Mom is 85 and in need of some financial aid or care. My dad was a WWII (one of the first navy seals), he passed away left my mom a widow in 1962. Mom raised three children and later in life remarried and divorced. The VA has denied assistance and the reason because my mother had remarried. The Assisted living want to provide all kinds of services (the cost are more than she can afford) if mom does not meet nursing home requirements, than I would have to take her into my home. I cannot help mom with all her needs. What can I do? I have called for assistance, and I have been passed from the VA benefits to writing congressman to meeting with nursing home staff, I have called medicaid and I have hit dead ends everywhere, should I hire an attorney? I am lost with all the needs and fiancial burdens. I do not know what to do and it is only getting worse. Moms health is declining and I cannot provide her needs, but I am worried that I may have to do what I can until one of us dies... I love my mother very much and have been her caregiver for years but the burden and financial needs are coming to a head.... Can anyone advise me .. If mom where to live with me I am afraid it would destroy me and my marriage... what should I do... ?? A loving son...

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Sacline - ok now onto the financial part....NH (aka skilled nursing facility/SNF or long term care/LTC) is paid for 3 ways: 1) private pay by either the elder or their family; 2) from LTC insurance; or 3) by qualifying for Medicaid. I'm assuming your mom is a widow and the below applies for widows. If she is married then there is whole community spouse financial aspect that is super sticky to deal with.

Medicaid rules determined by each state & are state specific even though it is a federal & state program. Medicaid is needs-based.You are expected to spend your assets first & foremost before the state will pay. There are things you can do to reduce assets but these need to be done by someone qualified to do this that will pass your state's review. An certified elder law attorney is best.

For NH Medicaid eligibility, an individual must show that:
1) are 65+ (can be younger if qualified disability),
2) medical condition requires skilled level of nursing care,
3) monthly income at or below their states max (varies, about 2K),
This is the “income test”– how much $ do you make.
4) all countable assets are at or below 2K (higher if community spouse).
This is the “asset test” – how much $ do you own.
5) not gifted away anything of value during 5yr look-back period.

If you do, could be a “transfer penalty” for gifting. Penalty based on each state’s NH daily reimbursement rate. For TX, $ 142.92 per day rate.

Look-back is up to 5 yrs. Most states require 3 – 6 mo. of all financials with application. You sign off on the state’s ability to Xreference records. State can require additional documentation if something pique’s interest, like paperwork to establish if insurance is term or whole life.

INCOME: Exact income max is set by each state. Most states have “income” at $ 2,022 per mo but it can be more or less. TX is $ 2,094. Income is whatever $ they get monthly – retirement, SS, annuity, etc. If they get something that pays annually – like a dividend – it can be sticky if the amount of the dividend for that month takes them over the income max and you likely will have to do a specialized form to have it amoritized evenly by 12.

If every month they are over the states income limit BUT not enough to pay NH in full for AND qualifies for NH in every other Medicaid way, then they can see an elder care attorney to do a "Miller Trust" or a "Qualified Income Trust". Say mom gets 1K from SS & 1,500K from retirement every mo. Income=$2,500. $ 500 over ceiling for monthly income. No matter what is always is $500 over. So this excess $ 500 is what funds the trust & therefore mom’s income is now 2K and within the states income ceiling for Medicaid. Beneficiary of the trust is state's Medicaid program and upon death trust reverts to the state. Miller really has to be done by an attorney who does elder law as it needs to be flexible / adaptable and meet the criteria of each state's law on probate (death laws) & Medicaid rules & MERP (estate recovery). Miller is totally legit and is especially used by retiree's who have railroad retirement as they are just ever so slightly above the 2K max.

PNA - For an individual in NH on Medicaid, all their income has to go to the NH less whatever your state has or their personal needs allowance (about $60). Realistically if they have a home or car (which are exempt assets) there will be no real monthly $$ to maintain them (insurance, taxes, etc). So if you mom has assets, this is something to carefully evaluate.

ASSETS: All assets are counted, unless the assets fall within the short list of "noncountable" assets:
- personal possessions,
- a vehicle (some states have a limit on the value)
- a principal residence, provided it is in the same state in which the individual is applying & the house may be kept with no equity limit if the "community spouse" lives there; otherwise the equity limit is about 500K (750K in some states)
- prepaid funeral (irrevocable, NCV, usually 10K max)
- small term life insurance (usually $1,500 & NCV)
All other assets must “spend down” to states max to qualify. The spend down has to be on either property they own or for things needed for themselves - could be funeral, burial stuff, dental work, getting a new water heater for the house BUT NO gifting to others otherwise you could face a transfer penalty.

None of this is easy. It's my firm belief that if they live long enough they will run out of $ & evenutally the caregiver will run out of ability and a NH will be needed.
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Sacline - none of this is easy, even for those with resources. I'm not familiar with VA but it sounds like the remarriage voided the possibility of VA Aid & Attendance. Now you mentioned Medicaid was a dead you have any idea why?

Medicaid is needs based, so mom needs to qualify both financially & medically for skilled nursing services, which is usually done in a NH. Some states have waivers for community based care - which can be in their home or in other "community" setting which can mean assisted living facility. Not all states do this, so you need to ask and find out what your state does. My mom is in TX in a NH and on Medicaid - for TX waivers are few and far between with waiting lists.

But back to Medicaid, why doesn't she qualify? Is it that she is viewed as having just too much $$ or that she doesn't medically meet the standards for needing skilled nursing. There are things you can do to make this happen - & none of this is easy but at 85 mom could be around another decade and you want her to have the best level of care and services which likely isn't going to be able to be done by you no matter how good your intentions.

The financials are what most folks focus on. But remember that they also need to medically qualify for skilled care for Medicaid. About 60% of NH residents qualify for Medicaid for their stay. Most NH admissions come from a hospital discharge as they get discharge to the NH for "rehab" then stay after rehab (which Medicare pays for 100% of the first 3 weeks). This 3 weeks in rehab creates a nice fat medical file which Medicaid can use to qualify them. But if they are still @ home it can be tricky...

ISSUES IF MOVING FROM HOME TO a NH: If they are living at home or in IL, and need to move to a NH, you will need to work with their MD to get the criteria in their medical history to show they need skilled nursing care. Just because they are old, or have dementia or incontinent, etc. is not enough. My mom went from IL to NH and bypassed going to AL. She was able to do this as she had a critical weight loss (more than 10% in 30 days), critical H & H and some other conditions. Sometimes the MD will need to change their meds – like go from Exelon pill to Exelon patch (more “skill” to apply); or change a med to one that needs to be compounded daily which you can’t do at home. Each state has it’s own criteria for admission under Medicaid. They will be evaluated at the NH and often are denied because they don’t have enough “critical” conditions because there is no history when living @ home. You will have to work with NH and your parents MD’s to get whatever done to establish the need for NH if they are coming from being at home or IL. There is a whole medical appeals process in each state for this and separate from the financial appeals. For those still living at home without a huge disease history, becoming a patient of the MD who is the medical director of the NH is good as they will know how to create & write up the health history chart so that it passes Medicaid medical review. Now this NH may not be your first choice but you can always move them once they get in an qualify for Medicaid.
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