Martha Mack, 93, of Keene, with her sculpture The Dancing Rabbis, is finding it difficult and expensive to provide the needed financial records to apply for long-term care Medicaid, even with the help of her grandson. (MEGHAN PIERCE/Union Leader Correspondent)
KEENE - For 93-year-old Martha Mack, navigating the application process for long-term home or community care Medicaid has been arduous and too expensive on her $1,000 a month Social Security income.
That inspired her grandson to push for changes to the process, which requires a five-year bank records check in an era when banks charge for such services.
Mack moved from Pembroke Pines, Fla., to live with her grandson, Todd Silberstein, in Keene in fall 2011. The lifelong artist and sculptor, originally from New York City, had lived in Florida for more than 30 years. Her daughter, Silberstein's mother, had lived with her for many years before she died in 2010.
Silberstein said he knew it was time to move his grandmother up to Keene after she had been conned out of money in a phone scam. She was also struggling to get by financially and having difficulty trying to apply for long-term care Medicaid on her own in Florida.
Since then, she has been living with Silberstein, his wife and their twin 5-year-olds.
"It's very nice. It's certainly better than being alone," Mack said. "The kids are just adorable. They call me Grandma Martha."
Silberstein and his wife both work full time, but Mack can take care of herself during the day.
When the family went on vacation without Mack in December though, Silberstein realized how expensive it would become if Mack were to need care. A relative was able to monitor Mack while the Silbersteins were away, but if they had to bring in outside help for her care it would have cost somewhere between $1,500 and $2,000 a week, he said.
"She doesn't have that kind of money, and we do all we can for her," Silberstein said. "But these are things that ultimately we recognized. Her care is going to be greater than we can provide. So we are trying to address those needs that we foresee."
Mack agrees. "I'm 93, something's going to happen."
Silberstein soon learned that to apply he would need 60 months' worth of bank records from any bank accounts that Mack has had in the past five years.
Because Mack shared some accounts with her daughter when they lived together, she has at least four bank accounts, Silberstein said. Mack has difficulty remembering.
"She's not able to tell me what banks she's had or what other records she has," he said.
He was shocked to learn there is a "huge disparity" in how banks release the records.
Wells Fargo charges $5 a month. Ameritrust charges $10 a page at roughly four pages per monthly statement. Northwest Savings charges $25 an hour. TD Bank does not charge for bank statement copies. Mack had accounts with all of these banks.
"The bank wants to charge me for the records, which I think is disgusting," Mack said.
Based on the fees set by the banks, Silberstein estimates it would cost about $1,500 for Mack to acquire all of her financial records for the past 60 months. She has no assets, he said.
Silberstein said he doesn't begrudge the banks charging a fee, but feels these fees are exorbitant.
"It's over 10 percent of her annual income," he said.
Federal Medicaid laws require the five-year asset check of those applying for long-term care or home community based care, said Joyce St. Onge, state Health and Human Services administrator of Program Operations for Division of Family Assistance, and Melody Braley, state Health and Human Services administrator for Field Operations for Clients Service.
While some states, like Massachusetts, prohibit banks from charging these fees to those seeking records to determine eligibility, New Hampshire has no law.
Braley said her department sometimes writes letters to life insurance companies on behalf of clients or issues letters for clients to give to banks. The letter states the person is applying for Medicaid benefits and is seeking financial records. The letter doesn't seem to make the process faster or cause banks to waive any fees, though, Braley said.
"The bank still has the final say," she said.
State Health and Human Services officials are bound to obey the federal mandate, and the state has no money to help cover the costs for seniors without the means, they said.
"We don't have any funds to cover the 60-month look back," Braley said. "It is a federal requirement to have that, and we can't make a found eligibility without that, so we tell them that it is needed."
St. Onge worked in client eligibility determination back in the 1980s when only 30 months of financial records were required, and banks charged no fees whatsoever for the service.
"The reason Congress did this, they were sort of pushed against the wall, because sheltering assets became big business in this country," St. Onge said.
The look back was first 30 months, then three years, and then in 2006, it was changed to five years.
When applying for regular Medicaid only the current financial history is required.
In the 60-month look back, Medicaid is looking for both monetary and property transfers.
If any assets were sheltered, the client would be subject to a transfer penalty that would affect benefits.
Recently Congress has been working to make electronic asset checks mandatory, but the law and, more importantly, the infrastructure is not there yet, St. Onge said.
This system, though, is only a few years away from being available and would take away the client's burden of seeking records from banks because the state Medicaid office could just do an online asset check.
"It will have a benefit for our clients once we are able to implement things, but the financial institutions don't like it," St. Onge said.
For now, Silberstein said he is contacting his state senators to ask that legislation be drafted to standardize how banks comply with New Hampshire's requirement to obtain financial statements. The service should be provided for free, he said.
"Our goal was never really just accomplish this for Martha. The frustration that I've had has really gone beyond that, and we really don't want anyone else to have deal with that. There could be some sort of legislation or rules that would govern what the banks could or should charge," Silberstein said.
Silberstein tried reaching out to the banks that charge and made pleas for reduced or free records because of the circumstances, but didn't get anywhere, he said.
"I have requested in writing from Wells Fargo the financial records, and they will not budge on the charges."
After he filed a complaint regarding Wells Fargo with the Consumer Finance Protection Board, he received a form letter that explained the policy, but didn't address Mack's situation, Silberstein said.
When contacted for comment, Wells Fargo media relations representative Emily A. Phillips said the fee covers the cost of printing and mailing the statements out. Customers that use online services have access to their records free of charge and can print them out themselves. She also said the Florida branch manager would like to help Mack obtain her records at no charge and asked to be put in contact with her by phone.
"We basically always tell our customers we are here to help them. and in special circumstances like this, we are always willing to help them," Phillips said.
A spokesperson for New York City Bank, which includes Ameritrust Bank, said if a customer requests bank statements for a Medicaid application, the fee is capped at $250. Branch managers have the ability to request a fee waiver or reduction of the $10 per page rate, the spokeperson said.
In an email, James G. Holding, vice president of communications of Northwest Savings Bank said he estimates it would only take half an hour for a bank employee to retrieve the records, which the bank would then likely prefer to email.
"Operations and in our local office tell me that they do indeed charge by time spent (not whole hour increments), and that they can't imagine the job would take more than half an hour tops. We'd prefer to email the images, which we store digitally, but we'd fax in a pinch. Overall? My experts figure $12.50 as a probable cost," he wrote. "The statements are accessible. We have personnel on duty. The ex-customer needs them. They're easy to send. We're not all hard-hearted."