I want to retain my mother's eventual eligibility for Medicaid, and god forbid she would ever be that sick but she is 94 and is quite disabled from severe dementia and a recent major surgery. My question: She has enough money to pay for her care, and I need to know what amount of compensation is allowed by Medicaid for her care in my home, equaling or surpassing the level of Skilled Nursing Facility care? The average cost of SNF in my state is about $5500, but locally it's much higher. Thank you all for your answers.

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Magnolia - ? for you, in reading your other posts….it's way WAY more complicated than just a personal care contract……so there is an existing caregiver agreement between you & your mom for 3K but mom on a visit to your out-of-state brother got very ill & hospitalized and he wants a 6K caregiver contract as he is going to keep her. And you are wondering what will happen if mom pays him 6K a mo., if your 94 yr old mom should eventually need Medicaid?

So if this the situation, I'd suggest you contact ASAP an elder law atty that is NAELA or CELA level in your brothers state. If mom is going to stay living in brothers state all her legal paperwork is going to need to be changed to be a resident of that state if you think Medicaid will be needed and perhaps make brother her DPOA too. The atty who did the existing contract between you & your mom, perhaps they have an atty in your brothers state to refer you to - I'd give your atty a call first & foremost. Also this site has a drop down list of elder care atty's by state.

Not to sound harsh but when they are advanced elderly, it is pretty much a #'s game. At 94 she has outlived the actuarial tables, so you more have to discuss what her likely future time is with her MD combined with what you think mom will do (like is her gene pool filled with those who died at 98-99-100) and look in detail at just how much $ mom really has. If it's probably 3 years and mom has 300K, Medicaid probably won't be needed. But if mom has under 100K right now, she is going to run out of $ and there will be a transfer penalty issue for Medicaid over the $ paid to both of you. You say "mom has enough money to pay for her care", really put pen to paper to see what her $ is doing and what current & future costs will likely be for the next 2 and next 3 years… there $ left over??? The costs of end-of-life care are horrendous, if she hasn't gotten all her last hospitalization bills, even with Medicare there could be a bundle of $ owed.

To me, in my not-legal view, the 6K is kinda high and likely problematic by Medicaid as it's at the price-point of what a skilled nursing facility charges and brothers home is not a skilled facility unless he is really converting a wing of his home to a mini nursing facility and hiring health professionals. And not to sound really really harsh, IF mom's level of care gets beyond what your brother can provide and she needs to go into a NH and applies for Medicaid in brothers state & Medicaid places a penalty on mom's application for all the $ 6K a mo. paid to brother, would he without a doubt private pay for mom's care for the entire penalty period? OR would he step back and make it all your problem to deal with? If you're still the DPOA it's your problem. Not to sound too jaded on this but AC has many posts by family who have had mom/dad gift $ to other family members only to have it become a Medicaid transfer penalty that they (the dutiful & responsible child) are stuck dealing with.
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Family providing in-home caregiving will NOT be viewed as an equivalent of care in a SNF by Medicaid. A SNF has licensed professionals on staff (RN, SW, RD, OT, PT etc) as well as all sorts of equipment and ancillary services and all 24/7 that you in your home do not have. It's not equivalent care.

The vibe I'm getting from your post is that it's a 5K SNF for your state (GA) so that amount is what you are perhaps thinking that your mom could pay you?
If so, that won't work for Medicaid review & will probably pose a transfer penalty if mom should apply for Medicaid later on. For mom to pay you for caregiving without problems, she would need to have a "personal needs contract" drawn up by an atty between her and you with specific details of what caregiving & assistance is being done; with her physician's note as to what care is needed & that sync's with what is in the caregiver contract; mom pays you all above board with taxes & FICA done. (You should ask the atty if mom's Medicaid review is requiring the MD note to have an ICD-10 coding(s) indicated too).

Payment allowed for in-home caregiving is more what an individual aide is paid in the $12 - 20 hour range. An agency can bill more $ 18 - 30 hr as they provide additional services (insurance, bonding, administrative, etc.) The amount kinda depends on what your community standard is for paying. If you work full-time at another job, you can "work" part time for your parent maybe at most 150 - 175 hrs a mo.

In order to be paid a higher rate, you would need to be a licensed health care professional like an RN, MSW, LVN, CNA PT or OT and you bill by the hour as if your were working in a comparable professional setting. Sometimes family caregivers take a course at a community college to get certified so they can "charge" a higher rate for at-home caregiving (or qualify to get their parents LTC policy to pay them rather than an agency). If you have a business and provide a service to your parents (like your a CPA, licensed financial advisor), your biz can bill them just as you would any other client.

Having mom pay you 5K a month, without any legit agreement done & notarized and taxes paid, is setting yourself up for a Medicaid transfer penalty inquiry. If she is denied Medicaid, can you personally private pay for her NH stay? and for months and months or possibly years? Really your 94 yr old mom needs to see an elder law atty to provide the guidance as to just what can be done at this very late date for her that will be within Medicaid review for GA.
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Medicaid will want a written contract, ideally one drawn up by an attorney. As far as being paid for care, make sure you have a form signed by the MD. I suggest using the VA Aid and Attendance form 21-2680 and/or an assessment of needs by a visiting nurse agency to help draw up the contract.
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First check with your Mom's State Medicaid office to see if there is maximum payment.

Now when I hired caregivers from an Agency, Dad was paying around $30 per hour, and the caregivers were certified, bonded, insured, plus had workman's comp in case they got hurt while on the job. And if a caregiver called in sick or was away on vacation, the Agency would send over a fill-in caregiver.

So use that dollar amount as a guide. Without an Agency, maybe $10 to $15 per hour depending on what type of work is needed. The higher the skill needed, the higher the pay.

And if your Mom is using an "independent contractor" [someone not from an Agency] your Mom would need to add a "workman's comp" rider to her homeowners insurance. Usually an independent contractor pays for her own payroll taxes.

Whatever you do, make sure there is an employment contract that shows the number of hours work for each day... the duties involved... the hourly wages... any overtime pay if worked over a 40 hours week... any time & half for holiday pay.
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