First check with your Area Agency on Aging to find out if Medicaid will pay for Assisted Living in her state.
Much depends on your mom'smarital status and level of income and assets. If she has a spouse living, ahe needs to consult with an eldercare attorney to protect the spose that is remaining at home
My mom just moved into assisted living and Medicaid is paying for it. My mom also pays a portion of it out of her income. She gets to keep $163 a month for personal expenses, plus she keeps money to continue making payments on a couple of medical bills. The rest goes to assisted living. Medicaid pays the majority though. I started the Medicaid process by contacting senior and disability services in our county and went from there.
What others have written is true, but I do want to clarify, that, at least for Arizona, IF the medical need for care is based on a dementia or Alzheimer's diagnosis, that Memory or Dementia care IS considered Assisted Living, and IS covered by Medicaid...whether the resident goes into a specialized unit in a nursing home, or a specialized unit or section of an assisted living facility or is going to live in a separate, specific facility for just Memory Care. In AZ, Medicaid will also pay for placement in small group homes for those with memory care problems, but in ALL cases, the facility must be Medicaid approved in advance. Not all are. And where they are, many will have only a certain number of authorized beds for Medicaid residents, because they will get paid much less money from the gov't for the Medicaid resident. When we had to qualify my Dad for Medicaid, we had an eldercare attorney and his office staff helped with everything, but a person can call their state Medicaid office and get their own representative assigned to help them with the paperwork too. If you already have your mother placed in Assisted Living, and they ARE a Medicaid approved facility, they should have a caseworker or social worker who would help you get started with the application process too. My Mom is in Assisted Living right now, and the one she is in, requires that one be private pay for three years before they would convert her to Medicaid and they rarely, if ever, have a Medicaid bed just be opened, because the residents living there are first on the waiting list for the 20 beds they have licensed for Medicaid. In general, for a Medicaid approval, there must be both a medical need and a financial need determination on the application. If the medical need is approved, and that's generally the fastest, easiest approval part of the process, then the representative will look at 5 years back of financial statements, and help you determine what you must do to get the financial part approved. My Dad had a 'spend down' amount of excess money we had to use up, before approval....so we had to spend about $75,000 on medical expenses for both him and Mom and do a lot of home improvement/maintenance stuff to use up the money. Those were the only two acceptable uses of money. Burial expenses was also OK, but Dad's was already taken care of when we applied. So we paid privately for his Memory Care facility for nearly a year, until we had used up enough money for his approval to come through. Now, had he already NOT had enough money, he could have started on Medicaid paying, within 30 days, in Arizona. You can also go to the Medicaid government website and find lots of basic information there...and go to your state gov't website and find out which agency in your state handles Medicaid and nursing home/assisted living/memory care facilities etc. In Arizona, all this is through our State Health Dept. I hope some of this is helpful to get you started.
Medicaid is funded jointly by your state & the Feds BUT is administered uniquely by each state within overall federal guidelines. To me, its important that you understand the basics on what Medicaid is about both for its medical & financial aspects. Care in a NH aka skilled nursing care is dedicated & required funding for Medicaid & they will need to show the "need" for skilled nursing care in addition to being "at need" financially (basically impoverished). But AL funding is done via a waiver (or a diversion of $) program. States can decide just how or what or even if waivers will be done & what the qualifiers are. Like CA has an established waiver program which is the IHHS (in home health services) system done county by county.
Most states do not do waivers for AL. Some states do AL waivers but narrowly limit the program. For example, TX has 2types of AL's....CCF which is 24/7 custodial care and not ever paid by medicaid and CBAAL which is community based alternative assisted living which Medicaid will pay for. CBAAL has a limited enrollment & pretty strict requirements for participating ALs so for families the # of available beds are teeny tiny and drawn from a waiting list. I found - when looking for my mom in TX - that less than 10% of AL in her area (big city too) even participated as CBAAL & realitically if you needed them to have 24/7 that meant getting them eligible - both medically & financially - for NH Medicaid or private paying for AL.
As an aside on this, the trend for waiver funding are PACE type of programs where they stay living at home or their kids home but go to a PACE center 2 - 5 days a week for care, medical monitoring & care, meals, etc. Family is responsible for care outside of the time at PACE. PACE is funded by medicaid to usually a non-profit partner who works with other health care resources (like Visting Nurses Assoc. to do flu & pneumonia shots) as well. There is a PACE by us - the Benson Center - that is very well received & run by division of Catholic charities in a repurposed school. So well received, that another one is being done by Catholic Charities into an old orphanage & school. If your state is doing PACE, you may find that they will need to be evaluated for PACE first & foremost before they can apply to another waiver program.
Medicaid is totally an state managed "at need" program which they have to clearly show "at need" medically (either from existing health chart or an evaluation by a health care provider at the NH, AL, PACE, etc.) for whatever program they are trying to get into AND to be "at need" financially by whatever income & asset levels determined by your state (usually impoverished).
Even connecting all the dots and completing the extensive paper work, the reality of California Medicaid is there are thousands of applicants for nonexistent beds.
I think when it comes to the word "Assisted Living" and "Nursing Home" is can be interchangeable depending on where someone lives. And how someone thinks what the facility does.
In my area, a skilled nursing home is a far cry from being an assisted living facility. Nursing homes are more like small hospitals without all the beeping machinery, etc. And the furniture is already there. And you share a room unless you pay extra for a private room, and there a hospital like curtains between the room-mates.
Assisted Living is more like a hotel with a nice private room where one can bring their own furniture, set it up like a college dorm. There are aides to assist during the day, but most people are doing what they want. When a much higher level of care is needed, then one moves to the nursing home.
SSBG Home and Community Services Assisted Living, Medicaid Waiver
What is Assisted Living?
A facility licensed in the state of Nebraska to provide residential and support services and approved as a Medicaid provider for clients eligible for the Aged and Disabled Medicaid Waiver.
Who needs Assisted Living?
Clients eligible for the Aged and Disabled (A&D) Medicaid Waiver who choose residential and support services in an assisted living facility.
What are my needs?
Access Assisted Living Choices to identify your needs and what assisted living facilities may be able to meet these needs.
Do I qualify for Assisted Living funded through the A&D Medicaid Waiver?
You may qualify if you are:
18 or older Eligible for Medicaid Needing help with activities of daily living (such as bathing or dressing) Eligible for a DHHS program that has the Assisted Living service, and a Services Coordinator has determined that you need Assisted Living
Much depends on your mom'smarital status and level of income and assets. If she has a spouse living, ahe needs to consult with an eldercare attorney to protect the spose that is remaining at home
Most states do not do waivers for AL.
Some states do AL waivers but narrowly limit the program. For example, TX has 2types of AL's....CCF which is 24/7 custodial care and not ever paid by medicaid and CBAAL which is community based alternative assisted living which Medicaid will pay for. CBAAL has a limited enrollment & pretty strict requirements for participating ALs so for families the # of available beds are teeny tiny and drawn from a waiting list. I found - when looking for my mom in TX - that less than 10% of AL in her area (big city too) even participated as CBAAL & realitically if you needed them to have 24/7 that meant getting them eligible - both medically & financially - for NH Medicaid or private paying for AL.
As an aside on this, the trend for waiver funding are PACE type of programs where they stay living at home or their kids home but go to a PACE center 2 - 5 days a week for care, medical monitoring & care, meals, etc. Family is responsible for care outside of the time at PACE. PACE is funded by medicaid to usually a non-profit partner who works with other health care resources (like Visting Nurses Assoc. to do flu & pneumonia shots) as well. There is a PACE by us - the Benson Center - that is very well received & run by division of Catholic charities in a repurposed school. So well received, that another one is being done by Catholic Charities into an old orphanage & school. If your state is doing PACE, you may find that they will need to be evaluated for PACE first & foremost before they can apply to another waiver program.
Medicaid is totally an state managed "at need" program which they have to clearly show "at need" medically (either from existing health chart or an evaluation by a health care provider at the NH, AL, PACE, etc.) for whatever program they are trying to get into AND to be "at need" financially by whatever income & asset levels determined by your state (usually impoverished).
of California Medicaid is there are thousands of applicants for nonexistent beds.
In my area, a skilled nursing home is a far cry from being an assisted living facility. Nursing homes are more like small hospitals without all the beeping machinery, etc. And the furniture is already there. And you share a room unless you pay extra for a private room, and there a hospital like curtains between the room-mates.
Assisted Living is more like a hotel with a nice private room where one can bring their own furniture, set it up like a college dorm. There are aides to assist during the day, but most people are doing what they want. When a much higher level of care is needed, then one moves to the nursing home.
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Home and Community Services
Assisted Living, Medicaid Waiver
What is Assisted Living?
A facility licensed in the state of Nebraska to provide residential and support services and approved as a Medicaid provider for clients eligible for the Aged and Disabled Medicaid Waiver.
Who needs Assisted Living?
Clients eligible for the Aged and Disabled (A&D) Medicaid Waiver who choose residential and support services in an assisted living facility.
What are my needs?
Access Assisted Living Choices to identify your needs and what assisted living facilities may be able to meet these needs.
Do I qualify for Assisted Living funded through the A&D Medicaid Waiver?
You may qualify if you are:
18 or older
Eligible for Medicaid
Needing help with activities of daily living (such as bathing or dressing)
Eligible for a DHHS program that has the Assisted Living service, and a Services Coordinator has determined that you need Assisted Living
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