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My wife is in the process of trying to transfer her father from an assisted living facility in Arkansas to either a nursing home in a different area of Arkansas or a nursing home in Kentucky. They set up a Miller Trust in Arkansas that allowed him to qualify for Medicaid LTC. We are trying to determine what needs to be done to transfer to a nursing home in either Arkansas or Kentucky. Can the same Miller Trust account be used if he stays in Arkansas? Will he need to go through Medicaid approval process again? If he moves to a Kentucky facility, would we need to set up a new trust or can it be transferred to Kentucky? Any assistance would be greatly appreciated.

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Medicaid transfers within the same state should not require changes to the trust. However, you will need to coordinate payment between the two facilities to make sure that Medicaid payment goes to the correct facility in the correct amount for the right number of days so that your loved one doesn't end up non-compliant for the payment rules.
Is there a medical need for the higher level of care? That will be one of the determining factors for the transition and will assist in making sure that Medicaid pays the long-term care need - if parent is currently on a Medicaid waiver for the assisted living and needs long term care, the new facility should have someone on staff that can help you with paperwork. But documentation of the medical need for the transition and higher level of care is a must. Please remember that the move will have to be paid for by family in most cases unless you can demonstrate that the move is driven by a lack of ability to care for the parent at the ALF and the medical necessity of the move -- you will also have to make sure that any medications will have to be collected from the old facility and taken to the new facility. Medicare and Medicaid only pay for a certain number of meds per period and if you leave medications at the old facility, Medicare/Medicaid won't pay for replacements. You will have to collect any medical equipment owned by your parent and coordinate personal effects being moved and placed in the new facility. That cost is on family too.
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Thanks for your response.
What if he transfers within the state from an assisted living facility into a higher level skilled nursing care facility? Do we need to make any changes to the Trust for that? I assume he does have to re-apply for Medicaid for the skilled nursing care facility, since his current coverage is for an assisted living facility.
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Medicaid stops at the state line. You have to qualify in new state. You need a lawyer as the Miller Trust was set up with Arkansas beneficiary and you want to change to another state with new rules.
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