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jmdonner16 Asked July 2016

How to apply for Medicaid for my mother?

My mother is living in an assisted living facility and is nearing the end of her money. The facility she is in will accept Medicaid. Can you please advise me on what steps I need to be taking for her to do this? I am her daughter and Durable Power of Attorney for her. Thank you!

igloo572 Jul 2016
Medicaid for AL is done via a waiver program by your states Medicaid program. It's different than applying for LTC Medicaid in at NH in that the funding is not dedicated (as it is for NH) but it's a waiver. As it's a waiver the participation in it by vendors can be somewhat limited. Most states do NOT have waivers to pay for AL. If your state does, consider you & mom lucky. You probably should start by clearly speaking with admissions at your mom current facility to get the details from them as to what they will need have you provide to include with your mom's Medicaid application which in turn they submit along with their request for payment to the state AL waiver program.

Really You kinda need to be absolutely sure that there will be a waiver program bed for mom at the AL for the level of care mom needs that will dovetail to the month she runs out of $. Sometimes availability is just a theory….Like for us, it was easier to get mom onto Medicaid into a NH than to get her onto a AL waiver bed as TX has 2 types of AL beds….CCF (basically 24/7 custodial care) which there is no-none-nada of Medicaid payment ever and then CBA which Medicaid will pay for but has just a few vendors and has a cap on enrollment annually. Keep in mind that for Medicaid, although folks tend to fixate on the financials, they need to also qualify medicailly for care. Often those in AL are just not at the level of care need for Medicaid to cover. So you need to find out if mom's care level will be ok for however your state Medicaids program needs it to be for her to qualify.

Each state runs it's Medicaid program uniquely…….

Financially mom will need to show no non-exempt assets over 2k and have her monthly income within Medicaid limits. There can be a 5 year look back but for us, since my mom was coming from IL to a NH, the look back was only 3 years & y6 mos (this seems to be common if they are already in a facility and private paying for their stay as the state knows where a lot of the $ has already gone). There will be required documentation on mom's funeral/burial polices to make sure they are NCV; her life insurance to make sure they are NCV also. NO CASH VALUE.

If mom still has any debt service (horrors!!!) like credit cards or funeral premiums still to be paid, or still owns her home, please give hard thought as to how you or other family want to deal with this as once mom is on Medicaid, all her monthly income will go to the AL as her required co-pay (her SOC - share of cost). Mom will have just a smallish personal needs allowance (varies by state from $ 35 = 105) and that's it, it's really just enough for beauty shoppe appointments and some clothing replacement.

The AL should have a list of the documentation required to be submitted along with mom's Medicaid application. You should ask if they will continue to have mom live there while she is "Medicaid Pending". This is mucho importante as otherwise someone (you) will have to do a private pay contract for mom during the application process. My mom;s application took about 5 1/2 months. So being "pending" is important. Really admissions should have all this info at the ready.
Good luck and try not to get too overwhelmed.

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