What do I do in the event that my mother out lives her money and therefore needs Medicaid?

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Mom is 94, her money will run out about a year from now; she has Medicare and the help of secondary insurance for her medical expenses and spends her savings for private care in a residential care home now. When the money runs out and she has to go to an actual rest home, I want to make the transition for being cared for, a kind one and have my ducks in a row. How can I find/talk to someone kind hearted to help me with her case. I need someone to sit down with me and help me get things ready. Mom is doing so well she will probably live longer than originally expected which means her money will run out.

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Contact your local long-term care ombudsman. They can help with the transition and have no "interest" in any particular facility. You can find this person on your stage website or at http://www.ltcombudsman.org/.
Carol
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Contact the assisted care facility to see if they have a social worker on staff. It's their job - and your mom is PAYING for this service - to help with transitions like this. They can help you plan ahead; they may know the regulations in your state concerning medicaide and, who knows, she may be able to stay there while she's on medicaide - provided they'll accept it as payment. Some assisted living centers DO accept it but residents are required to share rooms.

You might also talk with an admissions director at a nursing home that you prefer. Your local Area Agency on Aging might also be a good resource. They should be aware of state regulations for medicaide as well. Based on my own experience I'd urge you to ask a LOT of questions and don't consider any question dumb or goofy. It's complicated, each state is different; don't let anyone treat you life you're a pain in the rear!! You're trying to help your Mom, you're her advocate so give them all a huge pain - sometimes it's the ONLY way to get people to do the right thing.

From my own experience here's a quick run down:
There's a financial limit - 2000-2500 in most states, that's the last cash she can have left. The state may ask about valuables like cars, art, antiques or jewelry but generally won't force the sale of those things until after she passes away. They may expect that you to sell such articles to liquidate her estate THEN repay them the proceeds.

Once she's on medicaide, there may be an annual requirement that she's RE-CERTIFIED for medicaide. Usually it means they send a letter asking if you still need it; ensuring that she hasn't come in to any money or sold any physical assets like a house.

Her supplemental insurance may drop her. Be prepared for her supplemental insurance company to drop her coverage when she goes on medicaide. I've spent the past year trying to get medicare part D for my mom to pay for the prescription deductibles from her supplemental insurance. They kept accepting her then cancelling because they said her supplemental insurance was better than medicare part D prescription coverage. It's a safe guard to ensure people aren't over covered but it's a pain in this case. Finally, she got dropped by the supplemental plan and the part D wet through okay.
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Lynn's post is spot-on. I'd like to add to it, this will be a bit long.......

I just moved my mom (mid 90's) from IL apt to LTC in Jan and applied for Medicaid. She was in IL for 3 years and before that was in her home living solo. I am an only child, live states away. I have been executrix for other family members and have done Medicaid for my MIL & "aunt". Here's my insight on all this:

There are 2 facets to Medicaid: medical & financial. She has to qualify for both in order for the NH/LTC to get paid.

Just being old and having dementia is NOT enough to qualify medically. If mom
is in good shape and doing well but really can't live on her own - which sounds like her case - then you need to work with her doctor to have her on medications or other items that will qualify her for medical necessity and show that she cannot take/do for herself. What happened for us is that mom refused to take some of her Rx's. So when she went into LTC she came in with minimal medications and therefore minimal skilled nursing needs. She got rejected -- now her MD is the medical director for the facility and we were able to get this resolved pretty easily but still! My point is you have time to get "medical necessity" worked out.

Financial: First determine what the Medicaid ceiling is for the state she lives in.

Then figure out what her income is a month - she get's SS but does she also get an annuity or other retirement? Everything needs to be added up. One thing to remember, the monthly asset amount that Medicaid looks for is the overall amount she gets a month BEFORE any insurance is deducted. For example, my mom gets an annuity in addition to SS. Her annuity is around $ 1,200 a month but $ 200 a month goes to pay for a secondary insurance. The insurance is taken out before she get's her money. So she only gets $ 1,000 a month to have to spend BUT for Medicaid asset it is $ 1,200. The same thing happens with SS as they take out for Medicare from the monthly.

If she still has investments or savings, then figure out what the value is of those.
Those will need to be spent down in order to get her qualified. The spend down needs to be for her or if she still has a homestead, spent on the home. If she does not have a burial/funeral policy, this is an easy way to spend down a good chunk of money. It needs to irrevocable - so that there is no cash value. Spend down is good to use for hearing aids, glasses, "Hugo" style walkers/chairs. Dental work too - as this is very expensive and few DDS's take Medicaid. My mom was bad about dental care and needed 2 implants and gum work done - all in all about 5K.
There again was another good chunk of spend-down.

If she still has a home and you don't plan on selling it and letting it be subject to MERP (Medicaid estate recovery program), you can prepay for utilities, cable, taxes, etc as long as it is her home and she "wants to return". If she has a home, it must be valued at under 500K. If it is over that she will not qualify for Medicaid. Alot of elderly bought their homes in the 40's, 50's 60's and the value may have escalated in the go-go real estate of the 2000-2005 but they are unaware as their property tax is frozen since their over 65. So say mom's house bought in 1960 for
40K is now apprised at $ 550K but it is frozen at whatever was the property tax when she turned 65. Now she won't qualify as the home is valued at over 500K. So this is something to be aware of if she still has a home

Now when you tally up her monthly assets is it under her state's ceiling?

If yes, then you can start to do a notebook on what you'll need to get together paperwork wise for applying for Medicaid.

If not, and even if you spend-down all her savings, investments, etc. she is still over the ceiling then you need to see a elder care attorney. For example, one of my aunts had a railroad retirement - RR pays really, really well, who knew!
So no matter what she was always going to be at least $ 800 a month over the state ceiling. Too much to qualify for Medicaid but too little to pay for the NH. We
did a "Miller Trust" for her and she was able to qualify. These are sticky and you need an elder care attorney to do it for you all. It is very state specific. In essense what it is, is a trust that all the extra money goes into that cannot be touched until after her death and it ALL goes to the state. It enables her to qualify for Medicaid as it reduces her income to whatever is the state maximum. The trust is set up so that it is flexible - if her retirement increases due to a federal cost-of-living increase, then the trust does too. You don't need to reapply, it legally is set up to do this. Again an attorney is a must for this.

OK let's say she is looking like her money is going to be only at whatever she makes a month & will be under a state ceiling of $ 2,000.00 in December, 2011.
IMHO you really have 3 ways to get her into the NH/LTC, either 1. you get her in now as a private pay NH that takes Medicaid and have her apply a "medicaid pending" when she runs out of money or 2) you keep her in her current IL or AL
and have her run out of money there and you pay the difference for a couple of months so she totally qualifies under the Medicaid ceiling lookback for 90 days,
or 3) get her admitted to the hospital Nov/Dec and from there she gets discharged to a NH, where they accept her under those Medicare payment guidelines for whatever # of days while you apply for Medicaid - if she has a chronic disease then this could work.

Many NH want to see a 90 day review on assets in order to have her admitted as "Medicaid pending". Medicaid pending is really important in that you will not have to pay for the difference in private pay and Medicaid while her application is being reviewed. Most states require the initial review to be done within 45 days but
if there is a glitch it can take months to resolve, you do not want to have to pay the private pay difference if you can help it. For example, say mom gets $ 1,800 a month from SS and her annuity. Her NH is $ 4,000 a month. Under medicaid pending, they accept getting her $ 1,800 a month less her $ 30 - 60 a month for personal use. But if they do not take medicaid pending, you will need to pay
the @ 2,200 a month difference for her to be admitted.

Medicaid has a pretty big amount of paperwork required. Each state and each NH is kinda different. My mom's LTC had a preprinted list of 20 items, my MIL had a 2 page list with almost 50 items - both are in the same state.

Here's what the NH/LTC wanted in order to get in Medicaid pending and start the Medicaid application:
3 months of all banking and financial statements. All banks front & back.
for my MIL then wanted 6 months.
a letter from each bank as to the deposition of any and all account closed within
the last 3 years. For example, on 6/10/09 CD # 1234 deposited into Mrs. XYZ's
primary checking account # 5678. This takes time, so if you don't have a
relationship with a bank officer start one. Also you will need to have one as
there will be something that comes up and you want them to know you.
EOY SS statement - this get's sent out every January.
EOY retirement/annuity form
EOY brokerage accounts & broker name & when accounts closed and disposition
of the accounts. Again, "XYZ accounts # 899 closed with wire deposit to
ABC bank account 457 belonging to Mrs XYZ on 12/2/08."
citizenship - proof for my mom but not asked for my MIL.
current property taxes with ownership clear. If home is in a "Mrs" format then
you will need a copy of "Mr" death certificate and their marriage one too.
burial documents
funeral pre-pay documents - all pages. This need to show no cash value. If there
is a cash-out option then it either needs to be changed to NCV or cashed out
to pay for her care as it is an asset. Bummer if that is the case.
(Some HN require that if funeral/burial paperwork is not already done, be done in within 30 days of admission)
insurance policies - all pages. This needs to show no cash-out can be done.
I had to sent copies of all pages front & back, 20+ pages.
DPOA
MPOA
AD/DNR - Advance directives & Do Not Resusitate orders -.
Oil & gas leases - for my mom i just checked none, for MIL we had to do a
notarized form. This is Texas so this is quite common for folks to own. My
aunt had leases - a total PIA to deal with in probate.
Medicare care any other insurance cards - front & back
drug / prescription cards - front & back
any VA information - this takes time as VA moves glacially. I think they all can
qualify for an aid & attendance of $ 60 -90 month. The NH is going to want
this money.
I know if seems like alot but just think how organized you'll be and not in a frenzy when you have to deal with funeral/burial/death.

Other financial:
I'm assuming that all her banking is totally her's and there is NO co-mingling of accounts. This is tres important. You can be a signer on her accounts, and as DPOA you want to be but all the income in it must be 100% hers and used for her needs. They look back can be up to 5 years so if you are using it for anything for you then stop doing it. Medicaid will notice and you will have ? on this.

For example, in 2007, my mom needed a new water heater. House is OLD and historic so everything is vintage.......long story short. I on-lined got a water heater at Lowe's thru my commercial account. Their plumber found other items that needed to be done as the wash room connectors were not at code but circa 1960. All in all over $ 2K to get a new WH. Now I paid Lowe's and my mom reinbursed for it. I had to show the caseworker why. My point is you want to pay attention to any large amounts mom has spent and be able to justify to the caseworker that it relates to her care or her property and not for your or other family members gain.

Be patient. The caseworkers get paid really low wages and the more paperwork you provide the better it is for them. Anything that is different will set off a rejection for further review unless they can easily figure it out.

Also you will sign off a waiver that they can look into any and all accounts that are tied to mom's SS # and name, so you want everything to be accurate.

If she gets rejected for medical reasons, the NH/LTC will work that one out. The financial rejections are for the family, guardian or POA's to figure out.
Good luck and keep a sense of humor through it!
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Congratulations, Robin, and getting started on this in advance of need. You can see it is a Big Deal and it is better not to have to do it under the stress of a time crunch. I think you should start talking to the administrator where your mom is now. Many care centers cannot offer the level of care they do for the amount of money Medicaid pays. But some have figured out how many full-paying residents and Medicaid residents they can accept so it averages out. They take up to "x" Medicaid residents. Usually the reserve those spots for when private-pay residents run out of money. If your residential center is very small they may not be able to do this, but the first thing to do is to find out where you stand in that regard.

Good luck to you. I know it looks overwhelming, but getting an early start is on your side.
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Just to add one thing the name and number of the ombudsman should be in a general area of the facility she is in now. Also have the social worker where she is start the medicaide process it is very extensive and the social worker will know the in and outs of it or if you can use your mother's money to go to see an elder lawyer in your area -he or she will be able to help you-I tried to do it alone until one day I lost it while in the social worker's office and she got on the phone and got a lot of it done for me. You are very smart to realize this needs to be done and to start now-most people wait too long and it really becomes a hassel.
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You don't say much about your home situation, but would it be possible for her to come stay with you for a while? This wouldn't necessarily be forever, just time enough for every to get their ducks in a row and figure out what to do without so much pressure........not sure about what other home responsibilities you have!! Let me know what's going on----I'm in a similar situation, and I really do care:)
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Thank you so much for ALL that!!!! keep a copy of it so you don't have to re-write it for another person. It'll take me what feels like for ever to understand all you've experienced. I'm way to stressed out just reading all the details WHO EVER IMAGINED THAT TAKING CARE OF MOM WOULD EVER BE SO HARD!!!
Thank you again and may God bless you for sending that info to me.
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I'm on vacation now but will be in touch with you again when I get started.

Thanks again so very much!
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