Medicaid wants deposit/transfer/withdrawal explanations but my dad has a brain tumor and is unable to communicate?
And why deposits?? Medicaid (Wayne County NY) is looking for explanations on my dad's 5 year look back, but he has an inoperable grade 4 glioblastoma (brain tumor). He is only 65 and had no idea until an episode last Thanksgiving and has been hospitalized ever since. He is declining at a rapid pace and only has a few months at best. He has next to no short term memory and can't even remember his email password that he has used day in and day out for years, let alone why he wrote a check to cash 2 years ago. Even if he did remember he can't communicate anymore, most of what he says is gibberish or nonsensical. I have absolutely no way of knowing the who, what, when and where of his banking. I have copies of the checks written but many are to cash and the copies of checks and banking statements are no help. My dad barely got by, he has *no* hidden money. At 60-65 he had no reason to think he would be in a nursing home in the next 5 years to try to hide assets. He lives in a trailer after losing his home and vehicle when he was unable to find work. His income is SSI and still has to borrow money from my grandma from time to time. We don't even know how we will be able to pay for cremation and services.
I also don't understand why they are requesting info on deposits and minimal transfers (five for $60-$100 to my brother and I)?? I understand money out, but money in? How is that any of their business, and why does it matter who it was from? Money coming in and being spent on bills, personal items, food, etc is not being hidden?
I don't know what to do? Please help???
Pour yourself a cup of tea or a glass of wine. Look up his tax statements, interest or dividend paying accounts will be listed there. Start by printing out the past years statements for any and all accounts. Investigate any receipts, and look for the matching statements. Pile the year with the most recent month on top. Compare across accounts, maybe money moved from savings to checking. Maybe he had an IRA with a distribution.
Overall, you need to know the income declared in his taxes is accounted for in his spending pattern, acknowledging that we all have a bit of walking around cash that leaves no trail. Once you understand the picture for yourself, you will better be able to represent it on his behalf.
I happen to know my mom's financial picture, because I have been her errand girl for decades, otherwise this would be very difficult.
Dad did not have a secret money tree in the yard, I do think if you can represent the picture with confidence you can influence the investigation.
1. that the way you are presenting the details and documents to Medicaid are not "overwhelming" enough for the Medicaid caseworker to sign off on….it's just too much of a little here & a little there with too many missing parts.
2. problems in determining dad's "SOC".
Did you get a list of items required for NYS Medicaid review and have you submitted all the items on the list?
Vstefans is right, the caseworker does want to have your dad approved, but until you can provide what they need to do that, their hands are tied. Each state runs their Medicaid program under an overall federal guideline, some states (like NY & TX) are very document driven. For my mom (TX Medicaid), I got a 1 page list from the NH as to what would be needed to accompany her Medicaid for NH application. (the NH reviews the documents too mainly to determine if they (NH) will accept her as a "Medicaid Pending" resident). I submitted her details as an over 100 page document dump to the NH which in turn submitted it with their bill to the caseworker for their (the NH's) area; in turn the initial caseworker has about 10 minutes to scan to see what's there and if it meets the required "set" of requirements - my guess is that what you are submitting doesn't fit for how NYS evaluates; for my mom, the initial caseworker called me (also sent a letter too) as to the status on mom's insurance - whether it had any cash value - now caseworker had a copy of actual policy front & back (about 30 pages too) to read but he doesn't have the time to do that nor does he have the training to evaluate insurance policies but he can require that my mom provide those details. I got a broker who held a TX insurance license to do a letter stating that the policy was NCV - no cash value - and faxed it to the the caseworker, caseworker could then put the fax in mom's file and check off that item and put mom's application into the initial review "approved" pile. She had a secondary review too due to real property ?'s and that was a whole other set of issues…..My point is Medicaid is very detail driven of a review.
For your dad since he is young, he doesn't have the SS or retirement history and annual statements that Medicaid uses to determine their income and what their co-pay or "SOC" (share of cost) needs to be. The SOC figure is critical for Medicaid to determine just what they will reimburse the NH and what the NH is fully expecting and required to get paid from the resident. (BTW it's my experience that both the Medicaid programs and the NH do a piss poor job of explaining the SOC.) That is probably why you are getting these hurdles as to where the deposits are coming from, they are trying to get a fixed $ amount for his SOC. Like does the check for $ 866.00 last June represent something that dad would get every June - it's those sorts of ? that need to be determined to figure out dad's SOC. Understand? Without knowing what his SOC can be, Medicaid cannot pay the NH. Realize that most NH Medicaid are elderly and have an established SS statements and retirement / or annuity statements that match up to their SS # or their spouses SS # so determining monthly income (and therefore the SOC) is readily available and documented to be accurate.
So what to do??, if you can be very OCD on all this, you can basically reconstruct dad's financial life for the past 5 years, you will have to do (you do this as if dad was asking for this too as VStefans suggested) an IRS request for his last 6 years of taxes; contact anyone he worked for the last 6 years and all his banking for 6 years,. Yeah, the review is a 5 year look back but the states can go up to 10 years if they want. Then you get a program like Quickbooks or Quicken and get all dad's checkbook and other expenses in. Basically doing a P & L on dad to show that he is now impoverished & "at-need" for Medicaid (usually that is 2K in non-exempt assets and 2K in monthly income - but the income amount is set by each state and can vary, like my mom's was $ 2,094.00 when I did her application).
I would suggest you contact the caseworker directly to see just how they want the income and asset details presented to work for how they review in NYS also this shows you want to be transparent in all this too. Good luck and keep a sense of humor in all this.