Mom in nursing home on self-pay. When can I apply for her Medicaid?


Do I have to wait until she has less than $2000? Will we need to cover her nursing home bill until she qualifies? Will the nursing home work with us knowing that Medicaid will cover the bill retroactively? She has no vehicle or other property, only enough funds for about another 18 months and she hasn't given anything away.

This question has been closed for answers. Ask a New Question.
Find Care & Housing


Retired - well your mom is fortunate that she has enough assets to be able to self-pay for 18 mos. Average NH cost is 8K a mom. So mom has about 150K set aside? and although that may seem like a huge amount of $$, in the world of long term care costs it's really not.

My suggestion is to speak carefully & clearly with admissions & billing at the NH regarding how they approach Medicaid. Each state runs it's Medicaid program uniquely, so there are differences. For my mom, the NH provided me with a 1 page list of documents that would be needed for Medicaid. The NH in turn reviewed these to do their own determination IF mom would be accepted by the NH as a "Medicaid Pending" resident. The list can vary by facility too as my MIL in the same state but another part of the state got a 2 page list of documents the NH wanted to see for Medicaid Pending! Medicaid truly is a mice-maze to deal with.

Just clearly find out just what this NH will require from you for their application review. Some places allow them to be "Medicaid Pending" once she gets to her 2K asset & 2 K income limits (so she - or rather you - can fill out the Medicaid application); other places don't. Find out just what the approach is for where mom is. Make sure that they take Medicaid (& not just Medicare) & if there is a private pay waiting period before the NH will place mom on their Medicaid bed list.

In many ways, having funds right now gives you a lot of flexibility for what to do with mom's 150K other than just paying a check to the NH each month. If she does not have a prepaid funeral & burial policy, then I'd get those done & paid for from mom's $. Most states cap this at 10K, so you want to make sure you are within what Medicaid allows for funeral. They need to be NCV (no cash value) and the FH know how to do this so that no issue for Medicaid. Another thought is if mom needs any dental work done, use her $ to get this done now. Medicaid really does not pay for ANY dental at all. Dental is very expensive too - for my mom she spent-down a lot of her a$$ets doing dental work. Really you could easily spend 20 - 30K or more on dental and it really will pay off for them in the long run for their health as dental care just declines drastically once they are in a NH. Also Medicaid payments for glasses, hearing aids, walker are iffy & the absolutely the cheapest or nonexistent. So buying mom 3 pairs of glasses (as these just go MIA at the NH); really good hearing aids and a tricker out walker are all perfectly OK use of her funds for a spend-down. Really anything for her use or her care is OK. For my mom, I wish I would have bought lots more shoes for her - these too just go MIA in the NH; also lots more appropriate for a NH laundry system type clothing as it's super high heat machines and clothes get broken down easily in them. My mom's once lovely wardrobe was garbage within her first 6 months at the NH as the machines are just industrial rough. There is no reason why - if you have the room to store them - to get a couple of years of nicer clothing for her & do some spend-down $ for this. Please look to see what the other ladies wear @ the NH too so she fits in. My mom's NH is very much a pants, long or 3/4 sleeve blouse & sweater vest place as they don't like them wearing "house dresses" unless they are bedfast. If mom still likes to read, get her like 2 or 3 years of prepaid subscriptions to large print magazines; or 2 -3 years of books on tape subscriptions if that would work for her. If her NH has cable ability, then prepay for that for her for 2 -3 years if you can. Really all this is to do a spend-down on things with her $ on things that if she doesn't then you will end up paying for.

Unfortunatley it is probably just too late to do anything creative with her $$ as she is already in a NH and even if she has 150K it will just evaporate within a couple of years of NH & health care bills. The costs are just staggering.

Another thought, if mom has funds, I bet she & your dad may have done investments or better insurance. Try to find out if there is anything out there that could be an asset problem for Medicaid. Especially the insurance, if she has a whole life policy there will be a cash value and that is an issue for Medicaid. If it's term that's usually OK but you want to make sure the beneficiary is you or your siblings and not her estate. So carefully read the policy before you have to submit all this with her Medicaid application. Good luck and try to keep a sense of humor in dealing with all this.
Helpful Answer (0)

I think I can answer part of your question. Yes, the nursing home will allow your mom to stay there as long as she is applying for Medicaid and Medicaid will cover your mom retroactively from the date she becomes eligible. Until your mom is eligible all of her monthly income goes to the nursing home to pay for her board and care. This is also considered spend-down.

As for when you should apply on her behalf, the nursing home most likely has a social worker on staff. Talk to the social worker about when to begin the application process. They tell you the application process only takes a few months but it took us 6 months for my dad to be approved.
Helpful Answer (1)

The first answer is to consult an attorney who is aware of the Medicaid laws in your state. But of course this will be costly, and before immediately moving to the lawyer, you may want to start with the the Medicare.Gov site to get a "feel" for the amount of monies she can retain, the 5 year look back and the people you can contact in your state. Based on your information, it sounds pretty straight forward if the funds you refer to are in a liquid form such as a bank account,CD, stocks etc.Be sure you keep careful records about payments to the home or insurance, they will look for any moneys you take that could be recognized as gifts. In the state of Ohio, the qualified recipient must have a bank balance of only $1500.00 and is allowed $40/month for her expenses such as hair care, clothing etc. If she has a burial plot and the expenses associated with burial I believe are excluded. In terms of the facility helping you, yes they will but particularly if she is in a for profit facility they will in my experience insure they receive the greatest amount of funds possible. In the end it is best to carefully select the attorney, Check his ratings and it is helpful if he practices in the same county as the facility, since he will have interacted with the Medicaid local people and better understand how to interact more effectively. Hope this helps, I just learned my mother was fully qualified for Medicaid and she had similar holdings to your mother. She has been in the facility for 22 months, and it took 15.5 months to receive qualification. As I recommended to you, take a little time to learn about Medicaid on your own, then use a lawyer. In my case the facility said they would help but did not.
Helpful Answer (0)

This question has been closed for answers. Ask a New Question.