How is a "Gift" Problem Fixed?

This is the Million Dollar question. Once a person has made a gift innocently or not, how is the problem fixed.

First, it is important to understand what the problem is. Medicaid penalties only begin to run when:

1. A person is in a nursing home or at home and applies for Medicaid benefits;
2. If that person is single, generally, his or her assets must below $2,000.00 and if the person is married her or she can have no greater then $2,000.00 and the spouse at home must be below his or her spousal resource limit.

The problem occurs when a person is in a nursing home, has only $2,000.00, and is penalized for Medicaid benefits. For instance: If I give my daughter $10,000.00 thinking its "ok" because my plumber told me so, when I apply for Medicaid, I will be penalized for $10,000/$239.41 or 41 days. I do not have the money to pay a nursing home for 41 days (in New Jersey I could need over $12,000.00 to pay for 41 days.

Where do I get the money?
What will happen if I do not get the money?

Solution 1 - My daughter can give me back all the money. When I write "all", I mean all. If my daughter, in the example above, gives me back $9,999.99 I am still penalized for 41 days. Only if she gives me back all the money will my penalty be erased.

This is fine if my daughter has the money to give me. But what if she does not have the money? What will happen?

Not necessarily in order, the nursing home will sue me and my daughter. They may follow the notice procedure required in the State of New Jersey and seek my discharge. Or the facility will be stuck with me, without payment, for a period of time.

Now in this example, my daughter may have the money to give to me, but what if I made charitable donations, paid caregivers illegally, or commingled my money with my daughter? The outcome is the same - unless every penny "given" away by me is returned to me, I will be penalized by Medicaid.

The next blog entry will address an additional solution.

Post #1 - Welcome - Time to Suspend Reality

Welcome to the New Jersey Medicaid Pitfalls Blog. It is my intention to provide accurate information to Medical providers and patients regarding Medicaid eligibility in long term care facilities.

One theme that I want to begin with is how to think about Medicaid eligibility. Medicaid is a public benefit program. The basic rules are made by the Federal Government but States actually administer the Medicaid programs.

Unfortunately many people apply common sense thinking to the Medicaid realm. THIS IS AN ERROR. You cannot use common sense when trying to understand Medicaid. For example: According to the State of New Jersey when a parent pays a child's mortgage, that is a gift which results in a Medicaid penalty. If, on the other hand, a child pays for his or her parent's nursing home care, that is not a gift that reduces the penalty from the original gift from the parent.

The next several blog entries will deal with what are actually gifts for Medicaid purposes.