What do you do when your mom's monthly income is less than the cost of her care but too much to qualify for Medicaid nursing home costs?

Each case with Medicaid is considered according to state/local laws along with details of a person's unique decision. Only an elder care attorney or Medicaid official can give you the answers you need. Other's experiences here may not apply if they don't live in your state and unless their situation is exactly the same. There may be other extenuating circumstances that either qualified or disqualified them. I have learned the hard way to go straight to the source (or qualified attorney) that takes your unique situation in consideration. If her husband was a veteran, she may even qualify for VA benefits... again based on her unique situation. Her situation is unique to her and needs to be judged according to laws and strict guidelines to qualify for any program, whether Medicaid, VA benefits, Hospice or any other resource. I have been amazed at the doors that were opened to us once I went straight to the agency(s) making the decision! Do not let other's experiences convince you that you are or are not qualified for any one benefit. Other's experiences are valuable to make a list of questions that you may not have considered before... sometimes it also takes asking the right question of the right person. Sometimes it also takes asking for a supervisor to verify you have gotten the right answer. Your mom is blessed to have you advocating for her.

Call your county office for aged and disabilities, make an appointment to get started on this road. My mom had about $3000 a month between SS, post office pension and VA aide and attendance. And would have qualified ( she died 2 days before the appointment with our county office to make application) one month after I had to turn in her meager life insurance to pay rent…

i would look for a memory care that takes self pay for a period , that then moves onto Medicaid. My moms wanted a year self pay , she wasn’t going to make a year… they accepted her under those conditions anyway. Google care advisors and find someone local. These people will guide you with what is available, cost etc , set up tours.. basically walk you thru the process. They get paid for their invaluable service by the facility placed in…

Dementia is enough to qualify for Hospice. Also, if her husband served in the military during war time, she could get up to $1200 a month. Contact the VA.

Contact your contact county social services, she'll have to do a spend down but you'll need someone to help you through the process of applying for medicaid and getting it all figured out.

Kudos to your mother for hanging on at age 98 with all of those underlying conditions! Has she shown any sign of declining health? Yes, talk to her doctor about her qualification for hospice. It's possible that at age 98 she is qualified. Hospice care means that she will be made comfortable, but there will be no effort to fix health issues. My mother eventually hated going to the hospital (and at one point she was going often because she was falling frequently). We added "no hospitalization" to her medical directives (unless it was an immediate life-threatening situation like bleeding). When my mother qualified for hospice, we stopped the regular doctor, dentist and eye doctor visits, which my mother also was not understanding. Her eye doctor continued prescribing the eye drops for her glaucoma. And she had one annual doctor visit to qualify for her memory care (and then another when she needed to transfer to skilled nursing). She actually did better without all of those doctor visits.

We switched from a facility to an Adult Family Home that takes Medicaid. She has to share a room because of Medicaid but she had one since Covid. The owner and caregivers are wonderful. So much 1 on 1 attention. There are 4 clients in her 'house'. The facility she was in turned out to be horrible after the first year due to the high turnover in employees and directors. 3 years and $200k later which was every penny do to us 5 children (happily for my Mom) giving up our inheritance. She and my late father insisted on leaving us something. Turned out they left us the best thing, their love and memories. We also tried to get my Mom her VA spouse benefits due to my Dad serving 20yrs. They said her monthly $1000 SS income was too much to get the VA benefit!
However, we got a Medicaid Social Worker and she took us through every step and told us what we needed to do and then my Mom qualified. So my Mom has to pay a certain amount towards her living & care and the state pays the rest. She and my father worked and paid into it their entire working lives. Why shouldn't she get it. The VA has broke my heart. It usually all works out. Good Luck!

My Mom was denied VA because her her measly SS income was too much they said. It was just over $1k a month. My Dad served 20 years in the Navy and retired with Honors. I'm still in shock they did that.

Before 'spending down', either familiarize yourself totally with Medicaid rules/regulations or check with an elder attorney who specializes in Medicaid. I had to do that when looking at a similar situation for my 95 yo mother - she didn't have hardly anything in the bank, did receive a pension and SS that would bring her over the 'limit', and her small condo. One of the posters here mentioned, and this attorney brought to my attention that when applying for Medicaid - they look back over the finances for past 5 years. and if 'anything' looked suspicious, it could cause issues and further problems.

If mother had many of the same issues your mother has (7 of them), and if she hadn't fallen and broken her femur (requiring major surgery, which after 2 months resulted in an untreatable sepsis infection in the bone and passed away shortly thereafter), my mother would have probably lived until at least 99 if not longer since longevity runs on her side of family (grandmother lived to 104, great grandmother until 102).

I am from a different school of thought, perhaps the one touched by ocd, whereby I 'need' to look ahead so that I can prepare and be ready instead of having to deal with something at the time it happens. Especially in this crazy world and all the rules and regulations and requirements that surround aging, gotta be in the know-how, have to be informed and be prepared. Thus, when mother went into hospital for surgery and rehab (never to return back to her condo where she lived), I knew exactly what I had to do and when and how.

Seems she may not outlive her money. But if she comes close, talk to social services at her memory care facility to help with applying for Medicaid at that point.

I think you are wonderful thinking about the security of your Mom's future. There are many people in our world today who live to be 102, 103 and 104 years old. I do not have an answer for you as to what you can do but I wanted to let you know that I do not agree with our other friends who say not to worry about it. There is certainly no harm preparing and you will be able to fall asleep easily at night knowing she will be taken care of. The peace of mind itself is worth it. I would absolutely be doing the same thing. My Mom is 90 and we try very hard to keep making sure she has enough money until she is 105 years old age just so there are no worries. Since I retired and my husband died, she has been living with me for the last 3 years which has helped her money situation immensely even with us splitting the costs. Before that she was in AL which was eating her money away...

My mother was in the same situation, too much income to qualify per se. I got hospice to come and evaluate my mother. They took her based on her losing weight. So hospice can find reasons to take someone. I applied for medicaid, and bought pre paid funeral services. Then spent down her money on care. They accepted my mother on medicaid with a huge deductible, but once her assets went below 2000, hospice found her a good place. She has to give them her whole ss check minus 60 dollars and medicaid pays the rest. No lawyer needed. So once you spend down, and your mother has completed the medicaid application process, the facility will help you from that point on to transfer payment to her ss check and medicaid. That will pay for everything, and all you need to do is be there for her. Sounds like with all your mother's health issues it will be easy for hospice to accept her. You may have to move her to a place that accepts medicaid. The one my mother is in accepts a limited number of medicaid patients, but is like a hotel! Very good care, and I visitoften. No issues.

No one has mentioned this so my suggestion would be to spend some of the savings on a pre paid burial plan. Check with your state but that is considered an allowable expense. If she out lives her savings (which is really the issue here), when she does pass you do not have to scramble to cover all of that expense, which can add up even if you do the minimum ($2000 just for simple cremation) plus all the extras some, not all, places try to shame you into adding. If she or husband were military they can both be buried in a National Cemetery. I agree with others, ask for a hospice evaluation and when she is within 6 months of running out start the Medicaide process.

Maybe the Palliative/Hospice rules need to be changed from 6 months to 1 year..................guessing that would be a CDC ruling or would need Congress to kick butt. Just because archaic laws are in place, doesn't mean we all have to accept them without question. Write your Congress Person and maybe chat about that with your favorite Elder Care attorney. Maybe the Caretakers need to start marching so that they don't end up living the nightmare too.

My husband went through this with his mom and what happened was he got an expert, not a lawyer, who handles this exact thing and his mother qualified for everything in the nursing home. Again, she was placed in a nursing home. It cost my husband about $40,000 to have this done, meaning his mom to have it all paid for and get her on medical, I believe. It was grueling and eye-opening.
I wish you the utmost best. Our medical system for elder care sucks, and is inhumane and immoral, in my opinion.
I am right now in process of finding my mom an assisted living that she can afford, and boy, it ain't easy!

My cousin has been working on this issue for his father for almost a year. He has spent many hours and thousands of dollars to try to get a trust in place. First, it is not that easy to find an attorney who understands asset protection and knows how to prepare an irrevocable trust especially if you live outside a large city. We contacted over 20 lawyers before we found one. Second, the process is long and very expensive.

Great answers! I had the same question.

Did you all apply for Medicare by yourself or with a lawyer?

You can go to an elder attorney now to see what her options will be. The next step for her care (using Medicaid) is more than likely going to be a NH. There are some states that have Medicaid beds in memory facilities, other states only allow a regular NH bed.

The elder care attorney can figure out if the amount of money that is over the Medicaid income limit can go into a trust ($ that can be used for her) and the balance pay toward the Medicaid bed.

See an attorney now so you are prepared before she runs out of money: that you have documents to show how sale of house was spent, and/or other records that you need to have ready to go at the time she can no longer pay her own way. Medicaid does a 5 year look back period (in most states) and they are looking for 'gifts' or paying for things for other people besides her own care. If, for example, you sold the house and gave $5 grand to a grandchild for college - that $5 grand will count as penalty period. Penalty period is cost of NH per month divided by amt given away. Thus, NH = $5K per month, you gave away $5K, so she has to self pay for one month.

The atty is best way to go. They keep up with all the Medicaid rules and can best advise you.

I would consult and possibly hire an attorney who knows how to file the Medicaid application. . My mom is in a very similar situation and that is what I have just done. It may give you peace of mind and answers. Wishing you and your Mom the best.

I have not read all the responses, but if her facility is "Medicaid and Medicare" qualified, the "business office" people often can be very helpful with a Medicaid application. Ditto for your local area agency on aging, and of course an elder care attorney if one can be afforded.

When applying for Medicaid, one's total assets at the time of application MUST be below your state's asset limit. If that amount is $1.5K (for example) and your LO has $2K in the bank, write a check to the facility for an amount well below your state's asset limit (say a $1K check) and then apply. Timing is important as the state Medicaid folks looks at what is in the account at a specific time. So write that check 2 weeks before the last day of the month. Take screen shote (one has to have on-line banking for this) of your LO's bank account just before and after midnight the last day of the month; then file that first day of the month. Yes, a Social Security payment and pension (if one has that) may post the first day of the month, but that will post as "pending" for about 24 hours (that is those funds technically will NOT be in your LO's account just yet so your state's asset limit can be met.

The state Medicaid office will examine other paperwork, copies of the month Social Security payment received, ditto for any monthly pension payments or other incoming "funds/revenue." AND any outgoing expenses for health insurance (Medicare Part B premiums or other premiums). Your state Medicaid office will then calculate an amount -- the "cost of care contribution/COCC" amount -- that your LO will need to pay the facility monthly from their incoming monthly social security, pension, etc. income to the facility. The state Medicaid office will allow ONLY a minor amount from those SSA or pension payments to be kept (this year $84.00 but I believe that goes up to $93.00 effective July 1 -- your LO's facility could tell you).

Your LO's facility and her physician assigned to her at the facility will have to file their own paperwork to substantiate "the level of care" needed is Medicaid long term care. I would not worry about this part, given the age and reported dementia/health status of your LO.

Once qualified, you would need to write a check to the facility for the COCC (best done the first week of the month, so it clears quickly and well before the end of the month). AND ALSO IMPORTANTLY, keep the total balance in your LO's account BELOW your state's asset limit. If keeping that $84 (or soon to be $93) means the account goes above the state asset limit you can" 1) buy something for your LO for their personal use KEEP RECEIPTS!!!! or 2) write another check to the facility -- yes you then will have a "credit" -- but better that than exceeding the state asset limit as that triggers a disqualification of Medicaid.

Hopefully you have a POA and access to all your LOs record (bank, SSA payments, pension stuff or IRA if that exists, your are their "health agent" etc.) so you can handle all of this. Doing things on-line is best, quicker and so things do not get lost in snail mail.

I do all this for my mom who has dementia and a host of other issues and has been in a Medicare/Medicaid qualified nursing home for almost 2 years now. Medicaid pays most of her care (after spending all her assets down to meet our state's asset limit). I write a check off her account monthly for her "cost of care contribution" amount and often I write the "extra check" to keep the bank account below the asset limit.

Good luck with this. Talk with your LO's facility if they are Medicaid/Medicare qualified as they likely have LOTS of experience with this and could help you.

Hi Roxy50, some great advice posted already. I will say that I manage a client who is 105! Now, that’s not to say your mom would live that long, but IMO, you’re doing a great job managing her affairs. As stated, don’t worry about what to do when you spend down her assets on care. If & when the time comes, she may need placement in Skilled Nursing, but getting advice from an Elder atty now who does Medicaid planning can help put you at ease. If the time comes where she needs more care than what the AL can give her, they will give you very little notice, so I would maybe get some info on SNFs with a placement person now than later. If you need guidance how to find such referral sources, call your local Area Agency on Aging or 211 and they can guide you further.

My BIL makes more than what you show and he is on Medicaid. So the only thing that is holding her back is the money of the sale of the house. You would have to look at what your state has the limits of assets because each state is different. Some allow you to have just $2000 where if you were in New York it maybe higher.

I would apply for Medicaid to see what they say. Because it will show you what you need to do.

Prayers

If you have not already, apply to find out for sure if she qualifies or not. We have delayed benefits for my husband because we based our decisions on what others have told us instead of going to the decision makers. In most states there is a five year look back so it is probably too late to do Medicaid estate planning. You may be surprised though that some of the things you have done may have already helped. (Trusts, sale of home, etc.). If you are turned down, you will learn reasons why and better understand when the time is right to apply again. As others have said, qualifying for Medicaid for long term care is different from qualifying for regular Medicaid. Be sure to check on VA benefits if her husband was a veteran, there are spousal benefits too.

I would have her evaluated for Hospice.
Any one of the conditions with more added on just may qualify her.
I think you do not have to worry much if she has enough to maintain where she is for 2 years when she is 100 she just may need Skilled Nursing and that may, with the conditions she has she might be approved for Medicaid.
Planning ahead is great but at 98 I would not be planning and purchasing non refundable tickets for a trip in 2024. I might buy green bananas though.

First off, you say "she also suffers from hypertension, high cholesterol, polyarthritis, osteoporosis, muscle weakness, fatty liver disease, cholelithiasis, macular degeneration, glaucoma, incontinence, and profound hearing loss (hearing aids help but you still have to talk loudly for her to hear you). None of these guarantee that she will die within 6 months, so hospice is not an option." How do you KNOW that at 98 years old, your mom does NOT qualify for hospice? Have you looked into it via having her evaluated? My mother qualified for hospice based on her dementia ALONE, under the Medicare option of "Senile Degeneration of the Brain"; her CHF and other health conditions weren't even taken into consideration as qualifiers for hospice!

Even if she does qualify for hospice, however, that does not 'extend her finances', so one solution does not provide another. What hospice will do, however, is ensure that the MC will not ask her to leave and to go into Skilled Nursing *which will deplete her finances MUCH faster*; all the Memory Cares I have had experience with will keep the elder until death, as long as hospice care is in force; it's an extra layer of help and services that they can rely on. Not to mention, hospice covers the cost of Depends, incontinence supplies, meds, hospital beds, and all sorts of other supplies your mother is currently paying for.

Your mother has 2 years worth of money left to finance her stay in Memory Care and an awful lot of health conditions to indicate she will not live another two years. If I were you, I would not worry too much about what may happen 'after her money runs out.' The likelihood of her living past 100 years old is slim. My mother had advanced dementia and CHF, was wheelchair bound with pulmonary hypertension and a few other things thrown in, and I prayed DAILY for God to take her. The thought of extending her life, to me, was an act of cruelty, for the dementia ALONE.

My mother was acting pretty much okay when I got hospice on board, exactly 2 months and 1 day before she passed away. She was declining steadily, however, at 95 years old with all those health conditions I mentioned earlier. As it sounds like your mother is as well. One day, she just went into bed; she was exhausted and her heart was giving out. "Just like that", with no warning. She was immediately semi-comatose and passed on the 8th day after going into bed. I am extremely glad I got hospice on board when I did, b/c they were wonderful in so many ways, but especially with keeping her comfortable during that last week of her life.

Get mom's PCP involved to write an order for a hospice evaluation asap. Don't worry about 'money running out in 2 years', that's my suggestion. My mother's money was going to run out in August, and she passed away on February 22, 6 months prior.

Wishing you the best of luck.

Good god all those ailments and she is still alive at 98. The human bodies programming for self perservation at any cost is amazing and insane.

Roxy, have you talked to a Medicaid planner or certified eldercare attorney about getting mom qualified for Medicaid?

In some States, the cost of medical care can be counted as part of the spend down to Medicaid eligibility. Some states have qualified income trusts. It's worth it to use some of mom's money for a consult.

When your mom is out of money, she WIll qualify for long term Medicaid, or nursing home Medicaid. If the memory care facility she is in now doesn't take Medicaid, she will transfer to a Medicaid nursing home. You will want to start planning and looking at nursing homes that will accept her ahead of time, maybe 6 months before she's due to run out of money. There may be wait lists at the better facilities, so it may be best to start early and get on the list if you desire a particular NH.

If she does in fact outlive her money, there are Miller Trusts aka Qualified Income Trusts that help get public assistance for those over the monthly limit for income.

Do a Google search for your state, not all allow this, it will help you understand if it is an option. Because not all sources of income qualify I don't think this is a DIY project, you will need a certified elder law attorney to help you with this.

Moms money can and should be used for this. They will also do the Medicaid application for you, if you choose.

One thing to consider before getting to involved with this, 2 years is a long time and the rules change annually. I, personally, would only verify that it is an option in your state and is her source of income eligible. Other then that, who knows what limits and rules will be in 2024.

This poor lady. She really has no quality of life.

I would not worry about this right now. Spend down her money. When you get to only having about 3 or 4 months to cover her care then apply for Medicaid. In the meantime, see if your State allows a Miller Trust or Qualified Income Trust. This is where any money over the Medicaid income cap will go into this trust qualify Mom for Medicaid. If your State allows it, you will need an Elder Lawyer to set it up. Moms money can be used for that.

In 2 years, mom will be 100.

I'm going to say that again. In 2 years she will be 100.

Do you really think she will live that much longer? I mean, none of us knows what span of years we're going to get--but since you have funds to cover her care for 2 more years, I wouldn't worry about this right now.

She has ALL the 'old person's illnesses. I think she's probably living on borrowed time right now (I'm sorry if that sounds offensive, I'm being realistic, not cruel).

Don't waste time worrying about it, OK? Just give her the best quality of life.