest for me to do some more research??

Thanks EC you have been most helpful.

 

[ellencee]

AliVal

I hope you don't mind a few more questions. . .

not at all...

What if the "money" in question comes in, she cashes it, and she pays off all her debt? Will the nursing home know? Will the state know? Can the state come after that money for payment for time in the nursing home?

She can pay off all of her debt and all of his debt.
Yes, the nursing home will know, via Medical Assistance's review of your father-in-law's financial/income status for the past 36 months, the present, and any future income.
The state will know because the state is 'Medical Assistance'.
No; the state can not come after the money but the Medicaid will place a lien on assets and will impose a waiting period equal to the income divided by the nursing home rate per month, i.e. If your father-in-law receives $20,000 and the monthly rate for the nursing home is $5,000 per month, then your father-in-law will have four months of self-pay before becoming eligible for Medical Assistance Payment.

Also, forgive me, but all this is new to me. . .is Medicaid the same as Medical assistance?? Because my mother-in-lay filled out the paperwork for that prior to knowing about this settlement coming to my father-in-law. Should we stop that request (for medical assistance) from going through??

You are forgiven, my child; go and learn nothing new in the future...wait!wrong identity...
Medicaid is the same as Medical Assistance.
It would not change anything to stop the paperwork and refile later because of the 36-month "look-back" that will be done in qualifying your father-in-law for Medical Assistance.

Finally, is there any good websites you could suggest for me to do some more research??

http://www.retire-me.com/trap4.html
Retirement Capital Advisors' site, answers most of your questions and explains how to save your father-in-law's assets. It states that in PA, the spouse in the nursing home would only be held liable for 1/3 of the value of his/her share of the house/land; that's better than the 1/2 I had anticipated!

Thanks EC you have been most helpful.

You're welcome!

EC

 

[BlondiePB]

AliVal,
I totally agree with ellencee about the settlement money and will address the Medicare and Medicaid issues. Medicare will cover 100% of nursing home care for 20 days ONLY AFTER a RELATED hospital stay of 3 or more days. For days 21-100 after the initial related hospital stay, the patient pays up to $105.00 per day and ONLY if/up to the patient making more medical improvement. At the time it is determined the patient will not make any more medical improvement between days 21-100, the cost is then "Private Pay."

In some states, Medical Assistance for those that qualify can be in two different forms: Medicaid or Medically Needy. A person that does not qualify for Medicaid can still qualify for state medical assistance under a Medically Needy Program. Regardless of which one a person qualifies for, the person only has to apply for state medical assistance. Regardless, the settlement will have to be reported.

 

[txmom72]

WOW! Blondie can be nice!

I had a somewhat similar question as you, but unfortunately I had to read your replies to get some of my questions answered. At least Blondie didn't insult you. My Grandmother is in a nursing home and on Mediaid, her husband passed away in 1993. He may still receive some money from an ongoing Asbestos suit and we were unsure of how to handle that. I thought I had a legitimate question because I know nothing about Medicaid, but I guess I was wrong. Feel free to read my post in the Probate sections and see what I am talking about. Anyway, good luck with your situation.

 

[BlondiePB]

Am I now being trolled, txmom72?


AliVal,
Read txmom72's other posts and draw your own conclusion. You had no inconsistencies. Hope all is going well.

 

[Anorman]

http://www.retire-me.com/trap4.html
Retirement Capital Advisors' site, answers most of your questions and explains how to save your father-in-law's assets. It states that in PA, the spouse in the nursing home would only be held liable for 1/3 of the value of his/her share of the house/land; that's better than the 1/2 I had anticipated!

You're welcome!

EC[/QUOTE]

Hi,
I found your post and was wondering if you could help me. My mother is also on Medicad. She's a widow, in a nursing home. About 4 yrs ago, a quit claim deed was done, giving us 7 siblings her home and property, anticipating that mom might have to go to a nurs facilty, wanting to protect her or us from losing her home. Less than 1 yr after drawing up the first quit claim deed, a 2nd one was done without the knowledge of 5 of us siblings. Two more knew of this, and one taking mother to sign it, this same sibling signed it...adding a clause. "lifetime dowery" for our mother. Now this as created a nightmare for us. We're having to keep up this house, taxes, insurances, maintainance, etc. Nursing home says they'll take 1/3 of this if we sell it before mom's death. Is there anything that we can do? Was this a legal document...because it was done without our knowledge and without our other 6 signatures? I'd appreciate any help very much!
Anorman / TN.

 

[censored]

AliVal,
I totally agree with ellencee about the settlement money and will address the Medicare and Medicaid issues. Medicare will cover 100% of nursing home care for 20 days ONLY AFTER a RELATED hospital stay of 3 or more days. For days 21-100 after the initial related hospital stay, the patient pays up to $105.00 per day and ONLY if/up to the patient making more medical improvement. At the time it is determined the patient will not make any more medical improvement between days 21-100, the cost is then "Private Pay."

I totally agree with Blondie except that the criteria used to determine Medicare payment for a Skilled Nursing Facility is based on the provision of what is called skilled care, not strictly whether the patient is making medical improvements.

Skilled care is provided by licensed professionals including registered nurses, physical, occupational, and speech therapists. Skilled care includes IV medications, tube feedings, some wound care, and therapy among others.

The only time progress towards goals is considered in determining Medicare coverage is when the only skilled need is physical, occupational, or speech therapy. There are also requirements as to how much time is spent in therapy. For example, if the patient is only able to participate in therapy activities for 15 mins once a week, she would not qualify for SNF payments under Medicare, even if she is making progress.

It can be complicated, but talk to the social worker at the facility; you should be able to get an estimate of how much longer they think she will be covered as well as what her qualifying "skills" are.

 

[BlondiePB]

I totally agree with Blondie except that the criteria used to determine Medicare payment for a Skilled Nursing Facility is based on the provision of what is called skilled care, not strictly whether the patient is making medical improvements.

Skilled care is provided by licensed professionals including registered nurses, physical, occupational, and speech therapists. Skilled care includes IV medications, tube feedings, some wound care, and therapy among others.

The only time progress towards goals is considered in determining Medicare coverage is when the only skilled need is physical, occupational, or speech therapy. There are also requirements as to how much time is spent in therapy. For example, if the patient is only able to participate in therapy activities for 15 mins once a week, she would not qualify for SNF payments under Medicare, even if she is making progress.

It can be complicated, but talk to the social worker at the facility; you should be able to get an estimate of how much longer they think she will be covered as well as what her qualifying "skills" are.

Censored,
This is an old post that some knucklehead hijacked. My discussion of the Medicare stuff has to do with Medicare A and days 1-20 and then days 21-100 that are covered under Medicare A only, not what is covered under Medicare B for a resident in a nursing home once MMI has been obtained under SNF for coverage under Medicare A for days 1-100. These are two different things for a resident of a nursing home who is there long term. Yes, there still will be private pay for things by a resident once MMI is reached. What is important is what is ordered by the PCP, how the claim is filed, and what Medicare B will cover after day 100 or after the resident reaches MMI. Of, course anything can happen that will revert to Medicare B "kicking in" to cover things.