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she makes approximately $2200 per month so after her spend downwhen will Medicaid pay for her nursing home care or assisted living care and if it does how much will the family be responsible for

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Kim - realize that Medicaid is a joint federal & state program BUT is administered by the states uniquely. So each state sets it's criteria. That being said, you need to find out what your moms state has set as the maximum for monthly income & assets. Assets seem to be @ 2K but income varies.

At $2,200 a month, mom may be over the ceiling for income to qualify for medicaid. Each state sets it's impoverishment threshold. Like when I applied for my mom in TX income max was $2,064 & this would mean $136 over the max income limit. For this situation if their income is a secured source then mom does a Miller Trust or QIT for the overage, so can qualify. Otherwise she will be private pay. If mom is over, get an elder law attorney to have Miller ready to go before you do the Meducaid application. Miller is not a DIY project IMHO.

If she is approved for Medicaid, then all that is needed is for her to do is her copay or "SOC" (share of cost) to the NH, as medicaid pays the difference. She will get a small personal needs allowance from $35-90 a mo but other than that she will have NO money. So if mom has debt, that will be something for family to deal with. If mom has a home or insurance premium or mortgage due, family will have to pay for those costs if they want to keep the asset.

About AL vs NH. Medicaid is dedicated funding for NH. but for AL it is diversionary funding which means the state can shift NH $ to other programs like to PACE or AL or community based care. You need to clearly ask the AL if mom is guaranteed a Medicaid bed from day 1 or if not what the costs will be.

Also clearly ask if the facility takes the resident "Medicaid Pending", they don't have to. If they don't, then it's private pay rates till the applicant has been approved. Could be several months for application. For my mom, it was almost 6 months till she was approved for Medicaid.
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Also about medicaid pending, for my mom the NH gave me a list of items needed to accompany the medicaid application. If you are looking at places, you want to get the lists from each facility & start finding all the documents needed. If any of them are missing, medicaid can deny. There is a pretty tight window for document submission. Each facility can have the "list" slightly different too as it reflects how they do their internal "pending" review.

For my mom, i did the medicaid application at the NH & gave the NH the documents. Which in turn the NH reviewed to determine IF they would take her "pending". Then in turn NH submitted this with their bill to their caseworker. I didn't speak with caseworker till month 4 when there was glitches with moms application on her life insurance- had like 72 hours to get that problem resolved.

This time of the year is great as mom will be getting or just got her awards letters, any 1099's for interest or dividends, other income tax items, tax assessor bills, etc. makes it easier to review or find out about assets out there. Good luck
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Kim Davis depending on your state if you get the aid and assistance its not considered income but that's part of the 2200 don't count that
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When does it come into play? ONLY after you apply for it and ONLY when it is approved. Most delays and rejections are due to incomplete or inaccurate forms.
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Assuming she could get spent down to qualify for M.A. (pam is right you have to complete the applications process & get approved) the extended family doesn't pay anythjng. If she has a home or other assets it all gets applied to her care--whether it's sold now or after she dies. You don't mention a spouse but if so they get to keep half, as long as they ddon't also need M.A.
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