my mom is in a nursing home in Illinois - has been there since middle of April. She has no POA and I am the only daughter who lives nearby. She was renting an apartment before she had her illness and so my sister & I have cleared that out & told them she won't be back. Her dr. says she will be a long-term resident (she has cancer & dementia). She gets social security & a pension check at beginning of each month = about $2200. She was made 'skilled care' when she first got to nursing home - they said Medicare would pay for the first 20 days.. well, it's over 20 days now & I have had absolutely no word about how her stay is being paid. She has medicare & also supplemental medical insurance. Do they not care if they are paid or ??? As of now, she has her May checks in her account at the bank (the home has no banking info at this point that I am aware of). She has not been made Medicaid (and will have to be since her checks would not equal a month's say at the home). She has bills still that need to be paid and can get out to the bank w/ me to withdraw money. Since she isn't Medicaid yet - is it okay if I take her to get some money out so I can get her bills paid for her or should we leave all of that money sitting in her account? I don't know what to do and I don't want to get into any trouble if we take money out.. Any advice? Thank you.
You know if your mom has income and assets over 2K she won't qualify for Medicaid. You will have to spend down her $ on her care and needs to get there, Has anyone at the rehab/NH spoken with you about your state's income ceiling on Medicaid? Do you have a set of the Medicaid guidelines for her state?
They are on-line for all states.
In general the Medicaid max monthly income is 2K, if it is over that they don't qualify. What you can do - if she qualifies for Medicaid in every other way both financially and medically - is a "Miller Trust" or "Special Needs Trust" to get her income under 2K.
This is how Miller works: say she gets 1,500 from pension and 850 from SS - 2350 every month guaranteed. So no matter what she is over Medicaid limit by 350 every month. Now that 350 a month is what funds the Miller Trust - and when she dies the balance of the trust reverts to the state. Miller has to be done by an attorney who is familiar with your states estate/death laws and can structure it to be flexible. So that 2 years from now when SS goes up by 5.87 cents a mo (lmao) the trust seamlessly absorbs it. Understand? You can't rush through doing this, so start looking about for an elder care attorney or estate attorney. You can get the other legal, like DPOA, MPOA and update her will too done.
Each state runs the Medicaid program on it's own rules, so what flys in TX is similar yet different than for NY. Good luck and keep a sense of humor.
This will get worse and more difficult. Is it possible to get a POA for her now. Also, I give Igloo high marks for being really on top of Medicaid rules, but be sure to call your local Social Services department and talk to someone who handles Medicaid applications. Your mom may be over the qualifying income limit by a couple hundred dollars, but it might be possible that they would just apply the excess to her nursing home costs. I'm not sure, but check into it.
Good luck, Cattails
Your role as POA has ended, as you know. I don't know why the NH would expect you to take any action on your mother's behalf. Are you the executor? Is anything going through probate?
Are you willing to consider this one of Mom's final bills, and pay it out of the money that had been in her account before you moved it?
First, I'd contact the NH, tell them you got this notice in error, that you were the POA but that of course ended when your mother died. See what they say.
Sincere condolences on your mother's death.
You didn't mention if your mom had Medicare or only her private insurance. I would assume that the nursing home knows the answer, but do you?
Your situation is so unique. I've never heard of applying for Medicaid after someone has passed away. If your worry is what next, I would imagine you could ask the nursing home if this is the final billing or wait another 30 days and see if anything else comes in.
My gut feeling is that Medicaid will say if your mom had the funds to pay for her final bills then she should pay them. You might be best taking Jeanne's advise and just telling the nursing home that your mom did not have funds left to cover those final costs. Or you could say, we will pay the $1,200.00, but there are no funds left to cover any further costs.
Cattails
Hospice is covered by Medicare but if they are in a NH, Medicare doesn't pay for the room and board part of their care in the NH. My MIL died May, 2011 while in hospice and we still had to deal with her Medicaid application after death.This is what it confusingly long shook down to be for us:
-Fall 2010, MIL living in reduced rate/income based IL apt. Her apt was partially paid through State program for the blind and balance from her SS. She was not on Texas Medicaid but at income/asset level to qualify.
- Winter 2010 MIL hospitalized for fall, had surgery, then discharged from hospital to rehab at a NH. 3 weeks of the NH stay was completely paid for by Medicare as she is on "rehab" after a hospital stay which is covered by Medicare. Not feasible for her to return to IL so admitted to NH part from the rehab part - same facility but different billing. Son's apply for Medicaid to pay for her NH costs for her room and board for week 4 and thereafter. Submit paperwork. Paperwork runs into issues with checks cashed to the aide who came to her old apt, etc. State was attempting to figure out if there was a transfer penalty to assess and plus there was missing financials for 2005 & 2006 due to Hurricane Katrina. NH has her as Medicaid pending for payment and her SS less $ 60 a mo personal needs goes to NH.
- Early, 2010 and again Spring, 2010 other bad falls and hospitalizations for 5 days each time. Again released from hospital to rehab at the same NH. Again, Medicare pays for about 3 weeks of all her care @ "rehab" part of the NH. Then she goes back to being Medicaid pending for week 4 and thereafter. Medicaid paperwork still not completed. Now her health is not good and she is put on hospice at the NH. Hospice aspects of NH care paid by Medicare but room and board billed to her Medicaid pending.
-May, 2010 MIL gets septic and back into hospital. Medicare pays for all as she is in the hospital. She gets transferred into an in-facilty hospice and NOT back to the old NH, as she is very septic and not healing. Since this hospice is a free standing in hospital hospice facility, Medicare pays all. She dies in about a week.
- May 2010 Medicaid for NH denied due to incomplete paperwork. SIL files appeal.
- June, 2010, NH sends a bill for over 20K for about 100 days of private pay NH room & board as Medicaid denied. NH bill was sent as: Jean Smith c/o to each of the sons at each of their addresses. None of them signed off personally to admit her but done as her POA.
- July, 2010 SIL gets letter for hearing for Medicaid denial set for Sept, 2010.
- August, 2010 NH account turned over to collection agency. All sons get same collection agency 20K demand letters from Aug to Dec, 2011.
-September, 2010 Medicaid hearing which SIL handles.
-October, 2010 Medicaid approved. NH paid retroactively. SIL gets letter.
- Nov & Dec, 2010 cease & desist letters sent to collection agency
- Jan, 2012 collection agency sends confirmation of payment.
Can we say nothing but confusing fun with this!
If the NH turns your mom's bill it over to collections, it will not go away easily.
If you signed her in as "Mary Jones as DPOA for her mother, Jean Smith" then the collection agency and the NH or other debtors are kinda SOL on getting anything from you. But if you didn't do that you can be held responsible. So what is on the paperwork?
Are you doing probate? Who is the executor? Now usually in probate, funeral expenses get paid first and foremost. In some states her medical costs for the last few weeks or months of her life get paid after funeral costs. The medical costs could have a maximum amount claimable in probate too. This all varies by your state's probate/estate/death laws.If there is no $ left after funeral costs and no assets, there is nothing they can do if you didn't sign off financially responsible.
Now if she has assets, the executor can contest the debt and make them validate & present the debt to probate court. For a small amount, like $ 1,200.00 it's not worth the time and they won't do it. Realize you don't have to open probate immediately, so you could send a letter to each bill you receive that although you were DPOA because of death no longer serve in that capacity and to the best of your knowledge believe that probate will be opened in the near future and they need to look in the paper for the legal notice that probate is being opened and present the debt. Attach a copy of death certificate. If there are no assets, it will go away eventually. You just have to be able to be patient and able to deal with a deaf ear to collection agencies. Good luck.
You will need a Financial Power of Attorney to do any banking transactions or sell property. The States rule and you will have to check your State's laws for their specific regulations. Some States provide a Statutory form for you; in others you may have to consult an attorney. Financial POA's are also available on-line, but they must be State-specific -they are not one size fits all. A Financial POA is not the same as a general POA. A general POA may not provide for banking or other property transactions. A Financial POA should be 'Durable' and they generally should be registered at the courthouse (usually required if you are selling real estate).
You said your mother has dementia. You may need to go through the court to have her declared incompetent if she is not mentally capable (doesn't understand what she's signing) to become her 'Attorney-in-fact' or her 'Agent'. If you have signatory authority on her bank account or if she is able to sign her own checks you can pay her bills. You should not try to move any money yourself (big no-no and bank probably will not allow anyway and shouldn't) unless or until you have provided them with a conforming Financial POA.
As I'm sure someone has probably already advised, if she is or will become Medicaid eligible you need to get the information on that as quickly as possible from the Nursing Home manager or your local Social Services office.