QUESTIONS & ANSWERS

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AThe Medicaid penalty period does not work that way. A Medicaid penalty period will not begin until the person making the transfer has (1) moved to a nursing home, (2) spent down to the asset limit for Medicaid eligibility, (3) applied for Medicaid coverage, and (4) been approved for coverage but for the transfer. In other words, the penalty period does not begin until the nursing home resident is in the nursing home and out of funds. For example, if an individual in a state where the average cost of care is $5,000 a month transfers $100,000 on April 1, 2013, moves to a nursing home on April 1, 2014, and spends down to Medicaid eligibility on April 1, 2015, that is when the 20-month penalty period will begin, and it will not end until December 1, 2016.

AHow long Medicaid has to recoup benefits from the estate of a Medicaid recipient depends entirely on the rules of the particular state. For example, here’s how it works in Massachusetts: When you probate the estate you have to give the Medicaid department notice. The Medicaid department then has a certain number of months to file a claim. But the time period does not begin to run until you give them notice. This is entirely different from most creditors, who have a year from the date of death to file a claim. You will have to do online research or consult with a local probate attorney to learn the rule in your state.

ABased on the information you provide, your mother may well have grounds for appeal. The facility should have provided her with a Notice of Non-Coverage prior to terminating Medicare. They may have and your mother may not have known what it was or what to do with it. Ask for a copy and information about whether and how it was given to your mother. It will give you information on how to contact the Quality Improvement Organization for your region, which monitors these issues and appeals. You are too late for an expedited appeal but I’d be surprised if you can’t appeal at all. It sounds like you have one or two issues to argue on appeal: potentially lack of adequate notice, and certainly based on what you say whether your mother should have been terminated prior to the full 100 days.

AIf the house is owned jointly, then half of the proceeds will go to your dad. This will likely make him ineligible for Medicaid until the funds are spent down. The other half of the proceeds would go to your mom, which she can use to purchase a house. Spouses are allowed to retain some assets — called a community spouse resource allowance — but the amount varies, depending on the state. In general, the community spouse may keep one-half of the couple’s total “countable” assets up to a maximum of $119,220 (in 2015). The least that a state may allow a community spouse to retain is $23,844 (in 2015).

A It depends on the type of bill. Payments for medical, dental, and tuition are not subject to federal gift tax laws. But if you are paying other bills, you will be subject to the laws. This means that if you give away $14,000 or less to any one individual, you do not have to report the gift or gifts to the IRS. If you are married and file jointly, then you can give a total of $28,000. If you give away more than $14,000 to any one person, however, you will have to file a Form 709, the gift tax return. But just because you file a Form 709 doesn’t mean you necessarily have to pay taxes. The IRS allows you to give away a total of $5.43 million during your lifetime before a gift tax is owed (this is the threshold as of 2015).