An elderly friend, 102-years-old, is in an assisted living facility in North Carolina and has spent all her assets, but has a monthly income of $1600 from SS and pension. Can she qualify for medicaid?
Someone needs to talk to the facility. They may have where after she has paid privately for a certain length of time, the facility will except Medicaid. If you do not have POA, no one should be talking to you. Does she have family?
The amount the individual must "spend down to" is dictated by your particular state. This is something an individual must check according to the rules of their own state as Medicaid is a combined program of the federal government and the state. Luckily this individual is already in a care facility and they will be able to guide family in looking up and applying for Medicaid. There are a number of factors involved, and it is almost not a DIY project anymore.
One thing also to check with the ALF in No Carolina is whether or not they accept Medicaid in payment for care. Some ALF do not, and given they are private facilities they are not required to. Some few DO accept it.
A meeting with Administration in facility is called for now. They can guide you in application process and working out future care.
I just want to emphasize to anyone reading this post that they should *never* go into or put their LO in a facility that does not accept Medicaid, except if they are profoundly wealthy.
No one wants to have to move out and look for another facility when they are elderly and vulnerable and don't have other options.
My Mom keeps wanting to consider a very nice, new AL facility in a neighboring town. It wasn't even a continuum of care facility, so no MC. The first (and last) time I went there my opening question was whether they accept Medicaid. They said no and I said goodbye.
I bet the issue you will have will NOT be about this lady’s being within LTC Medicaid income and asset limits. Most States have these at $2742 and $2K and she’s under those so ok on that front.
But the issue will be finding out IF this current AL is on the State of NC LTC Medicaid waiver program as their payment for her. Medicaid paying for AL is not a given. It is not required and dedicated funding like LTC Medicaid program that pays for custodial care in a NH that provides skilled nursing care is. A state has to want to do a diversion of LTC Medicaid Nh funding to go instead to be available to ALs via a waiver. So this ends up being is most AL are purely private pay AND those AL who are in a State that actually does the LTC Medicaid AL waiver tends to be a small # of AL and the # of beds they have available for the waiver are just a few…… so that snowballs into having to be on a waiting list…. and it ends up being on the waiting list for a year or so…. usually ends up being 2 years…. Which at 102 years won’t work unless she has already been put onto the waiting list in the past at this AL if this AL participates in the waiver. Whew!
ok I know this is a lot to process but that is the system.
So my suggestions are to - first find out of this AL does the waiver and - if not speak with admissions at this AL as to where their existing residents tend to go to for a NH once their level of care gets beyond what the AL can do. - Then find out which of these NH take LTC Medicaid and has a current open bed and - that where you go to get her admitted as LTC Medicaid Pending resident. Whomever is her POA will need to work with the new Nh to get the paperwork done for her LTC Medicaid application. It is different than Medicaid as health insurance…. that is a different Medicaid program. But she will end up being on it as well (if she is not on it currently) as the low income custodial care residents end up being on 3 programs: as “duals” via Medicare and Medicaid for health insurance PLUS the LTC Medicaid program for room&board custodial costs of the facility.
Ok an update, so NC for 2024 is approaching “income” in a new way for LTC Medicaid custodial care in a NH facility. NC instead of the using the individual financially “at need” applicant standard for their income that most States have for 2024 of $2,829 (was $2742 for 2023), NC is using income available is under the pay rate of a NH that participates in LTC Medicaid in their community for their financial “at need” eligibility.
And pay rate to a NH participating is limited to NHs charging between $6,381.00 to $9,087.00 per month for their long term custodial care. So under the new system, if the applicant has LTC Medicaid participating in their ‘hood that charges $6789 as their rack rate for private pay as long as the applicant income is under $6789 they are ok for financially “at need”. And all the residents income is paid as their required liability (which other States refer to as a copay or Share of Cost) less only $70.00 which they can keep for use for personal needs. And the personal needs $ cannot be spent in any way on items covered and paid for by LTC Medicaid.
NC still doing assets as a max of 2K which standard for most other States for LTC Medicaid.
If i was to hazard a guess, done to appease NH lobbyists. A NH will make more $ this way and get a more affluent resident.
This is something an individual must check according to the rules of their own state as Medicaid is a combined program of the federal government and the state. Luckily this individual is already in a care facility and they will be able to guide family in looking up and applying for Medicaid. There are a number of factors involved, and it is almost not a DIY project anymore.
One thing also to check with the ALF in No Carolina is whether or not they accept Medicaid in payment for care. Some ALF do not, and given they are private facilities they are not required to. Some few DO accept it.
A meeting with Administration in facility is called for now. They can guide you in application process and working out future care.
No one wants to have to move out and look for another facility when they are elderly and vulnerable and don't have other options.
My Mom keeps wanting to consider a very nice, new AL facility in a neighboring town. It wasn't even a continuum of care facility, so no MC. The first (and last) time I went there my opening question was whether they accept Medicaid. They said no and I said goodbye.
But the issue will be finding out IF this current AL is on the State of NC LTC Medicaid waiver program as their payment for her. Medicaid paying for AL is not a given. It is not required and dedicated funding like LTC Medicaid program that pays for custodial care in a NH that provides skilled nursing care is. A state has to want to do a diversion of LTC Medicaid Nh funding to go instead to be available to ALs via a waiver. So this ends up being is most AL are purely private pay AND those AL who are in a State that actually does the LTC Medicaid AL waiver tends to be a small # of AL and the # of beds they have available for the waiver are just a few…… so that snowballs into having to be on a waiting list…. and it ends up being on the waiting list for a year or so…. usually ends up being 2 years…. Which at 102 years won’t work unless she has already been put onto the waiting list in the past at this AL if this AL participates in the waiver. Whew!
ok I know this is a lot to process but that is the system.
So my suggestions are to
- first find out of this AL does the waiver
and
- if not speak with admissions at this AL as to where their existing residents tend to go to for a NH once their level of care gets beyond what the AL can do.
- Then find out which of these NH take LTC Medicaid and has a current open bed
and
- that where you go to get her admitted as LTC Medicaid Pending resident.
Whomever is her POA will need to work with the new Nh to get the paperwork done for her LTC Medicaid application. It is different than Medicaid as health insurance…. that is a different Medicaid program. But she will end up being on it as well (if she is not on it currently) as the low income custodial care residents end up being on 3 programs: as “duals” via Medicare and Medicaid for health insurance PLUS the LTC Medicaid program for room&board custodial costs of the facility.
And pay rate to a NH participating is limited to NHs charging between $6,381.00 to $9,087.00 per month for their long term custodial care. So under the new system, if the applicant has LTC Medicaid participating in their ‘hood that charges $6789 as their rack rate for private pay as long as the applicant income is under $6789 they are ok for financially “at need”. And all the residents income is paid as their required liability (which other States refer to as a copay or Share of Cost) less only $70.00 which they can keep for use for personal needs. And the personal needs $ cannot be spent in any way on items covered and paid for by LTC Medicaid.
NC still doing assets as a max of 2K which standard for most other States for LTC Medicaid.
If i was to hazard a guess, done to appease NH lobbyists. A NH will make more $ this way and get a more affluent resident.
This program is reporting $1676 or less for single adults
$20,120 a year
Wishing you and your friend all the best!