What does Medicaid pay for nursing homes?

[garyt]

OP-

As noted above, most states have a program structured around these characteristics:

- Nursing homes can choose to have or not have “MediCAID” (Not Medicare) certification, meaning they have a certain number of Medicaid beds
- Medicaid certification means that the facility must accept what Medicaid pays, after the resident has met the asset/income tests (IOW, cannot self pay) in that particular state (IOW, the resident cannot be evicted for nonpayment)
- Most states have some form of asset recovery (Including the primary home) if Medicaid pays for care
- Medicaid will typically not pay for “Assisted Living” but, some (most?) states have some sort of graduated program to help with ADL when necessary.

I see you’re in Warren, Michigan. You may want to check out the PACE program, which includes services in Warren, if your in-laws are there (or in another area served by PACE).

https://www.michigan.gov/mdhhs/0,5885,7-339-71551_2945_42542_42543_42549-87437--,00.html

ETA: I went through this process in another state and, I found the State Agency on Aging VERY helpful. Suggest you contact them if you’ve not already done so.

https://www.michigan.gov/osa/1,4635,7-234-64081-295815--,00.html

thank you and thanks for the reminder about PACE, I read a bit about it before and even bookmarked the site but forgot about it

 

[razztazz]

There is a five year look back period on assets. Believe me that the feds and nursing homes have seen every trick in the book to shelter, transfer, or hide assets. My advice is to play it straight or you could find yourself in the Klink.

My statement was not addressing assets vs medicaid vs applicable rules. It was aimed solely at finding a place to get into even if you had a ton of money and medicaid was not a factor.

 

[Col. Klink]

My statement was not addressing assets vs medicaid vs applicable rules. It was aimed solely at finding a place to get into even if you had a ton of money and medicaid was not a factor.

No problem. I was not addressing any single person with this comment. I should have perhaps used the word "one" or "people" instead of the word "you".

 

[Dtail]

There is a five year look back period on assets. Believe me that the feds and nursing homes have seen every trick in the book to shelter, transfer, or hide assets. My advice is to play it straight or you could find yourself in the Klink.

Like the reference.
But as you mentioned in another post, if one can pay for a years' worth.......
So if the irrevocable trust is set up legally and a 5 year window has passed with the current assets not being touched, that should work, no?

 

[Golden sunsets]

OP-


ETA: I went through this process in another state and, I found the State Agency on Aging VERY helpful. Suggest you contact them if you’ve not already done so.

https://www.michigan.gov/osa/1,4635,7-234-64081-295815--,00.html

This is very true. When I contacted the Agency on Aging in my State they sent me a very comprehensive list of facilities with notations on which accepted medicaid and which did not. From that list I was able to make contacts and determine what options were available for my Mom.


Another comment someone has made here about protecting assets in a Trust, will only work if the transfer is made 5 years in advance of the need. If not the ¨lookback period¨will force a reversal of the trust. States are very careful about making sure that there are no assets overlooked going back 5 years. They will even disallow cash gifts to family members for birthdays etc. if the sums are more than nominal.

 

[Dtail]

This is very true. When I contacted the Agency on Aging in my State they sent me a very comprehensive list of facilities with notations on which accepted medicaid and which did not. From that list I was able to make contacts and determine what options were available for my Mom.


Another comment someone has made here about protecting assets in a Trust, will only work if the transfer is made 5 years in advance of the need. If not the ¨lookback period¨will force a reversal of the trust. States are very careful about making sure that there are no assets overlooked going back 5 years. They will even disallow cash gifts to family members for birthdays etc. if the sums are more than nominal.

So referring to your above comment, if one has 1mm in an irrevocable trust and there are earnings 150k of total interest in 5 years which is passed through to a regular taxable account.
The "principle amount of 1mm is not touched for those 5 years.

Isn't the 1mm principle still protected?

 

[tps7742]

https://www.agingcare.com/articles/how-to-use-a-miller-trust-for-medicaid-eligibility-207367.htm

 

[MichaelB]

https://www.agingcare.com/articles/how-to-use-a-miller-trust-for-medicaid-eligibility-207367.htm

Can you please give us a snippet or explanation?

 

[Col. Klink]

I have found that the folks who seek out a good attorney that specializes in eldercare usually get really good results on behalf of their loved one's. They can tell you what financial moves are appropriate and complete those arrangements. The long term care facilities (at least in CT.) know that a prospective resident represented by one of these respected lawyers is going to have an accurate financial disclosure statement. The really good one's will do educational seminars for Nursing Home Administrators groups to help the administrators fulfill continuing education requirements. Often they will consult with the associations that represent long term care facilities in each state. These might be good questions to ask the attorney prior to engaging them.

 

[Golden sunsets]

So referring to your above comment, if one has 1mm in an irrevocable trust and there are earnings 150k of total interest in 5 years which is passed through to a regular taxable account.
The "principle amount of 1mm is not touched for those 5 years.

Isn't the 1mm principle still protected?

I'm not an attorney, so this response is worth what you paid for it, but I would think that in the situation described the 1MM is safe, however, if the person who received the $150,000 is the potential medicaid patient, I would think that the continued receipt of funds from that trust would be analyzed by the State and either disqualify the patient from medicaid or be forfeited to the state, if less than the medicaid payment threshold. IOW, the trust could not arbitrarily stop distributing funds to that beneficiary.

 

[tps7742]

Can you please give us a snippet or explanation?

https://www.agingcare.com/articles/how-to-use-a-miller-trust-for-medicaid-eligibility-207367.htm

This link shows how to use a Miller Trust for Medicaid Eligibility.

Sorry it was late when I posted it. In the case of my mother going to a nursing home. For a number of reasons my mother wasn’t a saver and didn’t have significant assets enough to private pay a nursing home for a very long. She was a few hundred dollars short per month. I hired an elder care lawyer and he assisted in mom’s Medicaid application, setting up a Qualified Income Trust to send her social security and retired VA widow benefits to pay the nursing home. This is not a way to shelter the money just a legal avenue from a Supreme Court case is my understanding Miller Trust. At the time all the Medicaid rules apply, less than $2000.00 assets in the bank, less than $2250.per month etc. In her case her pension and social security was $3367.00 per month. Again, she still has to spend all her applied income to the facility with the exception of $60.00 personal needs. My mom lives in Texas and this Miller Trust may not apply in all states. I can’t stress the importance of getting a lawyer that specializes in elder care in similar situations.

 

[Dtail]

I'm not an attorney, so this response is worth what you paid for it, but I would think that in the situation described the 1MM is safe, however, if the person who received the $150,000 is the potential medicaid patient, I would think that the continued receipt of funds from that trust would be analyzed by the State and either disqualify the patient from medicaid or be forfeited to the state, if less than the medicaid payment threshold. IOW, the trust could not arbitrarily stop distributing funds to that beneficiary.

Okay thanks. I am dealing with their trust attorney on the setup, etc, but haven't made any distributions yet, so that concept was not discussed yet.
They don't need the income from the trust and likely would not need it in an LTC situation either.
My angle was the protection of the monies contrasted with minimizing taxes.

 

[tps7742]

I have found that the folks who seek out a good attorney that specializes in eldercare usually get really good results on behalf of their loved one's. They can tell you what financial moves are appropriate and complete those arrangements. The long term care facilities (at least in CT.) know that a prospective resident represented by one of these respected lawyers is going to have an accurate financial disclosure statement. The really good one's will do educational seminars for Nursing Home Administrators groups to help the administrators fulfill continuing education requirements. Often they will consult with the associations that represent long term care facilities in each state. These might be good questions to ask the attorney prior to engaging them.

Luckily the administrator at the facility my mom lives directed me to this lawyer. From what I have seen all residents get the same treatment private pay or not.

 

[Carol1862]

I have found that the folks who seek out a good attorney that specializes in eldercare usually get really good results on behalf of their loved one's. They can tell you what financial moves are appropriate and complete those arrangements. The long term care facilities (at least in CT.) know that a prospective resident represented by one of these respected lawyers is going to have an accurate financial disclosure statement. The really good one's will do educational seminars for Nursing Home Administrators groups to help the administrators fulfill continuing education requirements. Often they will consult with the associations that represent long term care facilities in each state. These might be good questions to ask the attorney prior to engaging them.

We spent the money and hired an elder care attorney. She was knowledgeable and efficient. All the running around I did prior trying to get answers was not necessary. She gave us a written outline of her recommendations as well as sat with us to explain all the details. She was thorough. In the end, you do have to do a lot of work gathering info, but at least you’ll have a true answer to all of your questions. Especially for your state.

 

[Carol1862]

As a Nursing Home Administrator, if someone had over a year of private assets to spend down prior to transitioning to Medicaid, we would usually accept that person as a new resident so long as the our ability to care for them on the medical side checked out.


This. My mother was accepted into the nursing home that was also a Medicaid NH. She had a years worth ($8000 a month) to pay for her care privately. She will then transition to Medicaid. I hired an elder care attorney who helped me get ready for the huge undertaking of applying for Medicaid. The 5 year look back is extremely time consuming, unless the person had no assets during that time. My mother did.

 

[Col. Klink]

Luckily the administrator at the facility my mom lives directed me to this lawyer. From what I have seen all residents get the same treatment private pay or not.

Federal law requires equal treatment and amenities for residents of a Medicare / Medicaid enrolled nursing home regardless of payer source.

 

[Teacher Terry]

The nursing home handled most of the Medicaid paperwork and I just submitted bank statement so really easy.

 

[zippy2020]

IIRC MEDICARE will pay for a very limited time, like less than 30 days.

Medicaid, for the long term indigent. As others have posted, very limited assets, usually a 2 year look back on assets, and claw of anything upon death , including home equity.

Medicaid changed to a five year look back on assets or asset transfers, quite a while back.

To the OP: Your best bet to find out what Medicaid pays is to talk to a local facility manager. Rates vary according to states because Medicaid is a 50-50 program: 50% Federal funds matched by 50% state funds.

 

[zippy2020]

This is true my MIL had dementia , she had money to pre pay for around 2-3 years but we had to select our second choice because our first choick told us very clearly that they didn't accept Medicaid. It was a difficult choice for the family because it was her third placement and everytime we switched her placement she declined significantly.

This is something that many people new to caregiving may not be aware of.

Change is very, very hard for people with dementia. Think of dementia as a "narrowing" of the visual world they see. As dementia progresses, more and more of those visual details begin to "lack sense".

Let's say there's a lamp on a table, between a sofa and chair. The sofa has a throw over it, as well as a few different decorative pillows. The chair has a seatpad on it, and somebody's sweater hanging on the back. There's tchotchkes on the table - a couple of photos, a few magazines, somebody's coffee cup.

Dementia turns this visual into a confusing, chaotic mess.

The clutter of so many details overwhelms the dementia-afflicted. Multiply that one visual by different angles/perspective - every time the person turns around, there are more shapes and colors and details crowding in!

Individual elements get "lost". Even something familiar may not be remembered, because there are too many things around it, and the dementia prevents being able to visually separate items into familiar/unfamiliar.

It all becomes strange and confusing.....which creates anxiety. The mind freezes up further under stress, and the anxiety continues to build.

The world becomes an unfamiliar, vaguely threatening, visual kaleidoscope every time the surroundings visually change. So routine is very comforting to dementia patients, greatly lessening stress.

Sorry to have gone OT, but the lesson we learned is, when you are caring for someone with dementia, you have to very carefully approach change with them. They don't take it well, so if you can avoid it, best to do so.

 

[NoiseBoy]

I think you’ll find most nursing homes don’t work this way. They either take Medicaid or they don’t. I don’t think you can “subsidize” Medicaid to get a “better place”? Maybe....but I don’t think so.

1) if a nursing home accepts Medicaid, once your in-laws assets have been drawn down to Medicaid levels (check your state laws for that level), Medicaid picks up the tab. What that amount is, is an agreement between the nursing home and Medicaid. You don’t “chip in more” to get a better room or better care at that facility.

2) if they don’t accept Medicaid, they don’t. Period. They don’t and won’t bill Medicaid. You pay the full amount and if you run out of assets you must move to a facility that does accept Medicaid.

This is how it works in my community, so I assume that it is the same for the entire state. We toured and filled out financial data for two different places and I had this conversation with their sales and marketing people. One place kept referring to a "fund" that they had to cover the gaps when a resident ran out of money, but when I kept asking for details, I learned that the fund was only enough to cover small gaps, like $500 a month. It smelled very much like they just wanted us to move our parents into their facility and then hope that they died before their money ran out. Very shady. The other place was a run by the Lutherans, and their marketing person was much more straightforward with me. It was 100% private pay (second best place in our community) and when my parent's money ran out, they would be moving out. Period.

It is my understanding that, in our state, if a facility takes Medicaid, like for when a resident's money runs out, then they are obligated to accept Medicaid only patients too. That is why most of the facilities near us are 100% private pay. There is no middle ground.

 

[marion10]

Our experience with my MIL was similar- she was a widow and went she entered a nursing home, she had enough assets to cover about 18 months of care ( at 8,000 or so a month). She went into a very good church run nursing home and stayed there for six more years! She had SS and a small pension and Medicaid paid the rest. My husband and his siblings did pay extra - maybe $200 a month to have her in a private room. We still give regularly to the facility- I know the Medicaid reimbursements do not cover the full cost and we are so grateful for the care she received.

 

[Dash man]

We put my MIL into a nursing home last year from an assisted living place. My FIL lives with us. The nursing home has a limited number of beds for Medicaid, but patients are treated the same. She is much happier than she was in the assisted living facility. Medicaid takes her social security and she gets an allowance. FIL takes her to get her hair and nails done. They keep her busy and frequently have singalong hours or other entertainment. FIL washes her clothes to avoid that additional fee, which we offered to cover. He’s there every day, so it gives him something to do.
The paperwork to start Medicaid was horrendous, but once done it’s been great. FIL could not have done it himself. DW did all the work, but the people in the home were great in helping. The county was helpful too.

 

[ncbill]

15+ years ago we were paying $120/day vs. Medicaid rate of $90/day at the same nursing home here locally.

 

[North Texas Cajun]

Medicaid laws vary by state. One important consideration is how much of a spouse’s savings must be spent before Medicaid will cover nursing home care. As I understand it, in many states almost 50% of combined IRA totals must be spent first, regardless of who owns the IRA. Furthermore, the maximum IRA allowed the spouse not receiving nursing care is as little as $126K.

https://www.elderlawanswers.com/medicaid-protections-for-the-healthy-spouse-12019