Ok, we talked to SIL and did some more digging and here's what happened. She went to the nursing home in mid-January of last year in a self-pay situation. The home asked her how she would like to pay, and SIL said she'd like to set up monthly auto-pay by credit card. (She's in the habit of paying her bills that way; she physically can't write a check). She paid $9000 a month by card for six months from January through July, spending down her assets. Her assets were exhausted in July and she qualified for Medicaid August 1. There was no pressure or double-dipping on the part of the nursing home. The remaining balance on her card is for part of July.
SIL didn't ask for help at the time she was setting up the payment method with the nursing home. In hindsight, yes we could have helped her stop the auto payments to the home as her assets depeleted, and helped ensure she wasn't incurring a debt she couldn't pay. And in hindsight yes, we would have preferred that the finance office at the home had sat down with SIL and explained all this, but they're a business and as far as I know they're not legally required to do that. I'm sure they've found over the years that the last month before the Medicaid transition is tricky to get payment for, and it's best if they get paid from the credit card company and let the resident's family sort it out. :/
SIL is thinking over what she wants to do -- try to keep her credit card 'alive' by setting up a minimum payment plan, or trying to work out a deal with the credit card company that would involve closing the card. The only piece to the whole puzzle that we don't know is if SIL would need a good credit score for some reason in the future that we're not thinking of, like if we were to move her to another facility. I don't
think she does, but we're not completely sure.
ETA: Oh f*k, I think you're right
@lutorm!
Thank you for pointing that out. If debt forgiveness by the credit card company is taxable income that would mess things up for sure for SIL. Welp, back to the drawing board to figure out that new wrinkle. My back-of-the-envelope math is that could boot her off Medicaid for three or four months. Gah. This goes hand in hand with
@hooplady's comment above about family members paying the bill, and THAT being considered income. In the case of the monthly minimum credit card payment (~$100) hopefully that's not enough to jeopardize her Medicaid eligibility, but I'll check into that too.
@yachi is right that nursing home care is so expensive that it can ruin almost any budget, even Fat Fire. Even if you have long term care insurance coverage for it it's no picnic. A good friend of mine is dealing with that right now, with her dad in a nursing home.