My sister, who has dementia, lives with her daughter and son-in-law. Can she qualify for Medicaid?

LSS it’s all State dependent. If NC does MC LTC Medicaid “waiver”, then the kids need to find a MC with LTC waiver open beds somewhere in the State and asap try to get her in as “Medicaid Pending”.

Why “waiver”? Under LBJ era Federal laws, Medicaid established there would be dedicated Federal funding for those over age 65 who were “at need” for long Term skilled nursing care in a SNF/NH. Federal payment to the States done via CMS (Centers for Medicaid & Medicare) based on States demographics. BUT Medicaid is administered by each State uniquely with each State determining “at need” financial eligibility but under overall Federal guidelines. What majority of States do is income max of $2829 and nonexempt asset max of 2K. All States have a required Share of Cost paid by the elder to the facility of almost all their mo income. NOTE: If your niece/ nephew are not aware of the SOC, they have to keep this in mind if your Sister has debts, like she’s still paying on a funeral plan.

But back to my Ted Talk: Each State determines daily LTC Medicaid room&board reimbursement paid to a NH with LTC Medicaid SNF beds. Some reimburse low (under $200 day), others much higher. This has led to unavailability. Plus health care has changed significantly since the 1960s for actually really truly having to have skilled nursing oversight. What a State now can do is ask CMS for a “waiver” for some of that dedicated SNF $ to go to programs that serve the same demographic. Voila! Waivers to put them in AL or MC rather than a SNF/NH. More butts in beds for less cost.

Not all States do waivers. Why? Big reason is waivers are NOT dedicated funding. Waivers run on 3-5-8 yr cycle's so State Medicaid staff has to do lots more paperwork PLUS something else could try to get that $ (like PACE, it’s the cute new girl for funding). For facilities, there's risk that waiver won’t be there continuously, so they don’t participate in waivers at all; or do so under allowed by their State the 2 yr private pay then eligible for one of the few waiver beds at the AL or MC system; or for LTC Medicaid accepting NH that are adjacent to an AL, the AL will do waivers but use the AL waiver beds only as placeholders for long time residents who are ready to be in the affiliated NH but no open bed in the NH yet. Add to this to keep in mind, MC are usually licensed as being an AL; it’s up to a facility to determine if the waiver is for AL bed or for MC bed.

My mom’s IL place had AL and NH all within its footprint; it’s was a true tiered complex; the AL Medicaid waiver beds were 100% beyond NH ready AL residents just waiting for a death over at the NH to get a spot. At the time I was really peeved when I found that out, as mom was not this but beyond IL. On retrospect, this makes total sense to do from a planning perspective.

For waivers, it’s a lot of moving parts that most folks have no idea exists or matters. It can be frustrating because it all seems so random. But it’s not.

Looks like NC does do AL/MC waivers. Kids need to search locally and then go to other counties if need be. Once Sis has cleared LTC Medicaid eligibility, they can move her to a closer place once a bed is open. It’s a bit of a ballet to do, but can be done.

As long as she meets all the Medicaid guidelines there should be no problem with her qualifying for Medicaid.

Does she have any assets like a house or cars in her name? If she does, then those will have to be sold and the money from them go towards what is called a Medicaid spend-down. That means she will be cash pay on the memory care bill until the money runs out.

If she doesn't have any assets or has tranferred them out of her name or into an 'Irrevocable Trust past the Medicaid 5-year look back period, she will qualify. The facility you put her in will take her monthly income then Medicaid will pay the rest. You can talk to a lawyer who specialized in elder law and estate planning for guidance, but if youe sister is holding assets in her name, there really isn't any way around it.

Great insights already given that should help you understand the Medicaid system, but the bottom line is contact the Medicaid office in your county. In fact, going in person is your best bet to get clearer answers. All the information given here is great to be aware of as it may help you be more prepared to make the most of your first trip. It can also be a guide to create a list of questions to get answers you may need to better understand the steps you need to take. I have not been down this path yet but appreciate all everyone has been sharing to prepare myself for that first visit should it become necessary.

Lisabee63,

In answer to your question, The Centers for Medicare and Medicaid Services (CMS) provides a glossary of acronyms used in Medicare and Medicaid. You can find it on CMS.gov. This tool allows users to search for specific acronyms and their meanings. If you need further clarification, you can also look at the Medicare.gov glossary for additional terms related to Medicare.

You qualify for Medicaid both by NOT having any assets (having only the assets allowed by your own STATE Medicaid; they vary) other than one home and one car. You must also qualify in terms of NEED. So you are no longer physically and/or mentally able to do your own care. This would be "in facility" care. NOT home care.

Memory care often isn't covered by Medicaid. It usually only covers nursing homes that are Medicaid approved. Memory care is private pay in most cases and corporate or hedge fund owned.

Giulyana55: Go to Medicaid.gov.

Only way to know is by contacting the local county medicaid office and applying.

I think your question may have been based on that Mom lives with a child. Your sisters income will not have anything to do with your Mom being excepted for Medicaid. Its all based on Moms assets and monthly income.

My Mom lived with me and then an AL. She had 20k left, I placed her in a LTC facility and she private paid for 2 months. That gave me time to apply for Medicaid and spend her down within the 90days allowed. She paid May and June, July Medicaid started paying. Her house was up for sale and was an unexempt asset until her death when Medicaid put a lien on it which was satisfied when it sold.

What is said and what can legally bedone are two different things, IMO. Federal and States share in the cost of Medicaid. The Federal money may stop but there is still the State money. I see cuts and revamping.