My mom just entered a nursing home. Is there anything I should know about applying for Medicaid?

I've gone through Medicaid for my mom and still deal with as her state (TX) does an annual recertification with documentation. Helped DH with his mom's in LA and then somewhat less for MIL when she went into NH in TX after hurricane Katrina.

What I've found is that although Medicaid runs under federal guidelines each state manages the program under their own rules. How detailed of an application review really depends on your state and the NH. Your state should have a on-line list of the required documents needed for her NH Medicaid application. Start getting all those things together now. What you are missing you will have to send letters off to get - all this takes time. Some states are requiring citizenship documentation - like birth certificate or naturalization papers. Be organized as you may be asked for the same documents again.

For mom & MIL both in TX but each NH had a slightly different list of things they wanted to see in order to accept her "Medicaid Pending". My mom's NH just looked at the documents (over 100 pages) and really only in detail on her banking statements - my mom was in IL before NH & still owned her home so her assets clearly showed a pattern of being depleated to pay for IL & house stuff - so mom was good for them. The NH (vendor program - like E mentioned) then sent my mom's packet with their bill to the state assigned to their NH caseworker. The caseworker was very helpful but they are working on strict rules and time constraints. He had like 15 minutes to do the review so if you are missing something (like copy of insurance policy or last year tax assessor form if they still have a home, etc), then it goes into a "documentation not provided pile" and you have to get whatever to them asap or they will be declined. For my mom it was whether or not her insurance policy was whole life or term. Got a broker the next day with a TX insurance license to do a letter stating it was "term" then faxed it over so that problem solved. Also I had to provide a notarized on letterhead letter from my mom's bank as to the disposition of each account, CD or T bill closed out within 3 years and 6 months. That was a full morning at her bank and fortunaelty each one at closing or non-renewal went into her drawing account, so she was good there. But it could have gone badly if one of them had turn to a cash out. Then a couple of months later I got a transfer inquiry letter regarding a car my mom gave to worthless nephew almost 5 years prior.It was imho way under 2k in value so I didn't think about it and it was ages before. But inquiry letter sent to me. So i had to get the BLue book value on that lowered so that it was right underneath her allowed asset - that took several days to do but got it done. She got approved almost 5 months 2 weeks from application / admission date into NH. She was Medicaid Pending and so did a co-pay each month of all her income to the NH less the state of TX personal needs allowance of $ 60.00 a month.

All states require a co-pay of their income. So if your mom has debt or things to pay each month (life insurance policy, mortgage, other house costs) realistically there will be NO money for her to do that anymore. the personal needs allowance is $ that they can use for their needs each month - like phone, cable, hair salon. Ask the NH just how they deal with this - it is often called a "resident trust". Some NH will strongly lean on you to have it placed at the NH, but legally you do not have to.

For my MIL application in LA it was all about missing bank statements and then she had too much $ in the bank and was over the 2K in assets - so did a simple spend down on eyeglasses and other health care stuff. Louisiana was easy and the NH she was in had several open beds so they wanted her there so they were OK on the spend-down & wait for approval. BUT for when she applied in TX, they were wanting documentation on checks she wrote to caregivers, what did she do with a withdrawal for $ 60.00 very detailed PIA stuff...and she died before even being accepted on Medicaid. SIL rode it out and she got accepted maybe 3 months after she died.

In general I think they are looking for patterns of spending. So if mom had 90K in savings 3 years ago and has been living for free with family and now has only 2K in assets, then someone will have to account for just where the money was spent. But if she had 15K in savings, then it makes sense that she now has 2K in assets.

There are some set rules: income has to be under whatever your state has set; assets have to be under 2K; anything with cash or other value (excluding their home & 1 car) that takes them over the 2K asset limit has to be either cashed in or spent down. Personally, I think that since the caseworker is local, they have a good feel for what the person's financials are. If they still have a home or had a home, they look at the zipcode. Some zipcodes are just viewed as wealthy and if the house is in that zone, then a bit more scrutiny is done on the application. That is what I suspect for my mom having an advanced review that went back 5 years.

The only thing I have heard of that is under the radar for Medicaid review is oil & gas income which I bet is because they are hard to ferret out ownership due to % issues & how they are recorded & paid. Good luck.

I don't know a lot about Medicaid, I only have our experience with it to share.

I was terrified of applying for Medicaid for my dad. I knew about the 5 year look back, plus my dad had lived with us and in that time, like in your case, he helped me out occasionally since I stayed home to care for him. He didn't give me cash but if I had an unexpected medical bill or my car was on the fritz, he'd help me out of his own money.

I went to the Medicaid office with the philosophy of, "Say nothing until asked", but the gal I worked with was so nice and so helpful I expressed my concerns to her. She told me it's rare that someone gets turned down for "vendor Medicaid" (nursing home Medicaid). Still, we sweated it out.

My dad's "contributions" to my own living expenses never came up. Regarding the 5 year look back, if Medicaid did in fact look back they would have seen that my dad had money from the sale of his house. We were never asked about that by Medicaid. The social worker at the NH had me scared to death that every penny my dad had spent in the past several years was going to have to be accounted for but again, nothing was ever asked of us.

At the time I applied on behalf of my dad he was in a NH. He owned nothing. Maybe that's why the process was so smooth but I see so many people getting terrified regarding applying to Medicaid and I always want to share our experience. It wasn't the mess I thought it would be and other than keeping in touch with our caseworker regularly I never even heard from Medicaid about anything. And that's something I would suggest. Keep in touch with your caseworker. Our gal knew me, knew my name, and we had a good rapport. I'm sure that didn't hurt.

My dad was finally approved for Medicaid. It took over 3 months and he had already passed away. But like Carol said, if you have a complicated situation you might want to bring in outside help. But don't be too afraid of applying for Medicaid. I don't know if they overlooked my dad or what but we didn't have to explain anything. Good luck!

Gifts - even money - may be a problem, though it depends on where you live. If your mom doesn't have enough to pay the nursing home costs, you need to call Social Services and set up an appointment to start the process. As mentioned by pstiegman, there's a five year look back on her finances, so the gifts will likely show up. Much will depend on the amount. The only thing to do is to start the process unless you think the money coming in will pay her bills. If you have a complicated situation, please contact an elder law attorney who knows Medicaid rules in your state. That may prove very helpful.
Good luck,
Carol

There is a five-year look back at what she spent. Rules vary from state to state. Start by checking your state medicaid rules.