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After the required two-year stay, my sister should be transitioning to a Medicaid pay in March of next year. Her bill from the pharmacy is currently about $250 a month, all over the counter medications prescribed by the doctor on staff. She will also need assistance with bathing and laundry, though not much else at this time if she stays stable.


I understand Medicaid will only allow a small allowance monthly for spending. How are medications and additional care handled?


I am currently having an outside agency handle my sister’s bathing, laundry, and bedding changes because the facility was doing a very spotty job. The outside service also handles transportation to doctors, which has worked much better than my sister taking the AL bus.

How it works with Medicaid is your sisters Social Security and any Pension will be used to offset your sisters care. Medicaid then pays their share. Your sister should get the same benefits the AL gives. Even if her care needs become more. Family should not be asked to pay anything towards a residents care. Medicaid is based on the residents income not the families.

Prescriptions, they would be handled by Medicaid. There should be no bill because the resident should not need to pay for anything. The OTC...my nephew has a feature with his Medicaid that pays for or partially for his OTC.

Personal Needs Acct, Medicaid allows a small amount of SS to be used for things for the resident, my state $50. When my Mom went into LTC on Medicaid, I allowed the LTC to be her payee for her SS and pension. The facility set up her PNA. If you are chosing to continue to handle sisters SS and pay the AL, you can deduct the PN amount your state allows keeping it in her acct but keeping records on how you spend it. This money is considered part of the asset ount allowed, my state 2k. So you cannot go over that 2k. Even if the PNA is handled by the NH.

You may still have to pay for the services you do now. They will not get better because she is on Medicaid. That cost will come out of your pocket. ALs can only provide so much care. There may come a time when sisters needs outweigh the ALs ability to handle. You may want to look around at some nice LTC facilities. The one I placed Mom in was so nice. I noticed the people were clean and fairly happy.

P.S. P.S. ALs usually have a limit on how many residents can be on Medicaid. You may want to check with the Administrator on how Medicaid works at their facility. They may have reached their limit when sister's money runs out.
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WearyJanie Jun 27, 2024
Thank you JoAnn. I am getting my info together to start the process of applying to Medicaid in another couple of months. We chose this particular facility for my sister because they have a guarantee that after you have been a self-pay for two years, you are guaranteed a Medicaid room. They do not double-bunk there, but you are in a studio apartment.

Even though this is what the contract says, I am afraid that somehow the rug will be pulled out from under her. This was a more expensive facility because of this guarantee.

The elder care attorney I retained to handle my sister’s affairs is retiring, but I am going to find a new elder care attorney to handle the Medicaid application and navigate any legal ins-and-outs with the AL.

Thank you for your response. That is very helpful.
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