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Mom is in a skilled nursing center in Michigan and on Medicaid. She has been on Medicaid for more than five years. She receives Social Security and pays all but $60 a month to her care. She has no other bills so her account accrues the $60 every month and is now over the limit by $500. Her son, my husband, is her DPA. I do all of her laundry and take her to her appointments and handle her paperwork. We need to get her balance below $2000 and keep it there. Any thoughts?

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Consider purchasing some kind of a prepaid funeral plan. Start with the $2,500 in her account now and then see if you can add the $60 each month to the account.
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Why isn't she spending her $60? Doesn't she have her hair done, order a pizza once in a while, buy cards to send to the grandkids? The way to keep the balance under the limit, it seems to me, is to encourage her to spend $10 to $15 on herself each week. My mom's nh took residents who wanted to go to Walmart once a month. Mom bought a blouse or a little plant or lipstick or nail polish or warm slippers, etc. etc. She had her hair done regularly at the on-site beauty parlor. My sister watched her balance and never let it get too high. If it approached going over the limit we discussed what to buy mom with the excess. Seems to me it was usually shoes or wardrobe items.

How can you get it under the limit now? As long as the money is spent on Mom, just about anything goes. Does she have a pre-paid funeral arrangement? Would it be good to increase that a bit? Would she like a more deluxe wheelchair than the facility provides? How about a wardrobe update? (Maybe replace all the things that the laundry has shrunk with nice pre-shrunk items.) Get a nice birdfeeding station to put outside her window.
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Yes, its a personal needs account (PNA). If you buy her clothes, take in the receipt and get reimbursed. She likes certain toiletries, food, candy. Buy it and get reimbursed. New shoes, housecoat. I would start thinking of things before Medicaid does their audit.
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I think you can create a Millers Trust acct. Seek a CERTIFIED elderlaw attorney for advice. It is going to be expensive but the lawyer will draw up a road map for you.
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$2 a day... that's a newspaper and a cup of reasonably nice coffee, isn't it? I like all of the ideas for little treats - encourage your mother to pamper herself :)

If her dementia makes her unable to pick anything out for herself at all, it is still fine to spend her money on things for her. And they can be as fun and frivolous as you think she will like.
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jeannegibbs May 2018
Um, no, CM, sadly $2 will not buy both coffee and a newspaper. But a newspaper subscription is a good thing to spend some money on. And a fancy coffee once in a while would appeal to many. Or a milkshake (not daily, of course).
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New eyeglasses? A housecoat? Anything that may brighten her day and outlook. Then do something nice for her monthly. A magazine subscription?
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After you’ve spent what money you can on her (all of the ideas given so far are excellent), if her account still goes over the limit, why not talk with the SNF. Could there be a combination pay where the excess goes to them and the rest is made up with Medicare/Medicaid? Or, if the things you do for your mother put you in a financial bind, I’ve seen discussions in this group about paying/reimbursing yourself as a care-giver. I don’t know how that works while the person you are caring for is receiving Medicaid, but I’m sure there are experts who could help. Perhaps st the SNF, or your area agency on aging, or, if all else fails, an attorney. Wishing you the best as you help provide this care for your mother. It is s complex and complicated journey.
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shakingdustoff, I know you were speaking toungue in cheek, but please don't give tax advice. You can't send some one a gift and "write it off your taxes"
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Especially not if they are on Medicaid.

Buy special treats for your mom, get her new clothes, new teeth, glasses or whatever she needs.

Do not pay more to the facility, use if for mom.
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Get her hair done each month. Since she has so much excess built up right now the new wardrobe sounds like an excellent idea. How about getting her flowers occasionally. My Mom's home charges a monthly fee for TV in the room. Would she enjoy her own TV? Does she have room for a lift chair/comfortable chair in her room? Possibly get that for her.
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Obviously we all could spend that money quickly. I believe the OP was asking what the excess can be spent on legally without Medicaid getting their shorts in a bunch. It was a legit question since Medicaid is watching every penny spent out of moms accounts and the yearly renewal catches all balances and large expenditures. As long as receipts are kept just in case, good advice has been given.
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Geez, just one more thing to worry about! Give me a break!
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Does your mom have a burial account? There are burial expenses that are part of the funeral home expenses...flowers, food, etc and mom could have up to $1500 in a burial account that can only be accessed with her death certificate (so not counted as an asset).
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I think the idea of contributing to a prepaid funeral plan is a good one unless there are other needs or wants that this money can help to meet. There's probably no need to "fritter" most of it away on stuff your mother couldn't care less about. Of course the OP knows what her mental and physical abilities are, and thus what things would be appropriate.
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If she does jigsaw puzzles, buy some nice ones at her skill level, that she can contribute to the activity room when she is done with them.
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I've also experienced this issue. What about a Fruit of the Month club? May sound silly but I think you can set them up to varying schedules and she can often be surprised by wonderful fresh fruit. Otherwise, if possible, work with caregivers to notify you of what clothing, toiletries are needed every month.
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Five years on medicaid and this issue is just now coming up? Did her social security inch its way up until there was a small excess?
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While I agree with the suggestions for paying the funeral/burial plan, we had to do this before applying for Medicaid & perhaps others do as well? Not sure. Anyway, with the small amount allowed to be spent ($50/mo in my state), we have done the following: postage for her stuff as needed, new underwear, salon, fax fees for her stuff, long distance phone calls pertaining to her care, she occasionally asks money to be sent to her church, new slippers, new socks, etc. Also, I don't know if your loved one can leave the facility for any length of time, but mine goes on day trips & these trips are an additional small fee - which we use the $50/mo to cover. You're probably having trouble spending this money because many families cover these incidentals themselves & they don't spend the person's money & then it accumulates.
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Careful with medicaid! I bought my mom flowers, candy, cookies she likes, fresh fruit, etc. & medicaid refused to let her reimburse me with money they ALLOW her to have in her bank account. They said she is provided with everything she needs by the nursing home & is not allowed to spend HER OWN MONEY on non-necessities for herself. I am thoroughly disgusted that she can't use the money they allow her to have little extras she wants.
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Our elder law attorney and the business office at the SNF, said that money can be used to buy presents for grandkids birthdays, or Christmas gifts, what Dad would have done. Dad gets a haircut every month, he can buy ice cream for himself or fresh fruit. These are things the POA should be doing so the amount stays under the allowed amount. Prepaid funeral plans, clothing, slippers, shoes, a new TV for his room, a new recliner for his room, a new jacket or coat, the POA can buy food for Dad to haveat a family party at the SNF, pizza, cake, whatever is allowed in the nursing home.
Our Dad is still pretty aware of a lot of things, so we can ask him what he would like to buy for himself, or what he would like to buy as gifts for birthdays.
I would check in your state Medicaid system, but this what the information the elder law attorney gave us. My Dad will get 70$ from VA and $50 to keep from Medicaid. The atty. said never let that get above $2000, or he won’t get Medicaid approval for that month.
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I would just go shopping for clothing, shoes; anything she might need, to bring her balance down below the $2000. limit. I used to do that for my Mom all the time, and she enjoyed the things I brought her. It doesn't take long to spend $60 in today's market.
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