Make Medicaid Easier – Prohibited Payments

Today we have another entry in my Making Medicaid Easier series. I write these for a couple reasons. First, I want to give you some practical tips. I also want to point out some common landmines to avoid. Next, we look at expenses because paying some expenses can actually create a eligibility penalty.

Our Medicaid regulations provide a list of certain services that an Applicant cannot pay a family member for. If the Applicant does, the HHSC can impose a Medicaid penalty. In addition to the Applicant, the prohibition extends to the Applicant’s spouse.

The general standard the HHSC uses is to impose a penalty if you pay a family member for services they would “normally” (in the government’s opinion) provide.

Avoid These Penalty Payments

That can be a little vague. As a result, the HHSC did include some specific examples of items that may cause a problem if they show up in your loved one’s Montgomery County nursing home Medicaid application. These examples are:

  1. house painting;
  2. house repairs;
  3. mowing lawns;
  4. grocery shopping;
  5. cleaning;
  6. laundry;
  7. preparing meals;
  8. transportation to medical care.

Steer clear of withdrawals to family members for these expenses during the look-back period. They will trigger extra scrutiny from the HHSC. Not only will they create additional scrutiny, they will also cause a likely penalty.

Does this mean a Medicaid applicant or their spouse can never pay a family member for any services they may provide? It seems like that, but with the proper steps there are some ways to pay family members for the valuable assistance they provide.

Check with your Woodlands Nursing Home Medicaid attorney to discuss your options.

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