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"Are You on the Hook for Mom's Nursing-Home Bill?"
Old 06-23-2012, 04:00 PM   #1
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"Are You on the Hook for Mom's Nursing-Home Bill?"

We've been discussing MIL out of money for co-pays and will we pay for her or not. Maybe we don't have a choice...

Family Value: Are You on the Hook for Mom's Bills? - WSJ.com


"Twenty-nine states have "filial support" laws that could be used to go after patients' adult children for unpaid long-term-care bills."

"Under Pennsylvania's filial-support law, the parents have to be considered "indigent," and the child has to have the means to pay the bill. Neither threshold is specifically defined, which gives courts a lot of leeway."

One recommendation was to make sure there is a smooth transition between private payments and Medicaid.
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Old 06-23-2012, 04:23 PM   #2
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It just so happens that I live in PA and was aware of this, going back more than a quarter-century.

I had nothing to do with my father after I left home when I turned 19 (long story). I became aware of this law and knowing that he spent every penny he made, I realized that it was a hook that could bite me in the a** one day.

When his mother passed (my paternal grandmother), I suspected that she was financially comfortable and that he would be the recipient of a decent estate, which I expected him to spend down, as soon as he got his hands on it, as he was the only child.

While I was not named in the will (didn't think I would be), I went to the county courthouse to get a copy of the will a year after her death, giving that amount of time for it to be filed. Since wills are public (and the reason I have a trust, which isn't), I had a document that showed that he had many hundred thousands of dollars and I would use it in evidence if I was ever asked to "pay up" in the future, per the law.

Luckly, he died many years later (didn't get anything in the will that time, either ) without being contacted for any end of life medical/living support. I don't know the facts of his passing, but at least he didn't "reach out from the grave" to further destroy my life.

Sometimes, relatives are the serpent in the sack that can really screw up your life.
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Old 06-23-2012, 07:27 PM   #3
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In at least one of those states, Pennsylvania, nursing homes have started routinely using the law to prod families into paying their elders' bills or completing Medicaid paperwork on their behalf.
Considering that most care facilities have one employee dedicated to Medicaid paperwork, and one more employee dedicated to billing, I can see why they'd use the state laws to scare the customers into paying up.

I get quarterly calls from the billing staff at Dad's care facility making sure that they have at least 6-12 months of time to complete the Medicaid paperwork. The patient is unable to comply, and although the family may be ignorant they're at least the next most likely person in the group to know the financial details. And let's face it, people have been learning for a couple of generations now how to evade Medicaid spend-down rules. This WSJ article is just those years of misconduct coming home to roost.

I think the laws are used to audit financial records to make sure there's been no funny gifting or re-deeding of homes within the lookback period. Otherwise the care facility just wants to get the Medicaid package approved and get on with the next patient.
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Old 06-24-2012, 07:41 AM   #4
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Regarding PA, I believe there was a recent court case that tested the law, and only mitigating factor was if the child could afford to pay. Obvious ?s:
What is meant by afford?? BTW, this is why ERISA protection is so important, PA can't touch a 401K (may not be true of IRA).
What if the child is in another state, can PA force a child to abide by PA laws if they live in another state??
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Old 06-24-2012, 10:55 AM   #5
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What if the child is in another state, can PA force a child to abide by PA laws if they live in another state??
TJ
I doubt it. When I was applying for conservatorship I had to sign an extradition waiver with the state of Colorado so that they wouldn't have to bicker with Hawaii to get me.

Of course ignoring a state's legal requests would just lead to more problems. They'd file a judgment that would end up on your criminal record checks and your credit reports. You'd be nervous about visiting the state... heck, you'd be nervous just flying over it and wondering if the aircraft had to do an emergency landing at an airport in that state.
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Old 06-24-2012, 12:12 PM   #6
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In the early 90s, MIL, mother of former wife, was committed to a home. Her son, a bank manager, had all her holdings transferred to he and his sister then applied to the government for social assistance.

I am pleased to see governments close such loopholes. She lived for 8 years in the facility at half price.
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Old 06-24-2012, 12:40 PM   #7
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As some others are saying, I don't think this is intended to put descendants on the hook for their parents nursing home bill in the general case, but they want to be able to broaden their search for asset transfers from parent to child and probably make it more difficult to play shell games to put the state on the hook for eldercare.

In other words, do the children have the means to pay because they worked hard and saved up all of their own nestegg, or do they have the means to pay because the parents have been transferring many of their assets to their kids for the last few years?
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Old 06-24-2012, 12:44 PM   #8
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Pennsylvania seems to be at the forefront of senior / nursing care clawback strategies.

A few years ago my uncle had to quit driving his elderly parents to grocery store and doctor appointments in his own vehicle. Seems in the event of an accident, regardless of which party was at fault, if an elderly occupant required nursing home care soon after, Pennsylvania was going after the driver's insurance for renumeration for long term care costs and were even considering civil proceedings against the driver's and/or vehicle's owners. He found out about it through some very strongly worded exclusion notices from his insurance company.
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Old 06-24-2012, 12:52 PM   #9
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Originally Posted by ziggy29 View Post
As some others are saying, I don't think this is intended to put descendants on the hook for their parents nursing home bill in the general case, but they want to be able to broaden their search for asset transfers from parent to child and probably make it more difficult to play shell games to put the state on the hook for eldercare.
Gosh, I am greatly saddened that I have reached the point in my life where my view of government has declined to the point that I find the above line of thought to be extremely naive.

(Meant more as a reflection of my own thinking than as a critique of Ziggy's)
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Old 06-24-2012, 04:58 PM   #10
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Originally Posted by kcowan View Post
In the early 90s, MIL, mother of former wife, was committed to a home. Her son, a bank manager, had all her holdings transferred to he and his sister then applied to the government for social assistance.

I am pleased to see governments close such loopholes. She lived for 8 years in the facility at half price.

About 25 years ago an attorney one of my brothers knew had his mother transfer all her assets into his name so she could qualify for Medicaid. About 2 years later he died. So much for being a slippery attorney.
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Old 06-25-2012, 03:11 PM   #11
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Same former BIL transferred all the assets of his aunt to his personal account when she died, cutting out both my former wife and the aunt's sister. We discovered this when one of their statements showing investments of $1.8 million was discovered in the basement behind some tools in an alcove.

I presented it to wife and said it was up to her. She confronted him, and he refused to talk to her again for now 20 years and counting.
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Old 06-25-2012, 06:20 PM   #12
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I "think" I would exchange $1.8 million for not talking to my sister, so I'm afraid to say the BIL came out ahead. She should have gone after him for the money - with a vengance.

I'm fine with any laws intended to rout out fraud like your former BIL transferring assets to avoid the asset transfer restrictions of Medicare. However, absent such fraud to go after Medicare patients' children simply because they are able to pay crosses the line. Next they will go after siblings who are able to pay. Where would it stop?
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Old 06-25-2012, 09:48 PM   #13
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I haven't been able to find an online source, but I believe filial responsibility laws go back to the 19th century in the US. It's not like they were passed recently to deal with Medicaid fraud. (Even if that's how they are being used today.)

I remember a story in the local newspaper about the "County Home", which was operating 100 years ago. They pointed out that the county always looked for the children of the elderly before the county accepted responsibility. I took it that they had the legal ability to force the children to pay their parents' expenses.
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Old 06-25-2012, 09:50 PM   #14
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Interesting. Strange, but interesting.
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Old 06-25-2012, 09:51 PM   #15
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Things like paying for your kids' college, cars, weddings, etc., have been discussed in many threads here. Maybe the rationale of going after the kids for the parents' medicaid/nursing home expenses centers around that--if some parents hadn't paid for anything for their kids beyond age 18, and didn't pop for extras before that age like car insurance, camp, whatever, maybe those parents would have had enough to pay for extended care?
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Old 06-25-2012, 09:53 PM   #16
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Things like paying for your kids' college, cars, weddings, etc., have been discussed in many threads here. Maybe the rationale of going after the kids for the parents' medicaid/nursing home expenses centers around that--if parents didn't pay for anything for their kids beyond age 18, and didn't pop for extras before that age like car insurance, camp, whatever, maybe the parents would have had enough to pay for extended care?
Nah. We would've spent 90% of the "extra" on booze & parties, and we would have just wasted the rest...
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Old 06-25-2012, 09:55 PM   #17
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Nah. We would've spent 90% of the "extra" on booze & parties, and we would have just wasted the rest...
But at least it wouldn't have put the kids on the hook for the parents' nursing home costs!

Think of the bumper sticker possibilities:

"We're spending our nursing home budget!" instead of "We're spending our kids' inheritance."
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Old 06-25-2012, 09:57 PM   #18
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I guess that gives me an additional incentive to manage Mom's nestegg prudently.
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Old 06-25-2012, 11:10 PM   #19
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Things like paying for your kids' college, cars, weddings, etc., have been discussed in many threads here. Maybe the rationale of going after the kids for the parents' medicaid/nursing home expenses centers around that--if some parents hadn't paid for anything for their kids beyond age 18, and didn't pop for extras before that age like car insurance, camp, whatever, maybe those parents would have had enough to pay for extended care?
How 'bout the following rationale?

People who raised children at least have contributed into the labor force, meaning adding their offsprings to the pool of slaves workers who are now paying SS and Medicare taxes. They may be forgiven if are now penniless.

People who have no children, but are now broke... What's your excuse? Uh huh... Booze and partying... I thought so...

Just give them a shopping cart and throw them out of the nursing home!

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Old 06-25-2012, 11:39 PM   #20
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Next they will go after siblings who are able to pay. Where would it stop?
Old boyfriends?

Ha
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