Mom just admitted to nursing home on Medicaid.

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Igloo, what an amazing amount of info! Thanks so much. I have a question. I'm 60 and I'm the only one out there for my folks. They are going to be in care soon. My concern is, if I choose not to have their funds dir dep to NH what if something happened to me? Would dir dep be a safer way to go in my case?
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If you are your mom's DPOA, then you control how her finances are set up. Now what I've found in this mice-maze of Medicaid & NH, is that the facility will press upon you that is is oh-so-much-easier-for-all that mom's monthly income from whatever sources are direct deposited or mailed to the facility.

Mom is NOT required to do this.
Again they may press to have you do it, BUT you do NOT have to do this.

Now Medicaid compliance requires that all their monthly income be paid to the facility BUT LESS THEIR "PNA". PNA is personal needs allowance and the amount varies by state (since each state administers Medicaid under an overall federal guideline). Find out just what it is for your state. PNA range from $ 35.00 to $ 105.00 (this generous figure is FL & MN).

For my mom in TX, it was $ 60.00 a month. Mom got $ 800 from SS and 1K from retirement, so every month $ 1,800 in monthly income of which $ 1,740 had to be paid to the NH. Your state Medicaid program should send you or whomever it indicated as your mom's point person in her application a notice of eligibility enrollment that states her income and what is due to the facility. That is the exact amount that the NH need to be paid. No more / No less. For my mom, I kept all going direct deposit to her bank account and mailed the NH a check for the $ 1740 each month. Mom's account built by $ 60 a month - now Medicaid allows for them to have 2K in assets (assets not monthly income) so you need to make sure that mom's bank account always is under 2K.

Has the NH spoken to you at all on their "NH trust account"? What is supposed to happen for those that dd funds to NH, is the PNA goes into their trust account. The NH holds it and it too builds each month by the PNA. And it too needs to be under 2K for Medicaid compliance.

For me the issue with letting the NH get the checks, is firstly that I'm pretty OCD in wanting to be in control of mom's meager $ and that IF she needed to move NH that dealing with changing DD would be a total pain. Now as it turned out, I did move mom from NH #1 within the first year to a much better NH #2, so it was oh-so-good that NH #1 was not the DD.

Also for both NH, I would need to go to the business office to sign out to get any $ from the NH trust fund. For us, both NH had business offices closed on weekends and 1 closed at noon on Fridays. If you live elsewhere and biz office closed on weekend, well forget getting $ from NH trust fund to go shopping for items for mom. Now I did establish a NH trust fund account for mom with about $ 100/200 in it to pay for beauty salon and on-site canteen. Mom's NH #1 never sent an accounting….NH #2 sent a statement every 90 days with a listing of services paid from the trust account and with interest.

For me what was good in having her account build by $ 60 each month, was that when I came in every 3 mos or so, I could do a bigger spending trip to Target for things for mom. So there could be a little stockpile of her body wash, slipper socks, etc. with her initials on it available for staff.

You may want to give some thought to keeping mom having a bank account too. My mom had her bank account set up for me to be a signature and POD to me. Mom died earlier this year and I have kept the account open and will keep it that way till all has cleared the probate process. NH # 2 sent me a check for the balance from mom's PNA too at about month 4 post death which went into the account with no issues. Keeping an existing account open could be a good thing in the long run, especially if you are going to have to do probate.

Also find out IF your state does an annual renewal for Medicaid - if so you need to keep a binder going on all things mom. For TX, the renewal requires all sorts of items (awards letters, burial & insurance policies, property ownership details, last 3 mos bank statements, the trust fund amount, etc) to be submitted. Really if you get a binder or a box going with all this, it will keep you from going loco for the renewal. Good luck with the NH too.
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