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Has anyone heard of a payback form that can be used to help get approval for Medicaid?

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Kimel - there is no “just 1 form & done” for anything Medicaid.

You, I assume, are mom’s POA & mom has filed for LTC Medicaid & is in a NH Medicaid Pending & you have gotten either a letter from the state or billing at the NH has said there’s a problem having her be “Pending”.
This is what I’m guessing is the drama, right?
If that’s it, you have to basically start putting together a forensic accounting of her past 5 years & get elder law atty. to advise process.
- ask her banks for 5 yrs of statements if you do not have these.
- find whatever monthly bills she had/has going back 5 years.
- tax bill for year it was sold. Probably not online.... so either you try to find it in her paperwork or go to tax collectors office for old bill.
- go online to County tax assessor records or Co. land records and pay for downloads on property sale. There likely will be 2 sale choices:
1. If an above board sale, buyer got a mortgage, so Warranty Deed will be filed & to the penny. So you’ll know who sold to, the date & $ amount to build back to. Mom has lived somewhere since house sold, she has bills, living costs, etc. You have to rebuild it.
If you can’t do this, there will be an elder law practice that has a forensic accountant they work with. PIA & $$$ but can be done.
BUT....
2. If sale was QCD (quit claim deed), it should indicate amount paid to her & hopefully close to that last tax collector bill, so you rebuild her expenses based on that amount
OR it was a QCD “gifted” Sale. If gifted, that poses a whole different set of issues for Medicaid eligibility for her..... you’re choices then are to either pay gifting / transfer penalty by private paying for her care till penalty time over OR hire an atty to get APS & police involved to file charges of taking advantage of a vulnerable adult against whomever got the property via a QCD for less than FMV. But you have to be willing - as her POA - to basically file a felony against whomever coerced mom out of home under FMV. If past AC posts hold, QCD often done with a mom “selling” property for zero to family member who has no intention of paying anything to get mom or grannie out of Medicaid transfer penalty hell.

If your NOT her DPOA already, then imo, your mom needs to be competent & cognitive enough to meet with atty to. do a DPOA to you & be able to go to bank and probably also get you on as a signatory on her bank accounts. And sign off on police report.
Can she do this?

If not, & not be sound harsh, you have to decide whether to front your own $$ to hire atty to seek guardianship for her OR let her become a ward of the state & let state appoint a guardian. Then state guardian works thru the beyond a hot mess of house sale.

If you haven’t personally signed a admissions agreement for NH &/or personally signed a financially responsible contract with NH, there isn’t much the NH can do to you easily. But if you did, they will attempt collections. Often for this situation family move elder out of NH ASAP & do at home care. She moves out with an outstanding bill & NH will turn it over to collections.

Whatever path you take, if she stays in NH, she MUST, again MUST, have her SS or other monthly income paid to NH. Usually NH will heavily suggest to be set up direct deposit with NH as her SSA representative payee or ACH draft from her checking account. Again her monthly income must go to NH less whatever is smallish personal needs allowance. PNA can be put into a facility based trust account for her to use to auto pay for things not covered by Medicaid, like for beauty shoppe.

Transfer penalty is a formula based on house FMV divided by state daily room & board Medicaid reimbursement. 200k house @ $195 day rate is 1,025 days penalty. Almost 3 yrs of private pay needed before Medicaid eligible.

There is no 1 & done option imho.
So whats the backstory on house sale?
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More information needed. Are you saying that your mother gave away the proceeds of her house sale, and that the donee can now pay it back again? How long ago? What has your mother spent that could be eligible for Medicaid 'spend down'? Records are important, but there may be other 'proof' options possible. You may need to get legal help if the situation is very complicated, but give and get some information here first. A 'form' isn't likely to solve your problem!
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Mom never deposited the money? If not, where did it go and how was it used? Did you add onto your home for her with the proceeds?

If we had more info, we may be able to point you in the right direction.
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You need to see an eldercare attorney.
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More info please. When the home was sold where did the money go? If the money is in the bank, it needs to be spent on the person's care until they run out of money. At that point they can be supported with taxpayer money. I have said before I am more than willing to pay taxes for the care when they have no money, otherwise..... An attorney is a good idea.
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Thanks for all the replies. We are now working with an elder attorney.
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