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So, I'm thinking ahead to the possibility that mom may need a nursing home. But I'm scared because, having approximately 2200/month in income, she'll make too much to qualify for Medicaid. What kind of nursing home is even an option for people with just above the Medicaid mark? Will this mean we have to have her live with us eventually? I hope this makes sense. This is her social security, plus my dad's pension of approximately $900-1000/month.

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My Mom had a Fed. Gov't monthly annuity pension which was above the Medicaid limit allowed. However, her income was not nearly enough to cover cost of being in the nursing home (she paid privately from savings - no Medicare Part B - until "destitute". Pretty sad!) Anyway, the way Medicaid handled the situation was that she had to be below $2,000 in total assets (Oregon) and I had to go through an elder attorney to have an "Income Trust Account" set up with her bank. I had her POA, and was in "charge" of her care, so I was the "Trustee". Her Fed annuity was deposited as usual every month into her regular checking account, but then I had to transfer a stipulated/calculated amount (actually most or all of the payment) into the Income Trust account. Medicaid calculated the outgoing expenses and directed me how much to pay the Nursing Home each month from the fund. Mom was allowed to keep $60/month for "expenses", and I was paid $50/month for administrating accounts. The amount I paid to the nursing home - basically her annuity payment amount - was then applied toward the monthly nursing home fees, and Medicaid covered the balance not covered. The bottom line was that even though she had an income above the allowed limit, she could still be on Medicaid because they took that money toward her costs.
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Also your concern of too much $ for LTC Medicaid is very justified. & it’s not just your mom that needs be concerned abt how to deal with this.

Maximum SS can pay is $2,788 a mo for 2019.
There’s a ton of baby boomers who are now 70+ and getting SS max.
Unless you have seriously planned and set aside 300k+ just for private pay (not for living costs till then) when they eventually need LTC care in a facility, they are going to be over the financial income max for LTC Medicaid. And there won’t be kids for them to move in with. There’s an oncoming tsunami of boomers who will be in this dilemma. Aging in America will not be pretty. It’s important to vote for those supportive of social service programs like Medicaid.
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You need to find out the exact maximum monthly income amount for LTC Medicaid for your mom’s state and then look at your mom’s “Awards” letters to see exactly where she is for monthly income.

The awards letters are super important AND right about now (Oct/Nov) is the season that SS, civil service/federal retirement and most pensions send out the awards letters for 2019 that state to the penny what their income will be. My hubs is past his FRA and gets SS and his came in last week.

If Miller isn’t an option for your state (this you can Google easily to find out) then she probably can do a Medicaid compliant SNT (the state as the beneficiary) to get her monthly income under Medicaid max. To me, neither of these are DIY but need elder law attorney to draw up.

Couple of other things to keep in mind:
- there is a whole stack of documents required to accompany her LTC Medicaid application. Just what depends on your state. All the NHs we visited who had Medicaid beds had a printed list of the documents needed. The list can vary by NH - even in the same state - as the NH likely has their own system to review the documents to determine IF they (the NH) will take her in as a “Medicaid Pending” resident. Go and visit a couple of NH and get their list so you can start to pull stuff together. If your mom has several bank accounts get them consolidated into 1 account with you as a signatory with online access and have it POD to you before this year ends.

If she has a home, talk with her about whether to sell it or have her continue to own it as an allowed exempt asset. If she keeps it, realize that due to Medicaid copay requirement all property costs will need to be paid by you or other family and after her death there will be Medicaid’s Estate Recovery (MERP) to deal with.

AND please please PLEASE stay aware that Medicaid is an “at need” program BOTH financially and medically.
She has to clearly show to be “at need” for skilled nursing care aka care in a NH. Unless she lives in a state in which Medicaid will pay for AL or MC. Just being old, or iffy on her ADLs or needing medication management will not be enough to show to be at need for skilled nursing care in a NH. Often for those living still in their home or in IL there flat is not the fat health chart that shows them to be at need. Think if this could be the situation for your mom.

Theres such emphasis on $ and spend down, but being medically “at need” is just as important. In a way it’s more involved to get thru unless she gets hospitalized (Medicare) and then is discharged to a SNF for post hospitalization rehab (Medicare up to 100 days if qualified) and then it’s determined after she ceases to progress in rehab that she is at need for skilled nursing & this is when she applies for LTC Medicaid. This is the route most enter into a NH & it’s after a fall with hip break.
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Your best bet is to meet with an elder care attorney and find out how to legally go about looking at your options and then finding places that have openings and/ or getting on lists for when rooms become available. There are ways to qualify for Medicaid depending on where the elders assets are and rules do vary by state. Most states have a 5 year look back period. This is put in place for people who who think they can liquidate their bank accounts and let the state pick up the tabs. As I mentioned before, there are ways to legally use Medicaid even if you have some assets.
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Rules vary state to state.  But have you looked into a Miller Trust?
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rocketjcat Oct 2018
Not all states allow have income caps or allow Miller trusts. She needs to do some more research regarding her own state.
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No. Is that the best plan? A caseworker? And thank you.
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JoAnn29 Oct 2018
Yes, you need to set up an appt. with a Medicaid caseworker.
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The Medicaid rules vary by state. My Mom in NY had no problem qualifying for Nursing Home Medicaid and her Pension plus SS totals $3400/ month. No other assets. All of it (minus $60) goes to the NH as her share of cost. Have you actually talked to a caseworker?
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