Is my income a factor in determination of Medicare/Medicaid financial eligibility?


For my 97 year old mother who now needs 24/7 care? More details: My mother moved-in with me 4 months ago. Her health has declined to where she now needs assistance in all matters, walking, toilet, diapers, eating. I see the need to place her in a nursing home asap. She has only Medicare Insurance and no other assets. Do I need to go broke to enable her to be eligible for financial assistance for a nursing home?

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Thanks Igloo for pointing out about Medicaid pending. Some nursing homes won't take Medicaid unless they have an available "Medicaid bed." Youngest.....get your ducks in a row now.
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Oh another thing, Medicaid is ONLY about your mom's income & assets. Anything that is tied into her SS#. What you have, your income or property ownership makes no difference for Medicaid.
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My suggestion is to start looking a NH asap and limit your list to those who that residents "Medicaid Pending" for admissions. For Medicaid, there are 2 tracks - medical & financial that mom will have to qualify for. For the financial, the NH will give you a list of document that they will want to 1. review on their own to vett if mom seems to meet the state's criteria for finances for Medicaid; & 2, then the NH will submit all these documents to the state Medicaid program along with their bill.

The list can vary by NH too. For my mom in TX, her first NH had a 1 page list but for my MIL in another part of the state, her NH had a 2 page list. They are all going to want to see mom's "awards letters" - this would be the statement that SSA sends out each year that details how much she gets in her SS check; Ditto for any retirement mom may get. They are going to want to see at least 6 months and maybe up to 5 years of mom's bank statements. If mom owns any real property or has owned in the past 5 years, then the details on that (like for a home, it would be the tax assessor bill & the act of sale & maybe HUD-1 statement if she sold the home); details on all her health & life insurance policies, funeral & burial policies and anything else that could possible have a cash value. They could also want birth certificate or naturalization papers. So get a binder started on all this,,,,,

For the medical, mom will need to have MD orders stating "skilled nursing care needed". Call mom's doc and see if they will do this. At 97, I would think this would be a slam dunk. But if not (WTF!!), then I would have mom seen by an MD who is also the medical director of one of the NH you are looking at. This is what we did for my mom. For the medical aspect, when they are moving into a NH from being at home (my mom was in IL before a NH, she bypassed the AL stage) sometimes they just do not have the fat medical file with a history to show the need for skilled nursing care needed. ALot of this will depend on how her doc keeps records. The MD with a NH know how to do a chart so that all works for Medicaid. Coming to NH from home isn't as easy as those com in in from a hospitalization to the NH for "rehab" - they have the fat medical file. Understand? I don't know if all states do this, but for Medicaid for my mom, the state sends out nursing staff to evaluate new non post-hospitalization Medicaid applicants at NH & they do a chart review. For my mom, the NH needed to add something to show a co-morbidity, so she got .81 of aspirin daily for heart disease.

Medicaid Pending means the NH will accept mom's monthly income (like her SS check and retirement) as her co-pay or her "SOC" (share of cost in Medicaid speak). If it's not Medicaid Pending, the NH can require monthly payment as a private pay resident probably with a full monthlies deposit and a private pay contract done. Avoid doing that if you can. Now if the NH who have beds are less than ideal, realize that you can move mom to another NH once she has been totally approved & on Medicaid. You just need to find a place for her soon. If you think you may want to move her, then you do NOT want to have the NH get her SS or retirement check. Will be a beast to change this. The NH may pressure you to sign over the check to them but legally they can't make mom do it this way. Mom can direct deposit her income to her checking account and then you as a signature on the account can write the NH a check for her co-pay. You do want to have mom establish a personal trust account at the NH for incidentals, like beauty shop. I keep about $ 200 in my mom's and write a check for that every few months if it dips below $ 50.

Good luck in all this. The document search can be overwhelming at times but you'll slog through it!
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No. You are not financially responsible for your mother. Medicaid differs from state to state. Here in Illinois, Mom would be paying privately until she "spends down" to a said amount. Then she will be contributing her monthly income to her care, less $30 dollars. If she has assets such as a home, investments, savings, CDs etc. she will have to use this for her care. "the spend down." Contact her doctor's office to let them know your mother has declined to the point that you can no longer provide care (24/7) for her. Check out some nursing homes now. They will assist you in the paperwork for Medicaid. Get going. You can do this.
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