Medicaid spend down issue

Saya_G

My LOs are in assisted living (I have two, they went to assisted living at the same time). They were 100% self pay for the first few months, both the facility and I knew they were going to have to go on Medicaid - neither had any assets, other than their small savings accounts.

The facility had an employee that promised to help me thru the process, since I had no idea on where to start, or what to do! She was wonderful, I really liked her. 

She repeatedly told me to buy the ladies any ’needs’ they might have, or would need in the future, because once on Medicaid they’d only get $60 a month for personal spending. She said to save all receipts - in case Medicaid asked about the purchases. She said that Medicaid would go back three months to pay any expenses the ladies couldn’t pay (I assumed that meant ANY expenses, like any balance on what they couldn’t pay to the facility.)

My LOs paid 100% thru February. By that time my LOs had not been approved for Medicaid yet, my advisor said that I needed to ‘spend down’ to get their bank under 2K (the amount TX allows folks on Medicaid to keep for rainy days in the future - since they will NEVER have any other income, but the allowed $60 a month again). So I continued to make ’needs’ purchases. 

I even asked my advisor if she had any suggestions as to what I should buy, she said things they might wear out, like clothes, hygiene supplies, even cigarettes for the one LO that smokes. After February, I would total the needs purchases each month, subtracting them from their bank balance, and then write the facility a check for the difference.

It took three months to be approved for Medicaid (Mar, Apr and May) - they were both approved in June. 

The facility has had major personnel turn over. The gal that was advising me was also training her own replacement at the time. 

For the three months after 100% self pay and their acceptance onto Medicaid, I paid partial payments, minus the needs purchases (my LOs funds were too low to pay full self-pay). The facility always accepted the check, as written, never said anything about the checks not being enough. I had been and continued to give them copies of my LOs bank statements, so they had to know what I was doing AND that I had obviously been ill advised or didn’t understand what I was being told.

I did ask several times when should I start writing checks for all but $60 of their income - as would expected on Medicaid. My advisor promised to let me know. It wasn't until mid May that she said that my LOs were close to being accepted, and that I would need to start paying all but $60 of their income soon. I started doing so in June. 

The gal that advised me is no longer employed at the facility, and her replacement was fired within a week or so of my advisor leaving. A new gal took over that department. All was good until the beginning of September, that was when the new gal informed me that both of my LOs have a significant balance on their accounts! I was shocked! How could that be?! Why was this the first time I was hearing that they even had a balance?! Shouldn’t the facility folks have told me their was a problem in March (the first month that my LOs started building a balance)? If they had, I wouldn’t have spent their money on needs (wheelchairs, clothes, hygene supplies, cigarettes, etc). 

Besides all that, I had done what I was told to do by their former employee! I now know that once my LOs couldn't pay 100% of their monthly fee, it was expected that they would pay as if they had already been accepted by Medicaid - in other words, all but $60 of their SS checks! If I had known, I would not have been purchasing things they might need in the future!

Now the facility wants to meet to set up some payment plan! My loved ones do not have the funds to pay their balances - and will NEVER have it! 

Anyone else ever have something like this happen? Any advice?

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Marta

This was a difficult lesson, but could serve to warn others. 

Financially speaking, the AL is not your friend and claims that you were following AL directives doesn’t serve as a defense. People who are planning to rely on government assistance need their own advocate i.e. an elder care lawyer to make sure their interests are being protected and preserved. 

I’m so sorry this happened to you. 

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Saya_G

We had the meeting, the facility director kept saying that I had no proof that I had been advised to spend on needs the ladies might have, during that time period, since the employee that told me to do so is no longer with the facility. She’s right, our communications were all oral. That said, I pointed out that she couldn’t prove that what I was saying wasn’t true. She point blank refused to admit that the facility had any responsibility in the situation. 

She insisted that I had been sent monthly reports, statements via the USPS! The statements would have served as notice that there was an issue. I told her that I have NEVER EVER received any monthly reports from them - in person or in the mail! Which is true! She insisted that I had to have received them. I said “I’m not a liar!” She said, I’m not calling you a liar, but we have records that the statements were sent. I said, you may have sent them, but I never received them - not one of them, ever! When I asked for proof that she had sent them, she said that she couldn’t prove that they were sent, but that they were. We verified my mailing address, they had it right. In my opinion, they never sent notification.

She then said that my LOs had been approved for Medicaid months before I was told they were approved. (I was told they were both approved in June, she claims April.) she then said that I had gotten notice of that too. I pointed out that I hadn’t, we went around about that too, until her own employee pointed out that they had received both their packet and mine! But that due to personnel changes, they would need to try to find my copy in the files, because off hand no one knows were it’s at! It’s a mess!

Anyway, we worked out a deal, my LO that owes the most, will pay them an extra $10 a month until the balance is paid off - it will take 30 years! The other LO owes much less, so they are going to let her balance ride until she (might) have a hospitalization. Why? Because if I continue to pay her applied income during her hospitalization, it will cause her account to have a credit - due to insurance paying for her hospitalization. They could then use that credit to pay back any monies in the rears! They think that will all work out. 

There were several other issues of mis or no communication issues that came up. I’m sure they will continue. Their facility is very much mismanaged. 

Ultimately, I think the deal offered was the best I was going to be offered. My hubby thinks I gave in to easily by accepting the $10 month payment - he said they should have whipped the balances off their books. Maybe he’s right. But the problem is that right now we have no other option. 

Martin Robbins

Sounds cool, Saya.

I know I read that facilities are not required to tell you when you eclipse Medicare coverage.

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dayn2nite2

The money spent on supplies would have been better spent on legal advice on their behalf.

As stated, the facility advocates for itself, not you or your LOs.

Get this agreement in writing or you'll be sitting here month from now in the same position, with recounting of verbal agreements that are different.

Have them add in writing that the facility agrees NOT to evict based on financial issues resulting from this matter.

If it's terribly mismanaged I'd be looking for another facility, especially since they are now approved for Medicaid.

You didn't address whether you took on any financial responsibility when you had them admitted.  Did you?

MN Chickadee

I'd be telling them to talk to my attorney. Not only because maybe they would shape up when it's clear you can't be walked all over, and also because I wouldn't trust them now especially if this new agreement is not in writing. What if this doesn't go away with their payment plan and when your LOS pass or move they are looking for more money again? I'd rather spend a few hundred on an attorney now and put it to rest.