My step-daughter is only 57 but at least partially disabled from a stroke. Clearly she cannot work; mobility may be fully regained, full vision, unlikely. She is single and doesn't qualify for Medicare. She will have proceeds from the sale of her house but those won't last forever. Any suggestions for handling "spend down" and on finding a placement for her in assisted living that will guarantee to keep her when she is no longer private pay!

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where is she now? Like still hospital, or in post hospitalization specialty rehab, or in rehab at a NH, or back at her home or staying with you all?
Personally I’d aim to keep her in rehab as long as possible and at whatever is the most specialized post stroke rehab program you can find. 57 is pretty young to be facing decades of future being disabled.

Has she been determined to be permanently disabled & will she get any type of retirement from her old employer?
Does her employer have a local HR dept or online HR?, imo she kinda needs to know ASAP how long till she’s officially unemployed, what kind of severance, vacations days, disability insurance etc to be paid and if any kind of GUL or other life insurance policy employer may have done.

if it’s that she is loosing her job, can she go onto COBRA? She might need to do this so that she doesn’t fall into an uninsured gap. Cobra is pricey but it’s guaranteed coverage. Cobra is super time sensitive, like you have to “elect” to go onto it in I think 60 days from when employer insurance stops.

If there’s a GUL (group life insurance) or other life insurance, imho, do what you can to keep it. It’s likely pretty low premium for a good bit of coverage. She should be able to take it - if it’s a GUL -with her on her retirement as the option to own it within retirement package. As long as she can continue to own it and pays the premium she’ll have life insurance. There’s no way she can ever get one now. She does want to not have her Estate as beneficiary, it need to go to whomever will be her dpoa imo. If it’s you as beneficiary, think of it as $ you’ll get back paid to you upon her death should she predecease you.

She - or rather you if your taking the lead to get stuff done for her - needs to know what her income will be.
Income is super important cause if it’s low enough, she may be able to get SSI & Medicaid. SSI is means tested & pays abt $775 mo. But Medicaid is included, which is a big deal $ wise.
if she had good earnings but now disabled, she could get SSDI & onto Medicare after 2 years of being on SSDI. She won’t have to wait till age 65 to apply for MediCARE if SSDI. Now insurance during that 2 yr period will need to come from Cobra, or maybe ACA or other health insurer. SSDI monthly varies as it’s based on your work history, but avg $1200. Right before yr 2, she signs up for Medicare. By that time you’ll likely know what her needs are to figure out whether to do traditional medicare & gap plan; or go with Advantage type of MediCARE.

SSI and SSDI both have specifics as to eligibility. SSA has pretty detailed info on their website. Investopedia website also imo has pretty good articles on what they are and how different. SSDI seems to need a atty who specializes in SSDI to do it as they all seen to be denied in round 1. Personally I think when it’s dealing with long term permanent disabilities and dealing with SSA / Medicaid, you best off with a savvy disability law attorney. She might be able to do a special needs trust that’s Medicaid compliant so that she can draw from it over next decades or so but not pose issues for otherwise being “at need” for getting on programs.

SC did not take ACA Medicaid expansion. It’s one of the initial 13 states who didn’t. Most of those states also aren’t into doing waiver programs like for AL or do waivers under very limited terms. If SC is this pattern, then her LTC options may be limited.
Yeah it will be quite the learning experience. Good luck.
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Have you verified that South Carolina medicaid will pay for assisted living? The first thing you need to do is find out whether or not SC Medicaid will pay for it-in some states Medicaid will not pay for it at all, while other states have a waiver that covers SOME of the costs of assisted living and unfortunately there is usually a waitlist for the waivers. So what I would do is figure out how much Medicaid will cover & how much her monthly income is (she must be receiving disability at least) and from there you can start contacting assisting living facilities to get pricing, ask if they will take Medicaid & arrange tours. Choose the best one she can afford and you might want to to get her in now because she may have to self pay for 2 years before the facility will accept her Medicaid. For the spend down, if she’s ready for AL now then the monthly cost of AL is a good way to spend down. AL’s in your state are very affordable! Otherwise spend it on her care—home caregivers if she needs them, any durable equipment that would make her life easier. Take her to the dentist and get all necessary work done.
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