Since becoming dad’s representative payee, I’ve received several disturbing notifications. The latest one stated there was an overpayment during a couple of months he was in the nursing home. They’re asking for repayment. The nursing home says they have no money in dad’s account and never did.
I requested a waiver because he only receives a small amount thinking that I was helping. Now I wish I had allowed them to take the money out of his check until all was paid back whether it was his fault or not (it was not). The reason being is that with the arrival of the waiver letter another letter came yesterday that totally upset me. It said his Medicaid and monthly SSI were being terminated and/or suspended at the end of this month.
Without Medicaid he can’t go back into a nursing home or remain on the waiver program for help at home. Without his monthly income, he can’t return home and pay utilities and buy his supplies and food like we are doing now.
This was the month he had to go back to a nursing home simply because these same two siblings (one that lives in the home and another) that always caused trouble (and I believe the cause of this trouble) would not agree to dad coming back to his home after speaking to all over the course of two months. I just don’t know how long before I get a hearing date for guardianship/conservatorship although the petition has been filed.
He was not the one that got or used that money but I feel like he will be punished.
- Jan 2021 dad on SSI lives in his fully paid off home w/daughter. Dad supports this daughter financially (1 of 8 kids). Dad on SSI, MediCARE & Medicaid. His SSI income $ 730 or so a mo?
- Feb 2021, dad breaks ribs, is hospitalized then to rehab at a NH. All covered by Medicare. This is correct, right?
? Did dad stay in the NH after he was released from rehab? So went from NH rehab patient (Medicare) to a LTC skilled nursing care resident (private pay, or LTC Medicaid) in the NH? It sound like he was in the NH for 2 or so months after rehab ended. Is this right?
If that happened, someone maybe did a LTC Medicaid application for dad for those 2 months & this is very different than his Medicaid as health insurance coverage he gets as part of his SSI.
This IMO is pretty important cause if he stayed after MediCARE rehab benefit ended (tends to be after 20/21 days), it would have started a caseworkers delving into dads financials as part of his LTC Medicaid application. If dad is showing in his bank statement that he is gifting Sissy $, or paying Sissy debts, he will have a transfer penalty affixed to ANY yes ANY LTC Medicaid application & the penalty will make him ineligiblity for LTC Medicaid in a NH for months if not years. If he has a home, the letters from the state on this would have gone to his home address back in March. You need to find out just wtf happened last Feb & March & maybe April for his care and how billed ASAP.
- Spring - summer 2021, dad at some point returns home. Dad deteriorates @ home so goes to live w you & hubs. Hubs & dad are oil&water. You decide to file guardianship & get an atty to start this
- Early Sept you call EMS to take dad to ER as out of control belligerent. You tell staff he & hubs argue big time. Dad evaluated for & paperwork done 4 hospice. Dad sent home after 5 hrs.
- few days later, dad back to hospital. This time placed into a behavioral unit at speciality hospital. Hospice application rescinded.
- mid Sept, dad discharged back to your home on new meds.
MediCARE hopefully paid for all of above.
- now, dad living w you but it’s untenable situation btw dad & hubs, so you r anticipating dad going to need a NH. Your guardianship hearing is coming up. You have letters canceling dad’s Medicaid and SSI and dad owes $1400.
is this kinda it in a nutshell??
Here’s my guesses: $1400 abt 2 mo SSI @ $700+ mo.
guess #1: He filed for LTC Medicaid & signed off for NH to be payee back in Feb/March. NH had 2 SS cycles paid to them. He is required to do a copay of ALL his mo Income to the NH less only a small PNA aka personal needs allowance. If his PNA was $30 mo and if NH gets the SS$ directly usually the PNA $ stays at the Nh & is used to pay for barber shop & this uses all PNA up ea. mo. & why NH says has zero $ of his. Then I bet SSI paid him also for that period. NH isn’t giving $ back as he was required to do the copay. So he owes SS the $.
or
Guess 2. Waiver was to have his income releasec from copay requirement and iwas disapproved. If copay was NOT paid, he owes that SS $ to the NH. If SSA paid twice, he owes SsA the overpayment.
Exactly which Medicaid program has he been determined to be ineligible for?
Exactly which waiver did you file for him?
and
to whomever exactly is $1400 owed to? Letter is from SSA right?
If he applied for LTC Medicaid, I’m pretty sure SSI stops cold as he doesn’t need that SSI $ to enable him to live at home as he’s now a full time resident in a NH. When that happens, I think, you go from SSI to regular entitlement based SS payment. ITRR is spot on that you can’t be getting 2 public assistance payments which LTC Medicaid would be one and SSI would be the other.
But I think you gave other issues that will be huge problems…
part 2……. Next
Guardianship was in the plan way back when mom was here and same sibling was trying to prevent me from helping to care and see. Dad came to stay with us after rehab from the pelvic fracture where the hospital convinced us that with more therapy he could recover even more but he could not get it in the nursing home because all days were used.
Hospice was not able to help get his anxiety under control and recommended the behavior unit. But no it was never intended to be long-term but I was hoping with the siblings seeing the improvement they would agree his home and those who wanted to would help care for him at this home. But since the sister that lives at the home and one other did not agree, I was making the arrangement at the nursing home by end of the month.
I couldn’t make more calls today due to the holiday.
Heres what imo could be future problems:
1. Insurance- I'm assuming dad fully eligible for Medicare. So any bills to Medicare are getting paid.
but
if he has Medicaid for secondary health insurance & it’s cancelled, those vendors paid by Medicaid will likely have payments clawed back. They will send new bills to dad. You need to get dad reinstated for Medicaid as his secondary insurance to Medicare ASAP, so that the vendors can rebill. Or you/dad pays the bills.
2. Transfer penalty- if dad is likely needing to go back into a NH for him to get LTC NH Medicaid, dad will need to submit up to 5 years financials. 5 years.
If his bank statements have checks written to Sissy-that-lives-in-dads-house or you or other siblings, or on debts owed by Sissy, etc. or bigger (over $500) written to cash, all those posed penalty issues for Medicaid. caseworker can ask for documentation as to each questionable transfer & if you cannot do this within couple of weeks, penalty gets placed on LTC Medicaid application. Penalty is by days based on amount gifted. If you find out that dad has gifted, please pls realize this means someone will have to caregive for him @ home till he is beyond past penakty period or someone has to private pay for dads stay at NH. If dad gave Sissy $ last March, that means May 2026 to be beyond a penalty. May 2026…. a l…o…n…g time.
3. Dads house -how are bills on dads home getting paid? If dad is using his SS $ to pay for meds, is there $ to pay all property costs on house he doesn’t live in anymore? Is this sustainable?
House can remain an exempt asset for dad lifetime if he applies for LTC Medicaid but will be required to do a copy of whatever mo income he gets from SSA less $30. Family will end up having to pay all property costs till beyond the grave. Is this at all feasible?
Are you expecting to sell house OR for Sissy to pay rent?
If Sissy can show she was a caregiver for 2 years before NH admission, she can be eligible for caregiver exemption for Medicaid recovery after dads death on home as an asset of his estate. & Medicaid can waive rent being required to be income paid to dad ea month. If she considers this to be an existing agreement between her & dad, Sissy may oppose your being named guardian if you r planning on selling house. If she wasn’t working full time and since dad went onto SSI, she’s been there while he has been disabled with SSA records to show this. She likely can show she was there for caregiving. She can drag this out if she wants to, needs to or just like being petty. Meanwhile if your guardian all paperwork and bills coming to you.
4 Guardianship- why guardianship rather than POA?
If you become his guardian, dealing with all this falls to you. You’ll be appointed by the court. You can’t say, “not my fault, I didn’t know, it happened before I was guardian” or “dad was under Sissys oversight at the time”. It’s all yours, everything from the past is yours. If Sissy won’t move out, you’ll have to deal with getting her out. If there are Medicaid penalties they r yours to deal with even if you were not the person gifted $. If property taxes aren’t paid, it’s yours to deal with.
Personally I wouldn’t become his guardian, I’d let it fall to Sissy as she lives in his house, she is getting the benefits of dads $, she has been his point person & knows where paperwork is. Let this become her problem. If dad did any gifting, he could have years of penalty placed against being eligible for NH Medicaid. I’d suggest that you look in detail on dad financials before ever being appointed guardian.
Also Sissy doesn’t have belligerent combative relationship that your husband & your dad have. As you posted earlier, it’s in dads EMS & ER records that they physically argued. Another ER visit by dad with any injuries, likely APS will be called in to evaluate. Not a good look for a guardian or their spouse.
Try to work something out with Sissy if you can.
I would also question them about if the sister did something to muck up the waters.
My dads social security payment was not going to be paid the month he moved to my home because they didn't have a valid address for him. His exthang didn't put a change of address in when they moved, her lifestyle continually caught up with her and they moved regularly with no forward. Praise The Lord I called and they informed me of the issue or which knows what would have happened. They will discontinue payments if they don't have a valid address.
Being on Medicaid for health insurance is not the same as Medicaid paying for a Nursing home. The criteria is different. Your sister had to apply for Medicaid to pay for his NH.
As said, you need to call Social Services and get this straightened out.
Supplemental Security Income (SSI) is a State program. As is Medicaid that goes with it automatically.
Social Security and Medicare Dad paid into based on his work experience. These cannot be taken away. He is entitled to Medicare at the age of 65. SS he can take anytime between 62 and 70 even longer. When he takes it depends on how much he receives. At 62 he only receives 75% based on his work income, depending on his birthdate, for me age 66 was 100%, age 70 135%. Social Security does not over pay. You get the same every month. In Jan there is an increase of some 3%.
I think you applying as his payee has nothing to do with the letters you received. It has to do with ur sister applying for Medicaid to pay for his care in a NH. She should have contacted Social Services and told them of the change. He probably will need to pay SSI back. How you go about that is between you and your Dads caseworker.
So sorry you are going thru this. I hope we have explained this well enough so you understand how everything works.
I would step away. If the state steps in and takes control, or if sibs step up and direct things, whatever.
If you try to control this $hit$how, you are going to end up damaged both emotionally and financially. Your PARENTS were responsible for planning all of this years ago and they abdicated that responsibility by not getting their financial house in order.
It is tough being the smartest person in the room.
I explained at that time that Medicare pays for the first 20 days 100%, 21 to 100% 50%. Did Dad sign up for Medicaid to help offset the cost of his care? Did the NH request that he turn over his SS to help offset his care?
I don't see how Social Security could over pay since they are not directly involved in paying for rehab care. You get the same amount every month.
When you say SSI do you mean Social Security or Supplimental Income that Medicaid health insurance usually comes with. SSI and Social Security are two different things. Now I could see having a problem with them. Thats a Social Service dept thing.
You need to first find out what the problem is. How he was overpaid. To do it, I would see if I could have an appt with either Social Security or Social Services. (I know that the County dept I got to Social Security and Social Services are in the same building). This way you are face to face with someone. I find that doing by mail rarely gets u anywhere. A Phone call would be next to face to face.
I would start with the agency saying his SSI and medicaid could be stopped.
I know I’m doing the right thing since becoming his representative payee and trying to cooperate, but had no idea they would be shutting him off. I hope it’s just temporary like due to an investigation or them determining if he will have to pay back or not.
Did he appoint any of his kids POA? If someone was POA when he was in the NH, then that person should have paid the funds to the NH from Dad's SSI and whatever other income he gets.
Has APS ever been involved? Is this reportable as financial fraud?
If yes, you need to get the authorities involved if your sibs took his money, because they are gonna hold you responsible if you were Rep payee. Actually you need to get the authorities involved even if you weren't, because SS is for the sole support of the recipient and they can't legally take any of it, even if he was home they can't take it for their benefit.
Dang lady, what chitshow this is for you.
Edit: the house will lose it's exempt property tax status if he doesn't live there. He gets that benefit, not his offspring.
Tax assessor may have it that if property is over 65 owner plus disability that it’s is excluded from annual tax sale but taxes exist and w interest placed. When they die or move, it goes onto delinquent tax list. I’ve done tax sales on delinquent & adjudicated property and stopped being surprised that heirs/family honestly didn’t understand how property taxes run and why Meemaws place was up for sale and got redeemed.
If Sissy-in-the-house used dads SSI to pay on things owed by dad (utilities, homeowners insurance, phone bill) or for his needs Diabetes supplies & food), SSA won’t be happy but I don’t see SSA making a big deal on it. They would likely then require the recipient to sign up for rep payee. The OP I think has gotten dad to do this. If the incorrect $ moves happened while she was rep payee, it was on her to do whatever to keep stuff like this from happening proactively.
There’s- I think - 10 siblings…. And you know at least half of those have spouses with definite opinions on the chit show.
and
The NH has gotten zero-no-ziltch of the payment required by Dad as a Medicaid LTC applicant or Medicaid Pending resident AND the NH has also not gotten any payment from the State via Medicaid as well?
Is this correct…..The $1400 is strictly 100% a bill from the NH?
Dad needs to pay that bill in full and you need for the NH to accept the payment as “paid in full, in totally for Jimmy Smith Jones for his stay in 2021” & do this ASAP.
Dad was legally required to do a copay of basically all his income (SS $) he got paid during the time he was in the NH earlier this year if he applied for or sought to have Medicaid pay for that stay.
if it’s not paid, the NH will turn it over to collections AND if dad did not do the follow thru to get onto LTC Medicaid then the bill does NOT have to remain at $1400. NH can bill him for full private pay rate at the NH as he stopped the application for LTC Medicaid. If this NH’s pp rate is $8500 a mo, then collections can be looking to get $17,000.00 paid plus interest and fees. Debt collectors will seek a judgement against dad. Judgement gets placed on his home (unless your in FL or TX where property right are pretty sacred). That judgement will have to get paid off to ever sell his home.
Debt collectors will try to get you or Sissy to pay the debt as well.
Whether Dad didn’t do the follow thru or Sissy didn’t do the whatevers back earlier this year for LTC Medicaid, paying bills, etc. doesn’t matter. He’s living with you, you’re seeking guardianship, it’s yours to deal with now.
Have dad get $1400 from his bank account and get a cashiers checks for the amount in full and get this to the NH ASAP with a paid in full letter for them to sign. That atty you’ve paid a retainer for can do this for you. Your gonna be beyond pissed, if your about to sell his house, have an Act of Sale scheduled only to find out that the Title Co. has found clouds on the title due to judgements and debts and it queers the deal.
Also in detail go thru all of dads bills to see just how much debt there is. Check w tax assessor too, too see if he’s delinquent on property taxes. If so, that is a whole other set of seriousness.
Dad did not apply for any homeowner's program. I confirmed with sissy and she says she applied for this program (something with FEMA) on her own. She only needed dad to sign so she could get a loan to cover labor. Again, if he will not be getting some of the benefits of his home, even for a short while, I don't see a reason to have him do anything.
I appreciate the help and input.
Will you let us know what the attorney tells you about this. I am really interested to know.
I decided not to become my dads RP because it read as though I would not even be able to pay his insurance with my credit card and then take the money out of his account.
So many nuisances when dealing with the government it is hard to understand.
I agree with you about your sins, you can't trust what you are being told. If she did it, why does dad need to sign. If they are living in his house and not letting him return, well..
Best of luck.