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My mom is in an assisted living home. She receives about $1750 per month from her husband's railroad retirement, and she has about $225,000 total in her checking and savings accounts (from the sale of her house and previous savings). She has no other assets or income.


Her current expenses are about $4550 per month, which includes the assisted living, medical/pharmacy expenses, cable TV, telephone, miscellaneous groceries/clothing, and occasional hair cuts and foot care. If my calculations are correct, her savings will run out in about 6-7 years.


The AL we chose accepts Medicaid after two years of private pay. So, I assume the AL would be paid by Medicaid?


However, once she is on Medicaid, how will we pay for her other expenses (cable TV, telephone, medicines, etc.)? Does Medicaid cover those also? I know they have a personal needs allowance, but that wouldn't even pay half of her cable bill, let alone medicines or groceries.


I am concerned about what happens at that point since we will be retired by then and won't have extra money to help out.

Medicaid pays for her medical care and medicine. She will need to be placed in a nursing facility that provides the rest of it. On Medicaid, she will only be allowed to keep 60.00 a month for anything extra. That's how it is in Texas anyways.
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I believe I know the answer but check with the local Medicaid office. If she is in a facility, they provide a television and I believe they allow periodic beauty parlor appointments - perhaps once a month or some reasonable period. Foot doctors come in and are paid by Medicaid. As to medications, I believe Medicaid takes care of that and any other medical expenses. She will get food in the facility so she won't have to buy groceries. I am a Power of Attorney to someone on Medicaid in a nursing home and everything she needs is covered in full. But be warned - Medicaid does NOT (please verify this) pay for ASSISTED LIVING. If the patient is in a nursing home, Medicaid will cover the expenses. So check carefully as to where you put her when the time comes. And you must NOT use your money - you will need it for YOU.
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Sackojk Apr 17, 2019
How about a residential senior home for Alzheimer s and does hospice still care for the person when on Medicaid?
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mountainsoft- bummer about the antenna. One of my brothers - the
one with money to burn - refuses to pay for any type of TV. He thinks Comcast is an evil empire - along with Microsoft, lol - he uses indoor antennas at both his house in the city and his five bedroom “cabin” in the Columbia River Gorge forests. No problems.

Can you talk to your mom about this - suggest maybe she starts eating the AL food - that she’s already paying for - and give the grocery money to you to stash in your name to pay for cable down the road? I doubt the Medicaid folks would notice that amount or require receipts- as it would fall into a reasonable “living expense”.
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mountainsoft Apr 13, 2019
An outdoor antenna, Netflix, and YouTube provides more TV to watch than we have time for. My mom, on the other hand, spends all day in front of the TV.

Mom eats lunch and dinner at AL, but doesn't get up early enough for breakfast. Most of her shopping is snacks, junk food, over the counter medicines, and paper products.

She did gift us some money last year after the sale of her house. It wasn't much, but I set that aside in case we end up having to pay for her personal expenses once she is on Medicaid. Her remaining assets should last 6-7 more years, so the gifted money shouldn't cause any issues for the Medicaid five year look back.
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Im honestly not a heartless b!tch, - however...

Once your mother is on Medicaid she will be living at taxpayers expense. Mom and her husband paid taxes for years and years, most likely - which will come back to her by way of Medicaid paying her medical expenses and her AL rent - and whatever comes with that AL rent.

But all the “extras”? I’m afraid to say moms gonna have to learn to do what people do when they don’t have money - cut back and live within her means and budget.

I know in my own situation - God forbid something bad impacted my family’s financial situation- the deluxe package from Comcast and the organic food would be the first things on the chopping block.

Im assuming the AL provides basic TV - if not there are still antennas that will pick up free TV - and your mom will still have the food provided to her that comes with the rent.

Mom may not like all the food and the same for the limited TV shows selection - but millions of folks are living that way as you’re reading this.

Honestly - I wish it were different. I wish Cadillac services and amenities were provided for all our hard working retired seniors. But they aren’t. It sucks. But it is what it is.

Unfortunately.
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mountainsoft Apr 12, 2019
Yeah, I understand what you are saying, it's just difficult to think of mom in that situation. Sometimes I ask myself why I care after she cut off contact with me over 20 years ago, but she's still my mom and I want the best for her.

The AL does NOT provide any basic TV channels. I can't install an outdoor antenna at the facility, and I tried two different indoor antennas and could only get one station with either of them. If she loses access to TV when her money runs out I honestly don't know what she'll do all day. That's all she does.

I'll do what I can to help, but we'll be retired by then so we won't have a lot of extra cash ourselves. We'll have to make cuts to her lifestyle whether she likes it or not.
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McMahon- regarding placing $ into an annuity, tread carefully.
When your in the maze that is LTC Medicaid, sometimes things are a dead end and have to track back, & imho, annuities easily fall into this. The issue will be “eligible” & “compliant” requirements.

Annuity are insurance products with usually a pretty hefty commission structure. Those “steak dinner” type of enticing keep govmint from gettin’ your $ events, usually are all about selling insurance product, through some type of annuity.

Here’s the rub:
- for Medicaid, the placement of $ by an person into an annuity in their name is allowed & viewed as an “eligible” movement of assets as the annuity in their name. So as it’s still their asset, it’s ok for Medicaid as far as being eligible for asset transfer.
BUT
- in order for annuity to be ok for LTC Medicaid, annuity will need to be also Medicaid “compliant”. Not just an allowed or eligible transfer of assets but compliant. Medicaid “compliant” primarily means that they are actuarial sound and have state as primary beneficiary.

State must become the primary beneficiary.

So if mom in a NH on LTC Medicaid dies with $ still left in annuity, state is paid first for all costs incurred by & paid by Medicaid for her care and if there’s any $ left, then it goes to whomever is secondary beneficiary. Now whether or not changing the payout or beneficiary on an existing annuity is easily done or even allowed, depends on the terms of the insurance agreement.

Actuarial sound part means that structure and terms of annuity fall into IRS tables within IRS Section 7520. Section 7520 stuff is way, waaaay beyond me. It’s imo tax atty or very experienced CPA to advise on.

Can annuities work for an elder individual...... depends...
Say mom’s 70; sells her home for 250k & buys 250k annuity that allows changes without penalty, she’s probably all ok should she like run out of nonannuity $ and apply for LTC Medicaid at 85.
But if mom’s 85, sells her home for 250k, & buys 250k annuity (& believe me there gonna be an insurance guy who will sell one to her & tout that is totally Medicaid eligible), there going to be problem for it’s being compliant if say in 5 years now 90 yr old mom needs a NH and has run out of nonannuity $. That annuity not going to be able fit actuarial tables. The policy won’t allow changes. She’ll have to get the annuity surrendered and that will have hefty penalties and fees to do. Once it’s surrendered, that’s an asset that’s totally reported and she’ll have to do a spend down to get down to the 2k asset impoverishment level for individual LTC Medicaid.

The commission structure on annuity are very very good for licensed insurance person who sells it for the length of the annuity. It’s so good, that those “steak dinners” often have 2-3 persons working the room who do not hold insurance licenses but get paid a % of the sale.

Devil is in the details on annuities.
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igloo572 Apr 13, 2019
Also the $ the annuity pays you each month is “income”. If it combined with your other income, like your SS $, takes you over the LTC Medicaid limit for maximum monthly allowed, your not going to be eligible for LTC Medicaid. Most states have monthly at about $2,050-$2100 max a mo. Some states are under 2k.

Avg SS is abt $1200, so if your annuity pays you 2k. You’re over for income. So that frickin annuities - even if you get it past the eligibility and compliant hurdles - will take the elder over the max income. I don’t know if annuities can be used to do a Miller Trust to deal with the overage; I’d bet not. So the annuity ends up having to be surrendered.

Imo the only annuity that works for Medicaid planning is a SPIA for a much younger &/or healthier spouse who will likely be a community spouse for years & years. Has to be done before Medicaid application is filed for the ill & needed not LTC spouse. Community spouse stuff complex, need CELA or NAELA level of elder law attorney. CELA = certified elder law attorneys; NAELA = member of national association of elder law attorneys.
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The prepaid funeral service is great idea, also any other expensive medical care ie, dental, vision, hearing aides, etc. Contact cable company, she may not be able to get all the channels she does now but quite a few companies do offer steeply discounted rates on basic cable and internet for those who are on Medicaid, low income. Does AL include wifi in her rent? Aren't her meals and snacks included in AL cost? If not, apply for food stamps when she gets approved for medicaid. Adding her phone to someone else's plan is a very good idea, if a family member has premium cable channels she can stream from her phone to a smart tv. Buy her one now before applying. Meds should be covered by medicaid. Not sure what type of foot care she receives, but it too should be covered if medically needed.
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mountainsoft Mar 26, 2019
Tried to preplan funeral with mom but she backed out at the last minute due to cold weather. Maybe we can try again this summer if she's still interested.

She has Comcast cable and they told me they have no discounts for seniors or low income (the package they offer is not available in our area). Yeah, I could go back to a lower cable package, but that's all she does all day.

AL has wi-fi in the common areas, but not in her room where she could use it for streaming Netflix or anything.

Yes, meals and snacks are included with AL, but mom is picky and prefers to buy her own. She earns too much with her railroad retirement income to qualify for food stamps.

We don't have cable TV so I can't put her on our plan.

Right now she also has internet service so she can watch Netflix. I set her up with Ooma phone service over her internet. I might have to find alternatives when she goes on Medicaid.

Foot care is just cutting toe nails and general foot exam. A local doc visits the AL every month or two. He doesn't accept her medicare plan but it's only $45 every couple months, not bad. She also gets her hair cut for about $20 at the "salon" in AL. Her medicaid "personal allowance" should cover these OK.
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Wow! My head is absolutely spinning, and please, please God, don't let my mom have to go on Medicaid - I could never cope with all this!
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No, Medicaid does not pay for tv, cable, electric, cell phone or any other expenses other than prescriptions and medical care. Her personal needs allowance would be no more than $60 per mth in my state (TX) but I don't know if that differs from one state to another. You guys will have to think of a work around if you want her to keep these creature comforts. Perhaps combining phone plans, adding her to your cable provider will help? And yes. The AL would be paid a PORTION of the required monthly amount. Your LO would be required to pay a patient copay each mth once Medicaid has kicked in. Whatever you do, DO NOT, I REPEAT, DO NOT get rid of any medical plans she has in place. If you cancel a Medicare Advantage Plan, your LO would then be on the hook for the 20% that Medicare doesn't cover....and there's NO LIMIT on that 20%.

Hope this helps ya!
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I don't know the answers but just so you know, and it could vary by state, but I don't think so - Medicaid does NOT pay for any services if the patient is in assisted living (AL) but will do so if the patient is in a nursing home. You need to seek out professional advice now and get all the facts. Once someone is in a nursing home, they get a ridiculously low allowance for "personal needs" which almost does not even cover the cost of a roll of toilet paper. Please seek out information.
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worriedinCali Mar 22, 2019
It actually DOES vary by state and Medicaid does pay for assisted living room & board in some states. In states where they don’t pay for room & board, they DO pay for other AL services. Medicaid in the OPs state DOES pay for Medicaid.
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It sounds like she has more than 1 Bank? Is Ally one of these?
If I’m not mistaken Ally has the best fees / costs for those purely SS income and they may do the same for RRRB folks.
Well whatever the case, if more than 1 bank, I’d suggest to try to consolidate all to a single bank with a savings that has most of the $ getting whatever pitiful interest and regular checking for her RRRB $ that gets auto deposited whatever is her shortfall each month plus 10%. As her CDs expire at other banks, that $ goes to the single savings account at the 1 bank.

On a personal level, as a “only”, I’d be concerned that you may find yourself tethered in your retirement to having to deal with your mom if you & hubs are planning on having a traveling & exploration type of retirement. If hubs does NOT have parents himself to deal with or he has oodles of siblings to share in parental oversight, this could cause a rift at home. Imho You need a secondary POA or an attorney to be legally in place to act in your stead if you are not there. Your mom has $ to pay for a CELA or NAELA level of atty to totally review her legal and create whatever new is needed, like a secondary POA, a “guardian in case of incapacity” type of document for her, do a codicil to tighten up her will and name 2ndary Executor. If there’s no real other extended family for you, then the law firm will have an attorney that can be the POA etc. May have a tiny annual retainer for this - see if not used if it pours over to cover costs should she end up on Medicaid. All this is totally legit use of her $$ should she outlive her $ & apply for LTC Medicaid years from now.

Really have a heart to heart with hubs on how he sees your & his retirement ahead. He may not find the increasing oversight your mom needs as she ages to be user-friendly for him. Like she breaks a hip and you have to deal with all that hospitalization and rehab and finding a NH and it that means cancellation of a trip to be what his retirement was to be about. Stuff like that builds resentment.
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Riley2166 Mar 22, 2019
To everyone who posts or replies on this forum, PLEASE, PLEASE SPELL OUT THE NAMES - DO NOT USE INITIALS, LIKE 'CELA' OR "NAELA'. Most of us have absolutely no idea on earth what you are talking about. I sure don't. Thank you.
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It sounds like you have a good realistic outlook. If there is any way to just go forward and do a funeral burial preneed for her - even if it’s on the downlow - do it and pay in full. Perhaps use your dads funeral burial as your template. She is not going to get easier to deal with as she ages.

One item I did not expect to have to get or deal for Medicaid with was an on bank letterhead signed by bank officer statement as to the disposition of any of my mom’s CD paid to her for 5 years prior in detail. As they were set to renew, instead of rolling them over along with their hefty interest rates paid, they were cancelled with full amount of the now cashed out CD deposited into her checking account in to the penny. So like CD #12345 $10,987.65 expired 1/22 deposited to acct #98775 for $10,987.65 on 1/22. Try to keep all her CD documents with cancellation stamp and it’s deposit slip just in case you need to rebuild it; her bank could merges with another 4 years from now and stuff goes MIA. This letter btw was in addition to monthly bank statements that showed interest paid, those deposits and each months cancelled checks. My guess is that cashing out and keeping CD $ is pretty tempting and happens.

There is the very very real possibility that she can flat outlive her $.

If you retire and plan on traveling, is there someone else to handle things for her and has legal paperwork to do this?
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mountainsoft Mar 21, 2019
Mom's savings and CD accounts are with online banks and electronic statements. Hopefully that won't complicate things too much when she has to apply for Medicaid.

Yes, I'm expecting mom will outlive her money, so I'm trying to learn and plan as much as I can before she has to apply for Medicaid.

Assisted living will take care of her immediate needs if we are traveling, and all of her bills are on autopay. In the case of a medical or legal emergency there isn't anyone but me to take care of things (assuming mom is unable to handle it herself).
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Its really "you have to pay "at least" two years" before Medicaid will pay. That also depends if the AL has met the % of Medicaid residents they allow if they even do. If Mom still has money after two years it has to be used for her care. I had 90 days to spend Moms money down to 2k (in NJ), meet all criteria and get her into a LTC. If I hadn't, I would have had to reapply.

Once on Medicaid Mom will have her Personal Needs acct. States differ in what is allowed, NJ its $50 a month. I think you can use the 2k for her personal needs. Medicaid will be her secondary insurance so Meds will be paid by them, with maybe a small copay. Dental and vision will be included. Cable and phone can come out of PNA. Otherwise, that will be on you. If in LTC, they supply cable. So phone will have to be covered by someone else.
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mountainsoft Mar 21, 2019
Will Medicaid replace her current medicare advantage plan, or do they pay the patient responsibility portions of her current plan? If she has to switch to Medicaid for coverage, I assume that means she would probably need to change doctors too?

Unfortunately, mom's assisted living does not include any cable or phone. Here in Washington state I think the personal needs allowance is around $60 or so. That won't go far, but it might help with cable. Watching TV is the only thing she does all day, so I will probably have to figure out how to pay it myself. I might be able to pick up a cheap Tracfone for her, or just drop phone service altogether. No one calls but me and her sister anyway.
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Your mom won’t qualify for Medicaid until the majority of the $225k is gone, you know that right? She’ll be self-paying for years before Medicaid kicks in. She won’t qualify until she’s down to her last $2,000. Medicaid won’t pay for cable TV or a phone either. She’ll get a $60 a month personal needs allowance once on Medicaid. The $225k she has now can’t be shielded from Medicaid, it needs to be used to pay for her care.
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mmcmahon12000 Mar 25, 2019
Not necessarily. If she were to take the $225K and put it into a paying annuity, it would then no longer count towards the assets limit with Medicaid bc she'd have it in distribution mode. (Found that out thru an elder law attorney. )
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Medicaid is so beyond the horizon for a mom with 225k assets.....

But before my thoughts on that.... My hubs family had elders with RRRB, the coding / payment system for RRRB MediCARE/ health insurance was different and had to be filed via RRRB system out of Georgia. This was years ago, but IF this still is how RRRB operates, this will be a snafu for the AL for any health billing they do or new health care providers this AL has its residents see if AL not familiar with RRRB. Please check into this ASAP. RRRB is great but operates on its own format for everything from how direct deposited to how medical billing paid. RRRB has offices all over often in an obscure quasi state/federal building but with knowledgeable staff.

So Regarding Medicaid, if your thinking that after 2 years of private pay that Medicaid will take over to pay for AL that is NOT, again NOT, going to happen. Even if she is fortunate to reside in a state that does AL waivers with their LTC Medicaid funding & lives in a AL that chooses to participate in Medicaid waiver program. She has too much $ to be “at need” financially.

Plus “waivers” are NOT dedicated funding; waivers run on 3-5 yr funding cycles. AL could stop participating in program or they have only 5 beds participating & until one of those open up & your mom is next on the list will she get that waiver bed. Or better yet, state decides to change Medicaid budget to stop AL waivers totally to instead go to community based program like PACE; so more benefit of each $ for wider group.

Right now your mom has 225k in assets plus RRB income $. Medicaid for LTC requires financially to be “at need” = 2k in assets so basically impoverished. Your mom won’t hit that for maybe 5 years as there will be increased costs by AL. Like rent increase. But also - & I’ll bet a case of Prosecco on this - the AL will determine that mom over time will need additional assistance above what is included in her admission contract. Read her admissions contract carefully..... If she’s AL, then in theory she should be good on her ADLs perhaps with some assistance. But once she starts needing “medication management” or constant toilet “transitioning”, the AL will place additional charges onto her bill. I think you are being way way WAY too optimistic to think her $ will last 7 years and that she will be in AL for all that time.

Imo 225k is sadly a pretty small amount of $ & at edge of being enough to warrant doing anything “creative” to get done before a 5 yr Medicaid lookback as she’s already in a AL facility (not IL). I assume she’s AL as she needs oversight. Unless she’s sharp active 70 or 80 & super healthy, the opportunity for creative financial planning to be beyond a Medicaid lookback has past, that ship has sailed.

But you as her dpoa do want to spend down her $, so that all her funeral and burial are preneed & paid. Update her will & all other legal, get her banking POD to you or whomever is to be Executor. She may be able to do a Trust that would be Medicaid compliant. Whatever she does now at this late stage of planning, imo MUST be Medicaid compliant. Not Medicaid eligible or allowed but compliant. She needs CELA or NAELA elder law atty to review her situation as to if it’s even feasible. Please don’t get snookered into her buying an annuity.... they might be allowed transfer of assets by Medicaid but they won’t be Medicaid compliant unless state is the primary beneficiary. Yeah, read that lil’ missive again.....

Personally if it was my mom, I’d spend 20k btw funeral & legal updating, another big $ to do dental work & put the rest into a boring savings account that pays some interest. & just draw down as needed to pay for AL & the more than likely eventuality NH or MC. She will have more options in NH if private pay. If she outlives her $, then she applies for Medicaid and she has a clear obvious legit documented spend down for past 5 years.
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mountainsoft Mar 20, 2019
I used a few different online calculators using moms assets, RRRB income, known expenses, tax bracket, and a 2% annual increase in costs. That's where I come up with the 6-7 year time frame. So far, the calculations seem to be holding fairly accurate, but I wouldn't be surprised if unknowns drop that to 5 years.

Right now her money is in a simple savings account earning about 2% interest. I also put about half in a one year CD earning about 2.6% and will reevaluate each year.

I had made arrangements to set up her funeral plans, but she changed her mind at the last minute. She said she wanted to reschedule later, but we'll see. I'm not going to push it.

I realize 5 years is a way out, but time flies and I like to plan ahead so there are no major surprises. We are making plans to retire in less than five years, so this factors into our own plans to some degree as well.

Oh, and the two year thing is the AL's requirement for medicaid. They only accept medicaid if you pay out of pocket for two years. Mom will be paying out of pocket much longer than that before she'll have to apply for medicaid. Just trying to plan ahead.
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TNtechie is right. In PA the NH subtracts the cost of the Medicare supplemental from the income they take every month from our cousin. PA requires you continue your supplemental so it pays hosp and other med bills before Medicaid has to. Her NH includes cable tv, no phone except the "house" phone everyone uses. PA personal needs allowance is $45 a month and the NH charges $35 for a haircut. No wonder most folks there look a bit disheveled. I asked about new clothing and such and was told "we have lots of clothes here"...made me sad the residents can only get new clothing via the stash of donated clothes. $45 doesnt go far. I would verify NOW that the AL does accept Medicaid. I thought Medicaid only paid for Nursing home care but each state might be different.
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Once she is on Medicaid, medicines and meals will be covered and the personal needs allowance is suppose to cover everything else (extra groceries, clothes, haircuts, etc). I would ask the AL exactly will be covered when Medicaid is paying the bill; I have heard some ALs include basic cable and a land line phone.

I suggest you to see an elder law attorney and see if some of your mother's money can be placed in a trust she could access after Medicaid qualification for her personal expenses.
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DeniseMiller Mar 25, 2019
My mom’s house just got condemned, long story but I saw our elder law attorney that is also a successor trustee on my mom’s trust I am POA. He told me that Medicare counts your house being in a trust as an asset, my mom is also 50/ percent owner of my grandparents which I own the other half in the trust. My mom has no money and it didn’t work out having her stay with me, she said I was holding her at her will and now she’s on the hospital and they are trying to find her a home. And the attorney is trying to sell my house Grandparents old home because Medicare will count as an asset and mine is worth about a million or so. That’s forcing me and my mother to be homeless. And I can’t afford care for mother. My husband wanted to retire next year. Doesn’t look like that will be happening. Mom was financially exploited and has nothing left , they depleted her and stolen all the families valuables. They do count a house in a trust as an asset. That’s what this attorney told me and he’s good he has a radio show about elder law on every Sunday. My grandparents did not want this house sold, they left all there money to pay for it for many years, but mom seemed to have gave it all away to these slum bags that were living and stealing from her. I tried stopping it years ago but no one not even this attorney could help, APS was even involved several times just to be told she could live what ever way she wanted, now we have lost everything. And they are still breaking into her condemned home and taking things out. I finally got a POA for five years Adult Protecive order. Those don’t work either, she keeps in contact with them. I don’t know what I’m going to do now. I also thought trusts weren’t counted as assets.
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