Earlier this week we were discussing Laurie, her mom and a very common disconnect we see when families speak with assisted living facilities. The facility explained its requirement that residents private pay for a certain period before being considered for one of its Medicaid slots. Laurie heard something entirely different, that as long as she meets that requirement, Mom will get Medicaid.
It’s easy to see why this happens. First of all, the Medicaid rules are quite complicated. The consumer is unfamiliar with them and the assisted living representative very often isn’t much more knowledgeable either. There are strict income and asset requirements. A single person’s life savings must be spent down to less than $2,000. In Massachusetts a single person’s income is limited to $72 per month! If Laurie’s mom has income that exceeds that cap, it will be paid directly to the nursing home or assisted living facility.
We also can’t forget about the medical requirement. To qualify for Medicaid, Mom must establish that she needs nursing home level care, not assisted living level care, to qualify for Medicaid. Nobody can say in 2 or 3 years whether she’ll meet that test and it isn’t up to Laurie or the facility to decide. Medicaid makes that determination after sending out someone to examine her. Keep in mind that if Laurie’s mom is in a nursing home it is difficult to argue that she doesn’t need nursing home level care, but the same can’t be said when she is living in an assisted living facility. Most people there do not need nursing home level care.
Finally, the facility can’t guarantee that a Medicaid slot will be available at the exact time when Laurie’s mom qualifies. It has a limited number of slots and they could be filled when Laurie’s mom is approved. It is impossible to in advance whether a slot will be open at precisely the “right time” for Laurie. It is a game of “musical chairs” of sorts. When the music stops (i.e. Medicaid is approved) will there be a “chair” available?
Laurie’s approach is understandable. She is trying to do what is best for her mom and she wants to know now that if the money runs out Mom can stay at the facility and transition to Medicaid. As you can see, it isn’t that easy to do, and a family being completely misinformed makes the process more difficult.
In fairness to the facility, they usually don’t even have all the financial information yet to be able to say, for example, that Laurie’s mom has too much income to qualify because Laurie simply asked a general question about Medicaid. She is still “shopping” and hasn’t yet made a commitment “to buy”. All she asked is “do you take Medicaid” and all the assisted living facility representative was saying is, “yes, we do accept Medicaid”. What the representative is not saying is that her mom will be guaranteed to get Medicaid.
When we explained this all to Laurie she became confused. “Does that mean Mom can’t move to an assisted living facility?” she asks. No, not necessarily. It just means she has to understand when Medicaid is and isn’t part of the picture. If Medicaid is not part of the pictures, Laurie and her mom should know that as early as possible, so we can help her put together a long term care plan that will work. As an example, if Laurie’s dad was a wartime veteran, then VA Aid and Attendance benefits, and not Medicaid, ought to be the focus at the assisted living facility.
By the end of our conversation Laurie was beginning to understand what we were saying. She was not asking the right questions of the right person. As elder law attorneys, we could put a plan in place to help guide her on how to get the best care for her mom at an affordable cost. She was grateful that she found us now, before she spent all her mother’s money. As I frequently tell our clients and prospects, “when you run out of money you run out of options”.
At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones. We provide clients with a unique education and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.
We encourage you to attend one of our free educational workshops. Call 800-964-4295 to learn more about what you can do to enhance the security of your family and legacy.
