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Has anyone gone through a Medicaid financial review? My mother is in a memory care facility. We are currently paying with private funds that will run out in a couple of years. I am financial/medical POA and have kept good records -- spreadsheet, receipts -- of monies that are being paid with these private funds. Aside from knowing that my mother will have to change facilities as the one she is in doesn't take Medicaid, what other financial issues will Medicaid be looking at in this 5 year look back? What tips and lessons learned can anyone provide as I move toward this Medicaid review? Thank you!

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Totally agree with IGLOO. Move sooner, not later.
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Thanks for these informed and thoughtful answers. I appreciate it!!!
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I’d highly highly suggest that she move into a facility that accepts Medicaid sooner so that she’s already a private pay resident at it (for several months or a year+) when she has to apply for Medicaid AND can be placed on their Medicaid bed list when she gets to her last 2 months of funds AND they will do Medicaid Pending when she’s out of $ & applies. I think you’ll find the facilities will be more ahem... welcoming to a resident who does this than for one coming in totally impoverished.

Also regarding Pending, not all facilities that accept Medicaid do “Medicaid Pending” status admission. If this is what’s what in your area, you might want to think about how you would deal with this.

Other suggestions:
- make sure mom’s income is under your states Medicaid max. If not, then mom needs to speak with atty regarding Miller Trust (if your state allows)
- condense all financials to 1 single checking account that you are POD on.
- if you close out accounts and they are at another financial institution, get a letter of transfer from them that clearly shows account details at closing so you can do a perfect match up as to where funds went. For my mom the 5 yr look back on closed accounts was something I didn’t know happened. What TX required was a statement on bank letterhead & signed by bank officer as to the disposition of all closed out accounts 5 years back, like CD# 12345 $9876.00 closed 1/12/12 moved to her checking account #45678 for $9876.00 1/12/12. All of my mom’s were at the same institution, so all info there for bank officer to pull & it took the better part of a morning & they did it for free. But if mom still had accounts with a FA or multiple banks within the lookback, it would have been a hot mess hurdle to get through.
- if she does not have a preened funeral AND burial, I’d suggest you price these out and set aside the $ for it within her checking. Not buy it, but plan on buying it so that $ is out in her last big spend down 2 months before she becomes impoverished & applies for Medicaid. So it clears her bank account & she ends her month before application under Medicaid asset limit of 2k. 
- give some thought get if you want the facility to become her payee once on Medicaid OR you want to keep things as they are now and so each month you write a check from mom’s account for the required by Medicaid copay of SOC ( share of cost) of her monthly income (I did this but I’m pretty ocd on control). The NH cannot required mom to let them become her payee but I’ve found they will heavily imply that this must be done..... but reality is you as DPOA can decide what path to take on this. If they become the payee and you should ever want to move her from this place to another, it will be a beast of paperwork to get done timely. 
- if she could benefit from dental work, spend down on dental. It’s rare for states medicaid to cover any adult dental care. Medicare kinda really only covers dentures.
- if you have a place to store stuff, buy her extra shoes and easy wear sturdy clothing that can withstand high heat laundry.
Remember once on Medicaid, all the extra $ they will ever have is whatever your state has as their Personal Needs Allowance. Average PNA is $50-60.
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This isn’t technical advice, but the only thing I can say is be open and honest. Don’t try to hide anything or pull a “fast one” on the Government because it will only come up to bite you in the end. They will invade your privacy and dig into past records and documents galore. Give them whatever they ask for. People who try to hide things and put one over on the Government seldom succeed, and when they think they have, they find out they haven’t. Answer all questions honestly, to the best of your knowledge. If you are denied, seek the advice of a reputable and local Elder Law Attorney who specializes in Medicaid. This is your best course of action after a denial as you can go around and around for months and get nowhere. Good luck!
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