She doesn't own a home and or any other assets except for $20,000 in savings. Her income is about $2,400 a month. I already know that the money in the bank needs to be spent down or used for the nursing home costs.
I want to know what is needed in advance so I am prepared. My concern is how strict they are during the look back period.
Thank you
You may want to consult with a Medicaid Planner or certified elder law attorney experienced in Medicaid for your Mom's home state. Her income may be too high for her state. If so, there's a strategy called a Miller Trust (or it may be called something else in her home state). She can legally "offload" excess funds into this trust account to help her qualify. Once she passes, these funds go to pay back Medicaid.
Once you submit the app, it takes up to 3 months for Medicaid to give you an approval or not. During that time, they may contact you (usually by mail) requesting different or more documents and you'll need to get them back immediately -- so make sure to open any mail that comes from them right away because (in my case in my state) they gave me a week to return the requested info. If you miss this deadline, you may need to apply from the beginning.
To qualify for Medicaid coverage of long term nursing home care there is a "2-part" test. First, YES one needs to spend down and meet your State's income and assets thresholds. A typical number for "total assets" is about $2K, but each State is slightly different. Part 2, is qualifying for your State's "level of care/LOC" deemed by your State that one indeed needs fully time SNF services. This second part -- the LOC documentation -- needs to be completed by the SNF and it is another good reason to get your LO in before the spend down so they "get that they will have to do their part" and they can start on the documentation for that.
The LOC generally is a combo of medical conditions (diagnosis of dementia might be one, but it is NOT a clear "get in" and qualified for Medicaid. There are other things including the inability of your LO to handle several ADLs and IADLs, independently and safely (such as cannot bathe themselves, cannot dress, cannot manage their medications, cannot feed themselves, cannot locomotive, cannot handle medical or financial decisions, etc.). Of course if there are other medical issues as there usually are; then those can be part of the LOC qualification.
For the paperwork, best if you can get on-line access to EVERYTHING. Bank, all financial accounts, pension, IRA, bills/utilities, insurance, everything as you'll need to down load and provide 5-years of records including past federal and state tax filings. And ANY funds that were gifted (not like $50 birthday money for a grandkid, but over $1K they will want receipts or ask.) ALSO BEST TO STOP now any cash or check writing, use a debit card so there is a clear receipt as moving forward ANYTHING bought w/their funds you need a receipt -- document, document, document.
Best if you are on your LO's bank account to "write checks" or otherwise pay out the monthly fee your State Medicaid will charge them, their "cost of care contribution." This amount is generally all social security, retirement/pension payments minus perhaps $90 which your LO can keep BUT the total asset limit MUST be kept below your State's threshold, which means from time to time you may need to spend some for you LO to remain under that threshold.
Then annually, there is a Medicaid "redetermination" process that will require the past year's financial and tax records.
The paperwork continues throughout, so set it all up on-line as it is SO SO Much easier. States allow one to use their Medicaid portal to upload all this, so NOTHING gets lost or delayed in snail mail.
An elderly care attorned licensed in the State where your LO will be OR the "finance director" at the SNF you choose, can help with this.
Good luck. I have boxes of paper files from my mom's 3+ year SNF stay before she passed and I have to keep that for 7 more years for tax reasons. Lots of paperwork. Sigh
Some here have suggested that choosing a facility that you like, and that will accept Medicaid, is a good idea, with admission and beginning to spend down that 20,000 while asking them to help you with Medicaid applications. Might be worth checking out?
Good luck. Hope it goes well.
Me, 20k got Mom into a NH for 2 months. Gave me time to get all info needed and spend here down quickly. Best way to get her into a facility, is to private pay as long as u can. Just make sure the facility takes Medicaid.
Here is a link to the 19 page application for Medicaid for LTC in the State of Maryland.
Medicaid application and rules are unique to the state.
I applied for my DH aunt with the help of her certified elder attorney who is an expert on all things elder care in her state.
Also remember that the financial status is one part, the physical status is equally important. Your mom must qualify for both. Financial need and medical need, not just custodial.
Here is another link that speaks to the health aspect.
https://health.maryland.gov/mmcp/longtermcare/Pages/Nursing-Home-Services.aspx
It is a lot to absorb. Wishing you luck.
everyone tends to get all fixated about the “at need” financially aspect of the LTC Medicaid application. But her being “at need” medically for skilled nursing care is equally as important and is way harder to achieve if that is a concern as you will be dependent on others to get what’s needed successfully.
If she does not have a current needs assessment that clearly show the need for skilled care for her along with a health chart that shows that as well, you may want to get an assessment done. A physician note on its own usually not enough.
The vast majority of NH admissions are post hospitalization discharge to a NH that has a rehabilitation sector. Both hospital stay and rehab are Medicare benefits. By & large rehab is covered for first 20/21 days at 100% by Medicare; then at 50% if they are progressing. Medicare pays like double ++ day rate than Medicaid. What tends to happen is a determination is made in that first 3 weeks as to if the Medicare paid rehab patient at the NH will get better and go home OR will transition from a rehab patient to a long term care custodial care resident at the NH. Custodial is not a Medicare benefit, it’s private pay, LTC insurance or LTC Medicaid if they are financially “at need” as well. Those weeks of rehab - along with those hospital records - provide a nice fresh fat health chart that clearly shows skilled nursing care needed.
Entering a NH from being at home, or in IL or AL can be done. (I did it for my mom, she went from IL to a NH bypassing AL phase) But it can be challenging to get their health chart sufficiently showing “need” in short order. If their medical gets rejected, it can be appealed and the NH kinda has to take the lead in doing whatever has to happen. Should this happen, it will delay their financial review. In my experience, medical ok goes 1st then financial. Mom took 5.5 months for eligibility approval and did the full copay Share of Cost of her incomes the whole time.
Best of luck in your quest!