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RayAnswers, Attorney
Category: Estate Law
Satisfied Customers: 37732
Experience:  Texas lawyer for 30 years in Estate law
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My father in law is currently in the hosp. and covered by

Customer Question

My father in law is currently in the hosp. and covered by medicare, however when he is released he will go into a skilled nursing facility and be switched to medicaid and all his assets (30,000 in a savings account) will be taken. We want him to live with us, however we need this money to make changes to our house to accommodate a wheelchair, ramp etc. What can we do???
JA: OK. The Estate Lawyer will need to help you with this. Have you consulted a lawyer yet?
Customer: No
JA: Please tell me everything you can about this issue so the Estate Lawyer can help you best. Is there anything else the Estate Lawyer should be aware of?
Customer: He is located in Tennessee and my wife has durable power of attorney.
JA: OK. Got it. Last thing - JustAnswer charges a fee (generally around $18) to post your type of question (you only pay if satisfied). While you're filling out that form, I'll tell the Estate Lawyer about your situation and then connect you two.
Submitted: 11 months ago.
Category: Estate Law
Expert:  RayAnswers replied 11 months ago.

Hi and welcome to JA. Ray here to help you today.

I think you may misunderstand how Medicaid works here.Medicaid will not take his $30k here.For him to be eligible for Medicaid he needs to spend down the funds first.He can move to your house and make the modifications needed to live there.He really needs to spend down his assets here anyway.

If he can go directly from hospital to your home that is certainly possible.Building a ramp here and other mods are reasonable for him to live with you here.Again Medicaid will not take his money here, eligibility is based on the amount of resources here.He would have to spend down for eligibility purposes.As long as the spend down is for his personal needs, a ramp certainly qualifies , then it is not going to be a problem.

He will have a period of time in rehab here probably 60-90 days max.You could use the time to complete the modifications.You just have to be sure in your mind that you can truly provide the care he needs in your home.Once he spends down here he may qualify for Medicaid Community based care, this is help in your home.

I appreciate the chance to help you today.I wish you the best here.Thanks again.

Expert:  RayAnswers replied 11 months ago.

After you have been in a hospital for at least 3 days, Medicare will pay for inpatient rehab for up to 100 days in a benefit period. A benefit period starts when you go into the hospital. It ends when you have not received any hospital care or skilled nursing care for 60 days.

Medicare Coverage for Inpatient Physical Rehabilitation

https://www.medicare.gov/coverage/skilled-nursing-facility-care.html

He would have up to 100 days in medicare skilled nursing.The key here is he has to make progress

or they discharge him.

Expert:  RayAnswers replied 11 months ago.

More

Medicare has many other criteria that must be met before it covers a stay in a skilled nursing facility. Medicare will cover skilled care only if all of the following criteria are met:

You have Medicare Part A (Hospital Insurance) and have days left in your benefit period available to use.

1. You have a qualifying hospital stay. This means an inpatient hospital stay of 3 consecutive days or more, starting with the day the hospital admits you as an inpatient, but not including the day you leave the hospital. You must enter the Skilled Nursing Facility within a short period of time (generally 30 days) of leaving the hospital. After you leave skilled nursing, if you re-enter the same or another SNF within 30 days, you may not need another 3-day qualifying hospital stay to get additional SNF benefits. This is also true if you stop getting skilled care while in the SNF and then start getting skilled care again within 30 days.

2. Your doctor has ordered the services you need for SNF care, which requires the skills of professional personnel such as registered nurses, licensed practical nurses, physical therapists, occupational therapists, speech-language pathologists or audiologists.

3. You require the skilled care on a daily basis and the services must be ones that can only be provided in a SNF on an inpatient basis. If you are in a SNF for skilled rehabilitation services only, your care is considered daily care even if the therapy services are offered just 5 or 6 days a week.

4. You need these skilled services for a medical condition that was treated during a qualifying 3-day hospital stay, or started while you were getting SNF care for a medical condition that was treated during a qualifying 3-day hospital stay. For example, if you are in a SNF because you broke your hip and then have a stroke, Medicare may cover rehabilitation services for the stroke, even if you no longer need rehabilitation for your hip.

5. The skilled services must be reasonable and necessary for the diagnosis or treatment of your condition.

How long will Medicare cover a stay in a Skilled Nursing Facility?

The amount Medicare covers depends on how long you stay in skilled nursing. Here is a breakdown of Medicare coverage:

Days 1 – 20
Medicare pays the full cost

Days 21 – 100
Medicare pays all but a daily co-pay. (In 2015, the copayment is up to $157.50 coinsurance per day.)

After 100 days
Medicare provides no coverage after 100 days.

If you have a Medigap policy or are in a Medicare Advantage Plan, you may have additional coverage.

Customer: replied 11 months ago.
I didn't give you the correct info for his situation. My father in-law is in a skilled nursing facility/nursing home. His 20 days for Medicare runs out the 23rd of Feb. They are starting the process to qualify him for Medicaid. If he has the fund will he have to pay the daily copay for Medicare for the next 80 days? If the POA takes the 30k that he has in savings out for repairs on our home in hopes that one day he will live with us, would that bypass the Medicare and start the qualifications for Medicaid? If the POA took the money how would he be penalized for that 30k? He has to have care in a nursing facility at this time due to a tracheotomy and feeding tube. Would Medicaid come after the POA?
Expert:  RayAnswers replied 11 months ago.

I think here he is going to have to spend down here for his care.He should prepay his funeral here as well while he has funds. I understand what you wan to do here but not sure time and his condition permit it.The risk here is that he doesn't own your house and medicaid may look at this as a gift here.And medicare here is likely wanting the copay, or the facility will. The problem is if you spend the money on your house and he cannot live there then they will call it a gift here no doubt.I have been dealing with nursing homes for 30 years.I honestly do not think it is possible here for you to care for him --a skilled care resident in your home over time.I know how hard this can be to make such decisions.But I am being honest here he likely will need to be in a home.And I need to tell you that statistics for skilled residents 90 % or more live five years or less.So the funeral if you haven't done so is legitimate spend down.

Also under medicaid he is allowed to own one vehicle no limits so purchasing a car for transportation is legitimate spend down.He would own it, carry insurance, maintain it, you and family can use it to visit or for transportation.The idea here if you do this you drive the heck out of it because medicaid will claim it when he deceases.This might be an option instead of the remodel here.

Expert:  RayAnswers replied 11 months ago.

Reference to the purchase of car as spend down.

http://www.steveandersonattorney.com/medicaid-exempt-assets/

Expert:  RayAnswers replied 11 months ago.

If you have more please just ask.Thanks again if you can positive rate when we are done it is much appreciated.

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