Assisted Living & Medicaid: Q&A

Q. “I want to take care of Mom for as long as possible but to be honest, it is getting harder to balance her care with all my other life demands especially with her dementia worsening. Her monthly social security is around $1100 and she has about $40,000 left in her savings. I don’t know what we can do.”

A. These are two different and equally important areas to address. One from the standpoint of stress, emotional ties and all that is entailed when taking care of a loved one; and how to decide when is the best timing to release some care when it is beyond our abilities. Family input, and sharing with

others in this position and seeking professional counseling advice is a good way to come up with a plan.

The other is the financial reality and how our area handles folks with little savings. Based on my findings of changing patterns in Assisted Living Facilities (ALF’s), these are factors to consider:

1. Some Assisted Living Facilities do not take Medicaid payment for long term care at all. This is based on the owner’s budget and/or corporate policy, if applicable.

2. There are some ALF’s that do accept a resident if there are at least 1 to 2 years of private pay available before they qualify for Medicaid.

3. Other ALF’s require 2-3 years of private pay before accepting Medicaid.

4. A few smaller Certified Family Homes registered with the state accept Medicaid as a form of payment, while others are exclusively private pay.

5. There are very few places that accept Medicaid payment right from the get-go, and they typically have either a long waiting list or have limits on the level of care they can offer.

From a strictly financial view, it is better to discuss options earlier than later to consider monthly income (such as social security, pensions, other retirement benefits) and what is left in her savings, in deciding when your mother should be placed in a long term care community.

Let’s take your mother’s situation for example. Assuming an average monthly facility cost of around $3600 ($43,200/year) for a person with mild dementia and some independent functioning, she would only have enough private pay for close to a year, just for her care. Her Social Security amounts to $13,200/yr. + her savings of $40,000 = $53,200 which only leaves $10,000 leftover for other expenses at the end of one year.

Q. “Why do some Assisted Living facilities not take Medicaid?”

A. Although Medicaid is a form of payment for Assisted Living managed by the state, facilities are not required by law to accept it.

Medicaid reimbursements are based on an individual’s assessment and calculated through a computer program, thus the reimbursement to a facility may be very low. The funds may be insufficient for smaller facilities to pay staff and other business costs if they accepted Medicaid as their sole source of income.

That being said, several places do take Medicaid but limit how many residents they can accommodate and still afford to operate their facility.

Others require 2-3 years of private pay before a resident’s assets allow them to become eligible and ‘roll over’ into Medicaid. They will not have to move, although some facilities may have them share a room.

Still other Assisted Living facilities, do not accept Medicaid residents at all and if the resident runs out of private funds, they will have to move out.*

As a whole, it is better to make that move into a facility while you still have some private funds available. Your choices are more diverse and you have a better chance of finding a great fit for your needs.

*Skilled Nursing facilities accept Medicaid as a form of payment.

Q. "Mom is only $100 over the monthly income limit to qualify for Medicaid for Long Term Care. Is there anything we can do?"

A. The Monthly income limits are different for single or married seniors and can change yearly so be sure to check the latest information either in your local regional Medicaid office or online at www.healthandwelfare.id.gov and look for Medicaid.

If your Mother is still over the income limit, there are some legal steps that can be done such as a 'Miller Trust' that can be a solution to reduce the overage in funds. I highly recommend a visit with a local ElderCare Lawyer who specializes in ways to navigate your situation.