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sacline Asked May 2012

My 85-year-old mother, currently in assisted living, is running out of money. How do I go about applying for assistance?

Mom has no assets .. only social security and a small pension.. less than 1500 per month total income...living cost currently is $2300 per month... Mom's needs increase everyday .. I have been moms caregiver for over 6 years. for 6 months mom has been is assisted living , but her savings is going to run out soon , I do not know what I will do....Please help , any advise as to where to get help...??

EXPERT Carol Bradley Bursack, CDSGF May 2012
It sounds to me like it's time to apply for Medicaid. If your mom's needs keep increasing, she may qualify for a nursing home, which would then be paid for by Medicaid (once she qualifies).
Since the qualification process for Medicaid takes time, I'd call social services soon and ask about the process in your state. Start gathering up paperwork - it's a process. You can also go to www.medicare.gov and follow the links for information of qualifying for Medicaid.
Good luck,
Carol

igloo572 May 2012
You can do it on your own....really. You kinda need to put on your best Nancy Drew and be organized. My mom's Medicaid application ran 100+ pages mainly due to her ancient insurance policies written to when they ran dz.'s of legal size pages long (My mom moved from IL to NH and bypassed the AL stage). Each state manages their Medicaid (a joint state & federal program) differently, so there is no 1 set paperwork for all. If her assets are only $ 1,500 a mo then she will pass financially for Medicaid assuming she doesn't have any cash value insurance or funeral policies - she will be an easy review too because her bank records should show a patterns of paying and depleting her assets to pay for her AL. Medicaid in general does NOT pay for AL.

However, the first ? is does mom's medical needs rise to the level that a NH is needed?. So much focus is on the financial side of qualifying for Medicaid but the "medical necessity" is needed to qualify.

Does her current AL have a NH and does the NH take Medicaid and are there beds available? Does her AL think she is at the level to need NH care? Imho you need to have a serious talk with the social worker at the AL to see what their take is on her and her abilities. If the AL thinks she works for them to move to NH then your problems are easily resolved and she moves from AL to NH side and goes in "medicaid pending". Doing Medicaid Pending is very VERY important - otherwise you may have to prepay or private pay for her NH till her application is approved. Could be 3 - 12 mos depending on your states backlog and if there are any glitches - this could be very VERY scary expensive. I prefer to speak with the social worker rather than admissions - admissions is going to in general push the longer stay at AL as AL is the profit center for a facility.

However, if the AL doesn't think she is medically necessary for NH then you kinda have 2 issues to deal with imho. 1. get her in a waiver program -If your state does a Medicaid AL waiver program (the state pays for her AL room & board) you can have her apply for that - my mom' state doesn't do one, Medicaid only pays for NH, so I have no experience on waivers. OR 2. get her medically qualified for NH - if her current AL wants to keep her as a resident and moved to the NH side then they can be immensely helpful in working the data needed for this. If the AL is free standing or is more for-profit motivated and not willing to work with you (e.g. they are thinking you or other family is going to private pay for mom @ the AL) , then you will have to find an MD who will provide the medical needed to have her qualify that will pass Medicaid review & then find a Medicaid pending NH to move her to.

What is the scenario for your mom and the AL she is in?

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sacline May 2012
Should I pay someone to apply or do it myself?

3pinkroses May 2012
If you have the time, do it yourself - it's really not too difficult. And I know lawyers who do it and charge a pretty penny. You can download the Medicaid application and after you review what is involved, decide from there. Hope things work out.

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