How can you get someone into a memory care unit when there is no money and we don't have the time to wait for elder waivers?

Well, an elder law office could help - KM, maybe worth the consultation fee for your situation too - and find out if a Miller trust is any kind of an option. That may be more for ongoing excess income rather than one-time gifts but I'm not sure. The 10K gift probably should have been refused - or maybe could have bought a prepaid funeral plan or something? Depends on details of all the rules and regs in each state. You'd think once it was spent down you'd be back on the Waiver already, though...

I've never heard of 'waivers'. What are these?

I am currently in Assisted Living. I have about $20,000.00 in savings remaining. I have been told that I will have no problems getting Medicaid (I am starting the application process) as they only go back 2 months-the supervisor of the ALS today me this. I always though they went back about 2 years into your resources,or those depend on state guidelines? I live in New York State.

Dear Mallory, I decidedly agree with you completely! I am extremely angry at people who are bums, never work and never save. My own uncle is like that and I almost want to strangle him when he tells how he gets people to clean his house, do his washing, run his errands and he gets freebies all the time- free gifts cert. for restaurants, free food from markets, clothing for free all from Title 19. And here's the kicker-2 years ago, I set up a budget for him when he had blown $ 5000. of my mother's inheritance money to him on pornographic videos! When he moved to low income housing, I filled 2 dumpsters with all the " stuff" he ordered and never paid for. It is unbelievable. He had a job as a dock worker in a dept. store and he did have enough to live on, with plenty to spare. But he blew it all and then got himself on Title 19 and just "expects" everyone to wait on him hand and foot. I try not to see him , but he is my only still living relative and I try to be nice, as I think it is the Christian thing to do, but I must tell, my blood boils everytime he brags about how he gets all of these services for free! There is more to the story, but I will leave it at that.
You are right- I am angry that some idiot like him gets on Title 19 and I, who have worked all my life, saved all my life, never asked a thing from anybody will be forced to lose all I had and go on Title 19. The system is all wrong. Those who lived life correctly, saved their money, but could not ever have enough to pay for Title 19 are losing out and all those bums out there and kids who owe tons of money for all their " gadgets"- which by the way, I still have just a flip phone, and until last year still had " dial up" on my 20 year old computer. Trust me, I am not the person you assumed I was in your first post.
So let's agree that we agree and that unfortunately, since my husband never saved any money and I was nice enough to stick it out with him through physical and emotional abuse, I am in a unique situation that because of him, I will end up in poverty, through no fault of my own and have every right to be angry that I am the victim in this situation. EK

And if I were making the laws, I would require a 30 or 40 year look-back....that is the only way to really make sure people don't take advantage (or steal) from the responsible taxpayers.

Medicaid is funded by the government, which is funded by taxpayers. Everyone who pays taxes is paying all those needy people's bills, and it is only right to have leftover estate assets used to offset the costs that we all paid, if there are any assets left. Just like most everyone else my family has had people on Medicaid and has had their assets "recovered " thru MERP. My own mother had mostly her home, and if she had gone to NH care, would have had to sell that home and use it for her bills. If she had lived to be 101 like her sister she also would have had Medicaid. There is nothing my mom, or I have done, to give anyone the right to be angry at me-- you don't know the whole story at all-- instead, you should be very glad my parents scrimped and saved (and passed those values down to me), thus saving all of you from having to pay her living expenses, at all. If you want to be angry, please consider the millions who do not save, do not work hard and who continually live beyond their means--and then expect the responsible ones (like me my parents and a minority of others, apparently), please direct your anger to those who refuse to live responsibly. Kids in high school need to start saving for their own senior years! But no, their parents are buying them I-phones. And everyone falsely believes there are going to magically appear a room in a nice AL or NH just when they need it. This is not only untrue it is extremely unfair and irresponsible. Everyone needs to work hard, save a lot, and not depend on taxpayers.

/To Mallory, I think you have the wrong opinion here, I am totally against having to go on welfare or Medicaid. As it turns out, you obviously do not live in WI. WI leaves you only $ 50,000. to live on. You are correct,you can keep your own house, but do the math. My real estate taxes are $ 7,000/yr. My condo fees are $ 4,000./year. I am 74. If I live as long as my mother, age 96, I have to stretch $50,000. over 22 years. Get real here. That is about $ 2,250 per year, so it sounds real nice to say you can stay in your house, but obviously I would have to sell it once we have only $50,000. left. No one can afford their home once you are on Title 19 and still have money to pay bills, food, car etc.
Further, my situation is that my husband never saved any money.We never lived " high on the hog" He just didn't make much. He was dead broke 3 years ago.No pensions or IRA. Even though I should have divorced him, I did the Christian thing and stuck it out, so now, while my husband is in a nursing home and I am paying $ 14,000. a month out of my savings, which is $ 168,000. per year. I also worked for 40 years at customer service in my own business ( and we have no pensions to rely on and my husband has no IRA) working on my feet about12-14 hours a day and worked to age 72 until my back gave out. and yes, I did save my money ( thank God) or we would be on welfare already! So unless you are a multi millionaire, tell me how long you could shell out $ 168,000 a year plus my own living expenses. Very few people could do that- if they could, how come 90% of the people are on welfare in nursing homes? I think it is unfair that I should end up in poverty just because my husband got sick and I had to use all my money and in the end, if I need care, I will be on Title 19 - and yes, there is a difference. In my husband's home, all Title 19 people are put in double or triple occupancy rooms , There are way too many people out there who illegitimately milk the system and so those of us who saved and saved and played by the rules get to end up in poverty. I just thought you should know more specifics since you think I am getting a " free lunch" Look at all the people who never worked, never saved and are bums and living off the government. I am very very angry about that.
I think a fairer way to do it would be to divide a couple's assets in half when one enters a nursing home. the community spouse would then have money to live on and stay in his or her home and the other one would pay till his share of the money runs out, That way the government pays for only 1 person on welfare, not 2. Are you aware a lot of states do it just that way. Not WI. As I stated, our seniors are on the second lowest rung of the economic ladder do to the state government. The federal government has no jurisdiction over the state of WI.
Perhaps now you will understand how upsetting this is and why I am angry. EK

Mallory - yes Omnibus had estate recovery in 93 Act. But whether states had to have in place a codified structure was not established till Deficit Reduction Act in that it was required to be done & enforced for co-sharing of costs (i.e. federal funding to flow). Prior to DRA, MERP was pretty much scattershot as done by the states. Many many states did no recovery prior to DRA as there was no federal requirement to be done; it was more of a guideline of what recovery could be.

MERP is somewhat similar in what PL 93-641 did for Certificate of Need reviews, in that before 93-641 CON was supposed to be done for cost-containment in health care but not required in order for a project to get approval or funding flow; there was no specific structure for CON only guideline of what review could be done. It was scattershot in approach for application as MERP was. Once 93-641 signed, there was a specific structure established for CON review. Similar to what DRA did to change what MERP has to do. CON ran for about a decade plus during the more go-go years of hospital build outs. CON laws got revised and most phased out as hospitals have consolidated & less competition, although a few states (MS) still have CON on the books.

For early preDRA MERP done, about 1/3 of states did zero recovery; others did it only for those who had estates with property assets over 500K tax assessor value. No uniformity or compliance standards.

What - imho - is likely to happen to MERP is that it too will change as recovery (& the windfall of $ from the elders homes) as a concept was based on what housing and real estate was in the first part of 2000 - 2005. Very different situation now in 2015. The states aren't really set up to have to deal with old houses with decades of delayed maintenance. (Like what LA & MS find themselves a decade post Katrina in dealing with property still with storm debris or left to go wild). If the state is going to place a claim or lien your parents home or ultimately take you & your spouses home once the community spouse dies - and make it very complex to qualify for exclusions and exemptions or have it so probate & its costs has to be done - then why would you spend a penny on the house that you absolutely don't have to?

If I'm not mistaken your mom passed away without ever needing to apply for Medicaid and died leaving a home and some degree of an estate with assets so MERP is not going to ever be a real time issue for you or your family. Your in the much more fortunate situation of having a parent with assets who died and dealing with problems of the more affluent like trying to find a company to do an estate sale for the contents of your mothers home. But for 60-65% of NH residents, they are on Medicaid to pay for their care, & as such they are already impoverished and MERP will be a real issue for them and their families. Most on NH Medicaid probably don't have a 400K newer home in a better neighborhood or 350K condo at the beach that can be easily sold. Based on those in the NH with my mom, their homes were bought 1950's - 1970's & now needing lots of work to even come close to realize assessor value in a sale. The elder did nothing to contest increased property value as their taxes were frozen. I'd bet that this is going to be a real issue for those states that have outside contractors for MERP to actually meet their goal of $$ recovered and paid ultimately to the states as houses aren't going to have assessor value in reality and many homes will not meet underwriters requirements to be sold with a mortgage. MERP will have an impasse on these homes with families as it's not cost effective to do recovery.

I never said "Bush's fault".

And under Pres CLINTON in 1993 the MERP revised in the "Omnibus Budget Reconciliation Act of 1993 (OBRA ‘93)5 that required states to implement a Medicaid estate recovery program." quoted from the same source.

Igloo, the MERP was begun in 1965. Please see http://aspe.hhs.gov/basic-report/medicaid-estate-recovery, where it states, "Since the beginning of the Medicaid program in 1965, states have been permitted to recover from the estates" and "The 1965 Medicaid law also gave states permission to impose liens on property in the estates" of deceased Medicaid recipients. It was most decidedly NOT "Bush's fault".

2006 Bush 2 administration is where medicaid rules & MERP took place.

The medicaid requirement of a 5 year lookback into all financials; the surrender requirement of any insurance policies with cash value; and MERP aka estate recovery were all placed into law by the 2006 Deficit Reduction Act which Republican President Bush administration heavily promoted and Bush signed into law 3/02/2006. The states then took anywhere from a few months to 5 years to sign it into law.

MERP as it is an after death recovery is very much interdependent on existing state probate laws as to how it can be done & how family can position themselves. What seems to be the situation - anecdotally as all this is too young for hard data- is that family are probate & attorney adverse so do not open probate so house defaults to recovery; family do not respond to the MERP intent letters so the house defaults to recovery; family cannot provide the documents required for exemptions or exclusions so house defaults to recovery. Once that happens and a claim or a lien placed on the property, it cannot be sold to anyone who needs title insurance as per their mortgage lender without the claim or lien lifted by settlement with MERP. Often family is unaware of MERPs claim or lien till they get to closing and title co search shows the MERP claim or lien.

Right now 1/3 of states have outside contractors who do MERP. Two main ones - PCG & HMS - both get a % of the recovery (from 12% -18%), plus fees. Interest varies (most 9%).

There are folks on this site who have dealt with MERP - 1 had a low value home (mid 30's value) & about 1/2 that in documented expenses who settled the claim for 4k; another is in NYS and going long view to ignore the lien for another decade so outside any statute of limitations but they are continuing to pay property taxes and other minimal on the property for the decade.

One of the issues with MERP is that at the time DRA was policy developed (2000-2005), real estate was totally a go-go....houses selling for way way over value. Folks with low income could get a house way way beyond what realitically they could afford. Homes often had deficiencies titally overlooked as there would easily be an underwriter who would take the paper. Grannies house could sell with plenty $ to go to family AND pay MERP. Everybody gets $$$$$$!
Not at all what the housing market is now.

DRA 2006 Bush.

KM1027, I am sorry your spouse is in need of such expensive care. Medicaid laws in all states, however, are mostly up to a mix of mostly appointed but also a few elected Washington DC elites, not your current legally elected governor. It is a fact that thousands of seniors discover every day, that they are required to "spend down" to a certified level of assets, before taxpayer dollars will pay their (extremely expensive) costs of nursing home. One thing to keep in mind, and you should read about it in Gabriel Heiser's book, is that the "community spouse" is NOT required to become penniless just because their spouse needs nursing home. Quite the opposite-- the CS is allowed a set amount (over $100,000, that's hardly poverty...) of assets, PLUS they can continue to live in the couple's home and drive their car....and if the NH spouse has a pension, the CS can even receive part of that pension, to allow the CS to STAY in their home all while the nursing home bills are paid for by your neighbors friend and foe alike. Yes there is definitley a 5 - year look back or qualification period,because taxpayer dollars are stretched as thin as can be, they are not going to pay for everyone's NH bills. That would be quite impossible, do the Math. Yes, the federal government (not Walker himself, but the folks in charge of Wash DC who are the "other" side of the aisle) does have something called MERP, which will "claw-back" money from sale of your home but not until you are done using it. You need to understand, just like everything in Life there is no Free Lunch, somebody has to pay for it and if lots of people want Free Lunch, for whatever reason, tax rates will go thru the roof and your kids and grandkids and so on will never be able to live half the life you have lived. So before you get all upset at having to spend some of your joint assets on your spouse, take a look at the Big Picture. You can't bring it with you. And whatever the country decides to do about too many seeking a Free Lunch (or a Free 10 years in NH, which costs about a million dollars, not making that up either), it's got to be SUSTAINABLE. I have relatives who have spent 90% assets in NH, and never once applied for Medicaid and I've had others who "planned" it very carefully in advance so they would never pay a dime in NH. Guess who had the nicer room? What do you want for yourself, something nice? Then you have to work hard and save for it, for Your Own Self. Government paying for you will not be a pretty picture, at all.

I get what you are going through. My state, Wi. is the second worst in the nation for elder care. Don 't buy into Scott Walker's talk. Everyone here hates him. In order for my husband to get into even a Assisted Living, we had to go the emergency room and prove with witnesses that he was trying to kill me by stranging me to death 3 times. They, then, admitted him into the hospital and contacted Assisted Living places and he got in, but almost every single one we talked to would only take him if we agreed to private pay for at least 3 years. They don't want Title 19 or Medicaid people.So I am private paying for at least 3 years for everything!
I did write to my state senators, respresentatives and governor
himself and heard nothing back. Their new law is to take all the proceeds from your home that the remaining spouse lives in if he or she decides to sell it to try to get enough money to live on, during the time they are on Medicaid ( Title 19), or welfare or if they sell it within 5 years after the death of the spouse. They want their money back that they spent on you and your spouse.I am livid about all of this. If you ever heard a commercial about a number to call if you have unpaid credit card debt or did not pay your taxes, you can get your debt 'forgiven' or greatly reduced. Those people were breaking the law and they are getting rewarded for it,. yet those of us who are elderly and who must care for some with Alzheimers are not given any help at all. They just don't care. It is not right, but I must watch 55 years of savings that we both worked for go down the drain in 3 years. I have given up and resigned myself to ultimate poverty. I could suggest if you have a ADRC- Aging and Disability Resource Center in your area, they have qualified people to help you. So sorry. EK

They must apply for Medicaid. They're only allowed to own $2, 000 of assets. Be prepared for the 5 yr look back.

I believe you have the right to an appeal of denial of benefits. Please check with your local Human/Social Services office to see how this process works. Best wishes.

If it is really too much for your sister to care for her in her home, it may sound drastic, but I wonder if she could bring her to an emergency room nearby with her Medicare card and ID, and say, this is my mother, she is not able to take care of herself and I cannot take care of her either. It might be quite a journey from the emergency room to the facility placement, but she wouldn't be just told to leave the ER--she would be overseen by somebody other than your SIL, finally. The mother and the whole family would probably be grateful to get back into a memory care facility.

Check with your local area on aging where the social service folks can give you the needed resources. You'll probably have to apply for medicaid, and they'll help you with this.

I don't know what state you are in. it takes a few months to get on medicaid with your state, (you want a long term care plan) that would be the way to go. I still have to get my mother in law a
psychological neurological testing. before they will pay for skilled nursing.
We are putting her in independent care today
until she can have that done, the social worker who came to our house for an interview found her still able to do most things, yet she can't function in daily living so we have to go this route so we can have someone else make notes if she gets lost/confused/angry/
I hope this helps, lots of paper work but well worth it

Help - memory was AL or NH?
Was MIL memory care actually AL or was it skilled nursing facility aka a NH? I'm gonna bet it was AL, is that the case??? Huge butt difference in AL and NH run for waivers & medicaid.

Why is there a 1 year waiting period? Is it the state that's saying this and is it that there's a waiting list for waivers (like in my state the list is now about 7K for a new AL waiver and they are SOL on ever getting a new one as state is moving to PACE); or is it that the old memory care facility only takes a very small # of waiver placements and those beds are occupied so maybe a year till a bed opens up - which is the story?

So AL or NH?
Was MIL assessed a penalty?
Does she owe any $ to old memory care facility?
Why did SIL take her home & what would have happened if she would not have?
The answers will make a difference in how to approach this......

If the waiver program she was on was at a AL then that is very very different than NH /ltc medicaid for your state for discharging a resident. A NH has to find them placement and has to coordinate with other social services to do this under medicare & Medicaid rules and state regulations as the resident needs skilled care. But an IL or AL dont have to as no " skilled care" required so they are not at risk by leaving. What was MILs situation?

If it was she was in AL Memory care then why doesn't she step up her needs and enter a new skilled nursing NH facility as "Medicaid pending"? Can she get MD orders done stating that she is "at need" for skilled nursing care needed? OR is she more in that grey area of being ok on her ADL's and seems pretty competent and cognitive so not really needing skilled? If its that she is not showing in her medical chart a true documented need for skilled, then you all are going to have to do whatever to see a & other docs to build her chart up to clearly show skilled nursing needed so she can qualify medically for a NH and apply for NH Medicaid to pay for it. Often memory care is custodial care and she isn't going to ever qualify for needing skilled nursing based on what the memory care facility has in her records. I moved my mom from IL to NH and totally bypassed the whole AL phase, took about 6 mos to have her medical records show need and the visit she has a more than 10% weight loss and a bad H&H lab report, her doc wrote orders for skilled so she could enter a NH as medicaid pending. Most NH admits are from a hospital discharge to a NH for rehab (a Medicare benefit) so they come in with a medical file showing need for skilled nursing care and then they end up staying at the NH and applying for Medicaid for LTC. For Medicaid to pay they have to qualify & show need both medically and financially.

Contacting elected is a waste of time IMHO as they voted these programs in place or are under huge budget constraints as it is for their share of NH costs. Also if your state even has waiver programs, it's a big deal as most states don't do individual waivers for AL at all (so mil was lucky to have gotten one) or are phasing them out for community based service programs like PACE.

I was thinking that what you could do in the meantime is to find out what the memory care place did to help this patient when they were in the facility and practice it in the home of whoever she staying with now. Find out what to do for this patient even if you must visit the facility where this patient was and ask any questions needed for the patient's care. Another idea would be to see the patient's doctor for possible ideas and caring for those patient while you're awaiting further financial help for a care facility. Obviously the patient needs memory care and someone needs to find out how to deliver that care outside of the facility until things get straightened out. Another thing I thought of is to speak to someone at your local hospital such as your hospital admins to find out where to turn in this particular situation. If this happens to be a situation that you're not sure that you can handle, they may direct you to the APS. Of course the last resort would be to bring your loved one to the hospital for evaluation if you could get that arranged through the doctor. The doctor may also be able to direct you on where to turn.

Immediately file an appeal to any Medicaid decision that is not favorable. Often you can get a decision reversed.
There should also be a State Ombudsman for Long Term Care. Contact that office ASAP
Good Luck

Does the place where your mom was at have a financial manager? I could not have threaded my way through the Medicaid maze without her. Most "lay people" couldn't. Speak with her or him and ask what your options are. Good luck!

I certainly agree with ramiller but added to that I would also make a very pointed threat stating that local media has a vested interest in these human interest stories....and be prepared to make good on such threats...it works!!!!

Just a thought but I would be on the phone to my state represenative toot sweet! If you live near his/hers office I would march over there and make myself heard this should never have happened.

You're right - this is unfair. If you reported the income that should have been used for her care and she still should have the waiver once that money was used. The problem is things like waivers depend on the good heartedness of your state. Sadly, some states support senior care far better than others. I wish I had some legal knowledge to help you get through this but I don't. I just wanted you to know that you've been heard. Please keep watching for input since there are people on agingcare who specialize in this area.
Take care,
Carol

We did report the income that is how she got taken off the elder waiver. Now there is no money to pay for a new place to live. The system is messed up.

Whenever the person on waivers or Medicaid has a sudden cash flow, immediately notify Medicaid or else things get very complicated. Even if you sell mom's old car, the income has to be reported.