Follow
Share

My uncle is entering a long term facility after his rehab has plateaued in the western part of NY near Buffalo. I am in the process of working with and eldercare attorney for the Medicaid application process. He will have LTC out of pocket for about 3 months and after that Medicaid will be accepted, hopefully. I am his POA and joint on his accounts.
What personal expenses will there be once Medicaid is in full effect and not covered by Medicare or Medicaid?
I have set up a Salon account for weekly shaves and haircuts every six weeks (enough for a year expense). I have purchased clothing in anticipation of future needs and with the knowledge that they will be lost frequently.
I am going to prepay a years of cable service. Would a Tracphone with prepaid phone cards be an allowable Medicaid (NYS) spend down expense? Can anyone advise on purchasing gift cards under $200 increments is Medicaid spend down acceptable for future needs that may arise while he is there?
I truly expect this to be a long term residence since he is only 83 years old. And, the monthly "stipend" NYS Medicaid allows is $50 on top of the assets limit that can be left in his bank account.
Thank you!

Find Care & Housing
I advise spending down his assets with a pre-paid funeral. I just pre-paid cremation services for my MIL on Medicaid here in MN (but she gets to keep $120 a month).

We also pay for salon services, cable and phone, and clothing. When we visit her we call and ask if there's any special foods or treats she'd like and we buy that for her. We also use her funds to purchase a supplement for her to prevent UTIs, and to "tip" the staff on special occasions. Sometimes they have special dinner events and her funds pay for us to attend that with her. She is 100% immobile and has mild dementia and short-term memory impairment. She got 2 govt covid payments so her bank account swelled up but honestly has no where to go since there's really nothing else she needs. Medicaid paid for a very fancy wheelchair with a higher back and side supports because she leans to one side and has chronic back pain.

I would wait for him to be in and on Medicaid for a few months before over-thinking it. You've done a good job figuring it out to this point. My MIL is basically healthy 88-yr old, just cognitely impaired and refused to get out bed anymore. But your Uncle may be more able to do things than my MIL, or have different needs.
Helpful Answer (6)
Reply to Geaton777
Report

Some things to consider. Yes, as others have noted pre-paying for funeral expenses (within reason) are acceptable from a Medicaid spend down standpoint. Ditto for legal expenses w/the elder care attorney. These expenses should be paid from his funds.

In terms of pre-paying for services, I would advise against that. Once he qualifies for Medicaid long term nursing home coverage, each month (assuming he receives a monthly Social Security payment and perhaps other "retirement funds/pension" (?); your State will calculate a monthly "cost of care contribution" amount he needs to pay from his incoming income. Generally, most States take about all of any incoming income except for perhaps $80 or $90 dollars.

So you will have to pay (as his POA) this monthly amount to his nursing home. Some of these facilities are not set up for on-line payment and therefore a monthly check has to be sent in (kind of a pain if you do not live nearby). I would drop off a check each month for my mom when we were in this situation as I could not trust "snail mail" (the check has to arrive and process within the month) AS YOU MUST keep the total monthly balance in his account BELOW your State's incoming limit,

Because of this "need to keep the balance" below the State's income limit on a monthly basis, paying for needed items as you go will help you keep that Monthly Limit. If you pre-pay for things now; YOU WILL STILL NEED to spend funds on something as this moves forward JUST TO KEEP him below that monthly income limit.

Keep all receipts as you'll also need to file annual taxes for him, another reason to pay in the year incurred rather than upfront! Hopefully you have on-line access to all his accounts (any banking, SSA, retirement, Medicare, Medicaid, etc). Handling it all on-line is so much easier. Also, each year there is a "redetermination" process whereby you will need to upload into your State's Medicaid long term nursing home portal (bank statements for the prior year, state and local taxes filed, receipts of expenses for anything spent out of his funds, etc.). Again, so much easier to do with on-line access.

Good luck with this. The paperwork on this continues until they pass, with filing their final taxes the year after they pass.

One consideration -- talk with elder care attorney -- if (this often happens) your LO needs to go to the hospital, Medicaid long term nursing home coverage does NOT include (except for a day or two) a "bed hold" at the nursing home. This means, even if he's in a top quality nursing home that your have worked out, IF he has to be hospitalized for something you may loose his bed and upon discharge he may be transferred to another (perhaps poorer quality) facility. Worth figuring that out and how much (if any) you or he is willing to pay for a "bed hold" which can be $400 a day or more.

The other consideration is to work out what if any DNR (do not resuscitate) decisions need to be made now. As lacking this, the nursing home staff will do what ever to resuscitate them and that likely sends them to the hospital. Hard, but this is a thing to figure out now when placed rather than in an emergency situation.
Helpful Answer (5)
Reply to Sohenc
Report
BurntCaregiver May 27, 2024
@Sohenc

If the nursing home bill is paid monthly that means the 'bed' is paid for for the month even if someone goes to the hospital.

What I did with my father who was in and out of the hospital several times during his nursing home stay, was to always get monthly statements from Medicare. If they were paying for some of the nursing home days because there was a need for skilled nursing for some days, I would deduct the cost of those days from the following monthly bill.

It takes a little legwork but no one has to pay a nursing home one cent more than they are owed.
(3)
Report
See 3 more replies
AMZebbC: In addition to all the monies he should be spending (not your financials), he could purchase funeral expenses as part of the spend down process.
Helpful Answer (5)
Reply to Llamalover47
Report

My comments only cover 1 topic: prepaid funeral expenses. Some time after reaching "senior" age 60 or so, my husband and I both purchased end of life policy or whatever they want to call it--ours from Neptune Society, but there are other companies that do end of life arrangements. When my husband died, I contacted Neptune Society, and they arranged the cremation, took the body, cremated it, and told me what to do, etc. took it to the cemetery, etc, I had picked out years ago, My grave with his is still there, awaiting me--I'm 84. And upon my death my family can call Neptune, give them my account number, and they will arrange to cremate my body and place my cremains with my husband's, whose remains are in the Veterans's area of the cemetery. I didn't want my family to have to do anything but call the company which does the cremation, and they take care of the rest. There should be no further costs, since it was prepaid. If there are more costs, my family can figure it out if costs are legal or not, per my contract for burial. People, don't make things hard, do some research now, when you have memory and health to think things through. Make it easy on your families.
Helpful Answer (4)
Reply to JosAgingCare
Report
ElizabethAR37 May 27, 2024
Like you, my husband (now 94) and I (87) prepaid our no-frills cremations through the Neptune Society quite a few years ago. I'm glad to read about your experience with them and hope that ours are as seamless as yours. I rather expected that there might be extra charges since it's so many years later. Maybe it varies in different locations.
(1)
Report
See 1 more reply
Take a picture of his clothes. That will prove easier to locate and proof of ownership should facility lose them and if so you should be reimbursed if they cannot locate items. They are more likely to be pressed about it. Keep the receipts for his recently purchased clothing
Helpful Answer (4)
Reply to Riverdale
Report
BurntCaregiver May 27, 2024
Or write his name with sharpie on the inside of his clothes on the tags or waistbands and on every sock.
(2)
Report
See 2 more replies
AMZ, fwiw the LTC Medicaid system is NOT 1 & Done!
there will be a renewal process as well and very much some of the items just submitted will be once again required plus newer ones. I had zero idea this happened and had out all of my moms paperwork into bins AND INTO STORAGE. Then the renewal letter landed….. was due in like 14 days for the date of letter which was actually postmarked later than the letter created date. It was a long azzz weekend.

so get a binder going to keep items of his as they come in for the renewal. For my mom her initial application was abt 130 pages, the renewals abt 25/30 pages.

oh and that at the NH in-house trust account that u put $ in for barber shoppe, that is technically his. And whatever in it along with whatever else nonexempt assets he continues to have (like in a bank account he still keeps) all - ALL - count towards his overall asset tally. If his state has nonexempt assets at $2,000 maximum, be sure you count that barbershop $ in the overall figure.
Helpful Answer (4)
Reply to igloo572
Report
Geaton777 May 28, 2024
For my MIL here in MN, we haven't had to do any renewal paperwork after her 2nd year of needing it. It has autorenewed now for the past several years (they just send us a letter saying it was renewed). But this may vary by state.
(1)
Report
See 2 more replies
He will get a Personal needs fund if you allow the NH to be payee of his SS and any pension. By doing this for my Mom, I did not have to write a check monthly. If u do write checks, you will be able to put a small amount of money aside for his personal needs. In my State, its $50 monthly.

Other than clothing there is not much he will need. His toiletries will be provided. As will his Depends. Not sure if I would do the gift card thing. I would check with a Medicaid caseworker.
Helpful Answer (3)
Reply to JoAnn29
Report

I’m with JoAnne and do NOT do the gift cards.
Geaton is spot on with her take on all this.

But what you can do is for every Care Plan meeting is request that someone from billing is in attendance. Normally they are not, it’s nursing, dietary, activities, social work, maybe PT/OT. But billing would be good as they can let you know what’s what and with input from the other teams as to where they see things he could need and that you can buy or they can order and either way you pay for it.

CPMs are required by Medicare. First one will be pretty soon after he officially enters as a custodial care resident. Afterwards they are every 90 days and you can do them via Zoom or just a on speaker phone call. Or have it set for a time to be when in person works for you. SW usually coordinate these. Fwiw I went to maybe 2/3 of my moms in person as I live in another State. And for these, I took in a snack (muffins, clementines, sm apples, sleeves of kids birthday party ice cream), after the first time I did this, nobody missed showing up for moms CPMs. They went from 15/20 minutes to 45-1hr. Anything extra went to the DONs office aka the Director of Nursing who is the goddess and ruler at the NH. Just sayin’…..
Helpful Answer (3)
Reply to igloo572
Report

You can do a pre-paid funeral arrangement. You can pay any bills he currently had. You also have a right to pay yourself (out of his funds) for doing the job of POA. People often think they have to do it for free. They don't. Ask the lawyer about it. I hope the lawyer is being paid out of your uncle's money and not yours.

When I was POA for my father I charged for that service even when he went to the nursing home. Every check I had to write or phone call I had to take on his behalf was paid for. The nursing home didn't like it because they wanted every penny and then some, and tried to petition for conservatorship over him which they lost. Check with that lawyer because you may have a legal right to get paid as POA.
Helpful Answer (3)
Reply to BurntCaregiver
Report

OP here. Thank you all for the suggestions.

Once my uncle is on Medicaid he will keep/receive $50 per month. That seem paltry to pay for shaves, haircuts and clothing.

I have and am still in process of doing spenddown. I also have retained an eldercare attorney for the Medicaid application and sorting out his financial situation. WOW, this a long and arduous process.
Helpful Answer (3)
Reply to AMZebbC
Report
Geaton777 May 28, 2024
Yes, it's often a shocking and exhausting learning curve. I wish I had found this forum back in 2016 when both my broke, in debt and clueless in-laws were failing physically and cognitively at the same time and thought my husband and I were their rescue plan.
(4)
Report
See 1 more reply
See All Answers
Ask a Question
Subscribe to
Our Newsletter