What if you qualify for Medicaid but don't seek a bed right away?

There seems to be some confusion here regarding the process of Medicaid and the way nursing homes work in regards to Medicaid Beds. I will try to break it down in a clear fashion.
Firstly, when an individual is living in their home and is looking to apply for Medicaid at home. You submit the Medicaid application when you’re financially and clinically eligibility and have met your states criteria. However, the Medicaid only begins to provide coverage once a Medicaid approval has been granted. It does not work like this in a Skilled Nursing Facility.

In a Skilled Nursing Facility, you submit the application when you’re financially and clinically eligibility has met your states criteria. However, while the application is pending approval the nursing home will continue to provide care. During the pending period Medicaid will not be paying the nursing home bill and you will not be covering the difference from your income to the Medicaid rate. Once the application is approved the Nursing Home will be paid retroactively from the date you requested coverage and met the Medicaid eligibility criteria.

As far as the condo goes. If mom is receiving community Medicaid she may live in the home and have it under her name. Yet, Medicaid reserve the right to place a lien on her property once she passes away. The lien will generally be put on a property up to the amount of money that Medicaid has paid out for the care and needs of the recipient.

If applying for Medicaid in the nursing home, the primary residence would need to be listed for sale (secondary residence would need to be sold prior to applying) in order to apply for Medicaid. If the home sells once she is already on Medicaid she would have to spend the assets down to her states Medicaid limit ( no gifting to family or friends) and reapply for Medicaid.

If the property does not sell until after she passes away, Medicaid will place a lien on the property for the amount of money that Medicaid has paid out for her care. If there is remaining equity in the property that exceeds the Medicaid lien amount the heirs would receive the money.
In either scenario heirs may either sell the home and use the proceeds to satisfy the Medicaid lien or if they wish to keep the home in the family, they may satisfy the claim with their own personal funds.

As far as Medicaid beds. There are a couple of things here. Medicaid approved nursing homes have a certain amount of beds that they are required to reserve for Medicaid recipient. The number is a small percentage based on the size of the facility. Most facilities have this quota filled by residents that came in paying privately and later converted to Medicaid. The reality is that cost of care in a facilities is astronomical that there is a very large percentage of the senior population that will need Medicaid so the quotas get filled up quickly. Filling a bed in a nursing home is unfortunately a business transaction. If the facility has a lot of beds empty one month they will be willing to take whatever comes there way. But if they have a choice between taking someone that pays privately or that is on Medicaid. Private pay is always significantly higher than the Medicaid rate. Although some facilities do have waiting list many times facilities circumstances may change and when they thought they may have available beds a month before it can get filled quickly. Reserving a Medicaid bed in advance is not always doable when still living in the community. The best way to reserve a bed for Medicaid is to first pay the facility a few months private and when ready for Medicaid the facility will be more willing to give you a Medicaid bed. I do understand that this is not always an option.

I don't know what state you are from, but in NY you must sell the condo, or spend the extra money 5 years prior to entering a nursing home. You can't sell your condo today, and go into a NH right away or less than 5 years, they will recoup the money.
We just went though this, and my Mother-in-Law passed away in December. We're not really sure what's going to happen, but we're selling her coop right now.
Good Luck and God Bless.

Also, I prob. could qualify for Merp @CarolLynn because she would have had to make a decision years ago without my kids and my tending to her needs. We did not hear about being compensated as a caregiver until recently so I guess all that income for my family is sadly lost. I'm not sure what value MERP protection would offer us if there is a bias when processing NH applicants as to who has the best ability to pay the most cash against the NH billings.

My mom is 88yo and mentally fine, some minor short term memory loss. The rehab center has done a complete reversal and intends to release her in a couple of weeks to live back in her condo, but limited to the first floor.

The family was strongly divided about the timing of securing a long-term Medicaid bed with many wanting that time to be now, sell her condo and be done. The problem is, she won't consent to selling, and the doctor has confirmed she is mentally sound. Plus some of the family is willing to allow her to return to the independent life she had a couple of months ago because she is lucid and pretty physically capable as well. It seems the cost of an Elder Care Attorney prohibits much legal advice for people like us and the set up of a trust to shield her condo is only a temporary fix since the nursing home business seems to want to know that real estate is available for them to lien against and will favor you over another when they are considering competing Medicaid pending applicants - along with considering the size of the Social Security and pension checks they will get dollar per dollar. Sad, but it sounds like money still talks even when trying to secure a long-term Medicaid bed for a loved one.

Oh, also, you can keep your primary residence ($ limits) and a car of any value and still get a Medicaid approval and live in the NH in a LT bed, but after burial Medicaid is going to lien on the house and get reimbursed for the room and board they just paid for, so not much shielding occurs once the primary residence is the nursing home.

My mom's future is in her own hands right now until she decides she cannot live on her own, or the ones caring for her decide for her. This has been an eye opener, and the family emotions have ruined some relationships. Bottom line is that it's not a vote when Mom wants her life back.

I'm so grateful for this forum - a sanity maker for me. Input is MUCH APPRECIATED. So many pitfalls and it's hard to think straight with so much emotion and drama happening on so many issues. People talk in a vacuum and you have to continually pull back and look at the long term plus the short term before making final decisions. You guys helped us do that so thanks!!! We now have an idea of what lies ahead and it won't be so stressful...about this anyway! :)

Never alone....As a REaltor, I have never heard of the Lady Bird Deed. I am already on the Deed with my Partner as the Trustee. I should probably talk to an attorney about this type of deed. WOW

Did your mother give you a gift to help you buy, or is she on title in Ca.?? I am a Realtor in Ca., but I have never heard of anyone being put out of their house because of a lien from a County in another State. Call a GOOD Realtor and get free advice...The Realtors have free legal advice available to them through the State of California Department of Realtors. ASK!!!

I was told that the care homes will let her live there knowing that the funds are COMING in the future. I don't know if that is true. My God, I cannot believe Genn15 had the County loose her paperwork. What idiots the County has working for them. I agree with her, if you can afford an Elder Attorney - get one now.

I don't know what the mental state of your mother is right now, but when my mother was first diagnosed with Alzheimer's we took her to a lawyer who determined her capable of signing a "Lady Bird Deed" which basically deeds her home over to my brother and I at the time of her death and removes her home as an asset that can be used by medicaid in the event we ever have to put her in a home. You may want to check into something like that if you can.

I meant to say "out of CA relatives".

Mom used Oregon Medicaid. Does that mean that I as a remaining CA resident daughter who co-owned, lived with and took care of her mother for over five years in our jointly-owned CA condo can still be forced to move out after Mom has died? To be displaced to CA homelessness or be forced to move to out to CA relatives seems cruel in my humane opinion.

There is no requirement to apply for Medicaid, but if your mother does not have the funds to pay the nursing home, then who will pay the bills? So usually what happens is the nursing home resident runs out of funds and in order to stay in the nursing home MUST apply to Medicaid. Once your mother is approved for Medicaid, the state will keep track of what they spend on her care, and upon her death they will seek to be reimbursed out of her estate. If the only asset in her estate is her condo, then they can force a sale of the condo to take what they are owed. If there is any money left out of the sale proceeds, it will go to her heirs or under her will.

Thank God my mother put her assets in a trust. Twenty-four years ago (1991), she and I had bought our CA condo in 50/50 ownership interest. We enjoyed our lives until Mom needed to go into assisted living in April 2013. Later that year, my Oregon family moved her up to the State of OR to qualify for Medicaid because Medi-Cal here is tough and might have taken our condo after she passed, leaving me homeless as well as an unemployed clerical worker in CA due to a genetic disability. After Mom passed in November 2014, I inherited her 50% of our (estate) condo which have just been recently transferred to my sole ownership. I understand that when I do eventually sell and move out of my condo, Oregon Medicaid will have to be repaid about $50,000.00 that covered my mom's care in 2013-14.

Also, another reason you need to consult with the elder care attorney experienced with Medicaid is that while Medicaid is a federal program, it's implemented by the states, and while each state must meet the minimum federal standards, there are differences in what the benefits are depending on the state. All states do not have the home care benefits. In Arizona, they amount to about 20 hours a week of in home help, and so the family still has to pay for any in home care they need beyond that. They will not force you to sell your home or one vehicle as long as you are at home. But once the home is vacated, it must be sold or there is a penalty period during which Medicaid would not pay for facility care. Get the advice of the elder care attorney. Ours has people in the office who helped with all the Medicaid application. If everything is turned in properly the first time around, coverage should start in 30 days. BUT, each month, there is a deadline to turn in the application. If you do not meet it, the whole procedure starts over again the next month and they all the new data from the previous month submitted. My Dad had assets, a trust, a wife still at home, a spend down period that we had to deal with, and it took almost a year to get everything turned in properly for him to qualify, even with the financial adviser helping me. We spent over $75,000 of his investments, down, for the private pay at a facility until he qualified. If there are no major assets to spend down from, it may be easier to do it alone, but I found it quite overwhelming even with the adviser, myself.

I also want to piggyback pamstegma's comment. If you go in private pay with no preparation, you will lose everything. And it's not necessarily true that you get into a nice facility because you're private pay. A bed has to be available and they have to accept you. It is possible to get into a nice facility if you're already on medicaid. However, Pam is right that facilities discriminate based on financial resources. They know that most long term patients will eventually be on medicaid, so what they're looking for is large social security checks and large pension checks which will go to them every month. I know for a fact that facilities will reject you if your ss check is small and you have no other resources. They will claim there's no availability, that they'll call when a bed opens, and somehow that never happens. In the flip side, when you go in with funds, they will enter fake charges on your bill in order to get even more money. As for a nice facility, unless the place is a true dump, the decent ones are all pretty much the same. There's nothing stellar about any nursing home. The medical care you get will be a real downgrade from the care gotten on the outside, sometimes dangerously so. That said, if you have run out of options and need a lifeline, a decent nursing home is a life saver.

And to answer your questions, once you have medicaid you have it. It's just like any other insurance in that regard. Medicaid will not make you apply to a nursing home and will not drop you if you don't go into a facility right away. Usually when you go into a facility on community medicaid the financial person there will convert you to institutional medicaid. The difference with institutional medicaid is that there is a five year lookback, so if you are looking at nh as a possibility for the future, you should proceed with that in mind. Talk to an elder law attorney about that now. There are ways to shelter your mom's condo, but there are rules around that and sometimes they change so you can't do this right without a lawyer. Leins come into play only after your mom's death. Believe it or no, after medicaid has paid for your care, they will look to the estate to see if there's anything they can recoup. They will then put a lein on the house if they can. If it's in a trust, they can't since the house belongs to the trust and not to the person's estate. Please dont even attempt this without talking to a lawyer first. The lawyer can present you with several options and since there's no immediate need, you can take your time, be thorough, and choose a great option.

A competent elder care attorney is a "must". And the cost will be part of the pay-down. While the state
Regs apply to all state residents, the application may be processed through a county agency. This can lead to differences in interpretation, timeliness, depth of application review, etc. The right attorney will get you through this. Lots of us have gone through this so ask around before you sign on.

I guess we'd all like to keep what we've worked for or reap the benefits but if the best use of Mom's assets works towards keeping her comfortable and content that seems like a good alternative.

On medicaid, you are still allowed to have a place to live! If your mom got medicaid now, she would have "community medicaid," meaning that she lives in the community not in a facility. She would be allowed to keep her primary residence, one car, her retirement accounts, a $10,000 burial fund, and a nominal amount of cash in the bank. There is no look back for community medicaid, so there's no harm in applying for that now if your mom is poor and needs the insurance. Community medicaid will pay for home care and respite care (up to 30 days) in a nursing home. Those are really good benefits that could potentially keep you out of a nursing home for years, depending on your condition. You don't say if your mom needs a nh now or if this is preemptive. Here's what I would suggest: join a local chapter of the Alzheimer's Association and join a support group even if your mom does not have dementia. Its free to join and every few months or so, they bring in an elder law attorney to fully explain medicaid in your state and answer any questions you may have. It's a great service and it's all free. If you don't need caregiver support, join on paper so you get notified of the seminars.

Good advice. About to go through this. Thanks a million! One day maybe things will change but for now this is so d*mn hard.

I was at my wits end trying to comply with confusing and contradictory Medicaid documentation requests then they misplaced mom's application. I got an eldercare lawyer and am stress free. It cost $10K but was part of our "spend down" so def worth it!

This is a complex issue. I agree and strongly suggest finding the most experienced elder law attorney in your area!

I don't know, bit this might help. 360financialliteracy/Topics/Retirement-Planning/Medicare-and-Medicaid/Medicaid-and-the-principal-residence

READ THIS and comply:
{Q}You need to see a qualified elder law attorney and find out your options before you make a misstep. {End Quote}
We are working with our elder law attorney { on a frail elder waiver} who has solid experience with the ins and outs of Medicaid politics.

Agree fully with Pamstegma. I will add there is no free lunch. We all worked hard for what we have in terms of house, savings, etc. Medicaid for nursing home coverage is a fabulous benefit in my opinion. If she needs the care, the personal cost is merely incidental, although I admit it is potentially highly emotional.

Most trusts are revocable and don't protect the residence during the 5 year look back, in case you're thinking they do.

What might prevent the government from going after recovery, MERP, could be if you satisfy the provision that you took care of her for over 2 years and prevented her from meeting today in a nursing home or on Medicaid.

Then there is an application process that the time you get notified of the MERP, and you don't have very much time to respond.

I don't know whether or not an irrevocable trust would insulate you, but I have a feeling it might have had to be in place long before now.

You need to see a qualified elder law attorney and find out your options before you make a misstep. With Medicaid, you have to get it right the first time. You can't unring a bell.

If she has more than $2000 in savings, she won't get Medicaid. Usually people go into a facility and spend down, sell the real estate so you can go in as private pay in a nice facility. Then when the money is gone, the application goes in. She can't afford a condo after that, because the NH gets her entire SS check every month.