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One question my family has been curious about is:


Is there any difference in care provided if the spend down occurs at the facility, or outside of it?


My mother is still relatively young - 67. We'd like to keep her out of a facility as long as possible, because she may well live quite a while longer, and it seems like it would be better to give her a year or two outside of a facility before she spends her remaining years there. We're wondering if we should spend that money on in-home care, and then go into a facility on Medicaid (when she's out of money), or if we should pay the $8K/mo. until she's out of money and then converts to Medicaid WITHIN the facility. Does anybody have any experience with this?

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My mother went in NH as private pay and transitioned to Medicaid when the money ran out. She remained in the same room with same care throughout. Our family was always convinced that none of the workers knew which resident paid which way
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My daughter says no and she is an RN in NHs. She says the aides are not prevy to who is and who is not on Medicaid.

But Medicaid requires 2 to a room. Even private pay is 2 to a room unless u want to pay extra for a private.
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The best strategy is that when she is close to needing facility care, to find a really good, reputable one that accepts Medicaid and have her enter it on private pay. This way when she qualifies she, as an existing resident, has first dibs on the Medicaid beds there. If she isn't in a facility when she goes onto Medicaid then she may be subject to waiting lists, depending on what state and city she lives near.

For my MIL, who went from private pay AL in a great facility, is now there in LTC on Medicaid. There's been no difference in the qualify of care she receives. It's been an awesome place.

FYI in the vast majority of facilities being on Medicaid means a shared room. So maybe you can ask this question before selecting a facility. Some good facilities have waiting lists just to get into AL or MC on private pay.

I suggest discussing things with either an estate planner or a Medicaid Planner for her state so that you know what to do and expect. Don't make any assumptions about it. Whoever is her FPoA needs to be extremely careful and transparent so that they don't inadvertently disqualify her. Most states' Medicaid financial app has a 5-year look back. Medicaid in most states only pays for LTC, which means she would be basically immobile and bedridden or profoundly ill needing a lot of daily medical care. Just because she has ALZ and needs MC doesn't mean Medicaid will cover it in her state. Knowing this and other details will help with the planning and save a lot of headaches and surprises later on.
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