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We are in Minnesota. We are bringing her here from Kansas. We found a place that seems nice. We had a long conversation about the ability for her to age in place. We understand there are situations where that might not be possible and she moves to a nursing home. So, can anyone say if they have had trouble moving to Medicaid in a Memory Care place after private pay runs out? Has anyone had experience with moving someone to a NH after their private pay runs out and their current place doesn't have a Medicaid bed available? Or, is there some sort of assurance that we can get from the MC place that they will keep her until a bed is available without expecting us to makeup the difference, which wouldn't be possible? Our biggest fear is that we have this great place that will deplete us of all her money and then when she really needs help/care, they say goodbye. What prevents them from doing that and kicking her out?

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Talk to other ppl whose parents are there.
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Get a "medicade application." The elgibility will kick in when spend down is complete. If spouse is alive up to one hundred thousand can be transfered to other spouse. The medicade app. must always have a "return home" even though it will never be a option.
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AlvaDeer Sep 2020
In general great idea, but that doesn't insure that the Assisted Living will accept medicaid payment. Most will not. Most are private pay and when the money is gone, so, sadly, are you.
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You MUST ask IF it's a facility that is already Medicaid approved.NOW, before she is admitted. Everyone in the U.S. eventually lands into the Medicaid realm, so it's a common subject to discuss.

IF the facility is BOTH Private Pay AND MEDICAID-approved, then she "should," be allowed to stay, if her contract states that her bed will be converted into a Medicaid bed. (Yes, specifics need to be in writing), Ask if she will be changing rooms or if it's just a billing switch;it's best to know what's involved in the switch from private to Medicaid payer status. Usually it's just a billing switch, since Medicaid directly pays the facility.

In the meantime, look into creating a "special needs trust," and look into what needs to be done to get her into Medicaid, for when that time arrives.

What "prevents" them from evicting her? Federal laws mandate that a SNF/LTC resident cannot be evicted while waiting for his/her Medicaid approval.

As mentioned, ASK the facility if THAT specific facility is currently Medicaid approved. IF it's a Medicaid approved facility her contract needs to clearly state that her bed will be converted into a Medicaid bed.

BTW ONLY Medicaid approved facilities can convert a private pay bed into a Medicaid Bed. Ideally it's in the contract signed to stay in the facility. Transitioning to Medicaid billing"should" be problem free.

Social security sidebar: if she will be receiving social security, when she is approved for Medicaid, SHE will be billed a social security based amount as her co-payment.
What?? HOW?
-->The County where the facility is located will calculate her portion of the Medicaid charges due each month. As an example if she receives a notice that she will be getting $930 SS per month. the County will receive the same notice. The County subsequently will calculate her monthly portion due payable by her, to the facility.
It will be ALL of her SS minus a monthly allowance of about $50.
--> In my example the county will send the facility a calculation sheet that states the amount to bill the person; $930 - $50 = $880/month

Our facility has BOTH private pay and Medicaid pay residents/patients. One Private pay bed is billed at $10,400/month while One Medicaid bed is billed at $6,600/month. If the SS person in my example were staying here s/he would be billed $880 each month. The Medicaid co-payment is a federal law, meaning zero negotiation exists.

Sidebar: Augustana Care in Minnesota runs VERY NICE Private pay Medicaid approved facilities.

Their Colorado facility has individual private rooms for each person {Each Medicaid + Each private pay person is in an individual single private room "bed"}. It's in a crazy wealthy area.

Good luck.
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Yes, there is a way. Get the promise that they will convert a bed to a Medicaid bed should private pay run out; get this statement in writing in the contract that they will ask you to sign. And before you sign it, have it reviewed by your attorney.
I can't tell you the number of places that have not had available Medicaid beds when a long time resident runs out of private funds. When NJ maintained government run LTC facilities, we often took these residents but government facilities were not beautifully designed and decorated as the private facilities so both families and residents had to accept big changes. Remember, the promise is not to keep the resident IF a Medicaid bed is available. The statement you want is that they will CONVERT a resident bed to a medicaid bed when/if private pay runs out. Please feel free to message me if you want to further discuss.
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Shane1124 Sep 2020
That would require the facility to apply for and complete the state certification process which is not going to be worth the time it will take for the facility. You can’t simply “add” another Medicaid bed; the place will need to go through a process including an inspection from a surveyor.

That’s a huge reason that many AL/MC do not even have Medicaid beds. They are not Medicaid certified and cannot bill until they have a Medicaid provider number.

That’s not likely to happen. I wouldn’t bet on this.
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When I was looking at places for my mom, several private-pay places came right out and said "We don't accept Medicaid." They were quite clear without saying as much that we weren't going to get her in for a few months with private funds and then transition to Medicaid. Smaller care facilities seem to be more flexible and compassionate. As others have pointed out, absolutely, positively get any promises in writing. (Although if the facility were to change hands, even that written promise might not be honored.) Ideally, I would try to find a placement that does accept Medicaid just so you don't have to make a move down the road, when it will probably be even more traumatic to do so.
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Make sure you ask them before you put her in a Memory Care Facility.. My husband is in a private owned Memory Care Facility and they do not offer Medicaid. We are now in a position to find a home that does offer Medicaid. We are going to see an elder care Lawyer that deals with Medicaid to see what our options are. Here in Il it seems mostly Nursing Homes offer Medicaid.Get everything in writing.
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If they say they will keep him, get it in writing! Personally, my experiences are such that I've become cynical & don't trust what I'm told verbally. If you have a written contract where this is promised, regardless of who owns the business then I might believe it. One of the ways Assisted Living & Long Term Skilled Nursing Facilities get around something like this is to say a resident threatened suicide & pack them off to a psychiatric hospital. (They're lucky if it's one strictly for geriatric patients.) Then you have to pay the facility to "keep the bed" & even then the facility can refuse to take them back on the grounds they aren't capable of providing the services the individual needs. The social worker can manipulate a person into saying something that if taken out-of-context can be made to look as if the person is suicidal or they can report that a resident became violent when that wasn't really the case. Sorry, but I haven't had the best experiences with either type of facility. I hope you have far better ones than I have had.

ci
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I don't know how different states handle money running out. However, I do know that there are a few places that WILL keep residents who run out of money after being there a certain period of time - subsidy. You have to call and talk to them as who will and who will not do this. I am also guessing they might put her into a nursing home that will accept Medicaid. Medicaid does not pay for assisted living, only nursing homes. I don't think I would worry too much but you have to start searching and asking questions now. Good luck.
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Look into putting her $ into a First Party Special Needs Trust, which, as I understand it, protects her $$ and makes her eligible for medical benefits the very next day. Talk to a lawyer to verify this info, but there are definitely ways to safeguard your parent's $$ and be sure they can have services.
You can Google to get more info. Definitely worth exploring.
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JoAnn29 Sep 2020
Special Needs trusts revert back to Medicaid. They are irrevokable. Money can only be used a certain way. Not on housing or food.
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Edit - Medicaid can be tricky.
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I asked my friend, who's mother went through this. She said there was a contract guaranteeing that her mother would not be kicked out for inability to pay through Medicaid. They did all the Medicaid application stuff so that the family did not have to do anything. In her situation there were 3 levels of care, and her mother was taken care of through all 3 levels without a problem.

Hope this helps.
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Imho, you may do yourself a favor by seeking out legal counsel on this matter since Medicaid can he tricky and you may he applying for Medicaid.
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I called my daughter who lives in Washington and cares for her father. She said the AL place where he is, has limited medicaid beds, but if you self pay for 2 years they will do their best to keep him in the same room and not move him to a Medicaid room. He self paid for 3 years and he was able to stay in the same room.

I think you have a lot of work to do. If you get discouraged or it feels overwhelming, just remember this saying, "How do you eat an elephant? One bite at a time". In other words, do a little bite into each phase. or as in cleaning a dirty room, pick a corner and start.

I think there is a host of good advice here. Consider purchasing a notebook, start chapters, like Medicaid, assisted living, or memory care, whichever it is. Maybe a chapter on Attorneys and other legal stuff like POA. That helps me. I have a file for my husband, who is home with me, included is two files for the two times someone has complained to APS about me. etc.
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Frances73 Sep 2020
That’s what we have been hearing in Ohio. Few AL places accept Medicaid Waivers, only SNF are required to provide beds for these residents. Unfortunately most MC facilities at present are part of AL homes, and less expensive than those that are part of nursing homes. Sadly when a person most needs the extra care is usually when their funds run low.
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Be careful. I placed My husband in a rehab/nursing home after he fell and broke his back. When they said he was not progressing with rehab we were told they did not have a long term care bed available
these homes are tricky.
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My Mom's Memory Care has a 2yr private pay requirement before going on Medicaid. When the funds start getting low, we'll put her on the list for a Medicaid slot.
Also, for anyone who was in the military, or their spouse, check into the VA Aid & Attendance program. Assets need to be less that $129k. Monthly checks are around $1200. So far, our claim has taken 8 months, but when they approve, we will receive pay from the first date of application.
Take care of yourself. Your assistance will still be needed when he does go to a facility. But, much less.
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Frances73 Sep 2020
Yes! Mom was just qualified of Aid and Attendance which is a military pension available to anyone, and dependents, who served in the military during a time of war. My dad didn’t serve long enough to get a pension but because he was in the service before Dec 31, 1946 Mom is getting $1200 a month. This can be used for home care, AL, or SNF.
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You can find out if they have Medicaid beds. But, you should remember that these facilities can change hands and perhaps next owner will only take private pay and no Medicaid beds. This facility, if they have no Medicaid beds, should have a social worker who will help you with the paperwork to apply for Medicaid when private funds are about to run out - and assist in finding a Medicaid bed at another facility.

The only kind of real assurance that current facility will keep her after funds are gone is to have it in writing. A verbal conversation will be a moot point several months or years down the road. It will probably be a moot point if the facility sells out to someone else.
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I think you are better off in a Not For Profit place  I know someone whose parent was in a for profit place, that got sold, and there were a lot of issues.
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You are asking the wrong place. You need to sit down with the facility and ask all your questions. No matter what anyone tells you here, you need to hear it from the facility, and perhaps get their response in writing.
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Frances73 Sep 2020
Ask for the paperwork you will be required to fill out, it should all be in writing.
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If the facility does NOT accept Medicaid, then they cannot keep her when the private money runs out. (It would be unfair to expect them to provide free care to your mother - even for a short period of time. If you are her POA, then, yes, you would be expected to "make up the difference.")

You need to find out if the facility accepts Medicaid or not. If NOT, then you need to start looking for a different place before it becomes an emergency situation (i.e., she has no money left).
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Have frank discussions with the administration and social worker at the facilities you are considering. The places that accept Medicaid and Medicare should have protocols in place for applying for this assistance.
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Frances73 Sep 2020
That's what I did, I told each one I was looking into that Mom might outlive her funds and have to go on Medicaid. Most have a Legacy program that requires a 2-3 year residency before they will accept Medicaid.
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The elder care attorney is the best angle. My family is also concerned about this, as her current MC situation does not accept medicaid. So a trust has been established for her, and we've negotiated with the MC to change a clause in their agreement so that the trust is responsible for her financial situation, not her children as individuals. It sounds cruel, and maybe even self serving but it isn't. None of us can afford what it would take to fund her care if her funds run out, though we'd try if push came to shove. It may also be possible to negotiate at least some sort of lengthier rate freeze for perhaps 18 months or longer, if the current agreement stipulates a 12 month rate freeze. As a side note, we also learned that age in place really doesn't mean what we think/hope it might mean, so we're girding ourselves for that eventuality. Good luck.
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There is probably a clause in the contract about it being null and void in a number of different circumstances. What if the home goes bankrupt? What if she develops behavior issues and is a danger to herself and others.

Why from Kansas to Minnesota? That is a long way if there are problems that you need to respond to.
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whaleyf Sep 2020
They are in Minnesota.... She's in Kansas. That will put her closer to them.
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In the state of Maryland, memory care facilities (MCFs) are private pay. Most nursing homes are private pay but a few accept Medicaid. I visited all 6 facilities within the 20 miles radius of my area that accepted Medicaid and they were all the same: terrible! I would not want to live there.

This is the time to call and ask them directly if they accept Medicaid clients when the money runs out. Some places will avoid answering the question directly because they do not want to lose a chance to get your money now, but ask again until you get a YES or NO.

Good luck.
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I would suggest finding a NH that you would prefer her to go to once the money runs out and get on their waiting list.  If it is a nice place with a good reputation, they will have a waiting list.

The assisted living facility that my mom is in keeps raising their pricing structure and moms money is dwindling down quickly.  So, we are in the same boat as you.  I am still looking for the right place to be her next step.

Good luck.
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I think each state regulates insurance and nursing homes. You may want to speak to an attorney in your state who specializes in elder care.
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In Virginia, it is not allowed by law for Medicaid to pay for AL. I think its stupid because AL, even MC is cheaper than NH, but thats the law.
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JoAnn29 Sep 2020
Medicaid does not pay what private pay does.
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With every State Medicaid is a little different when it comes to will they pay for an AL/MC facility. This is what you need to find out.

1. Will your State Medicaid pay for MC.

2. Does the MC except Medicaid and if so what is the criteria. Not all
except Medicaid and are not required to.

3. There may not be any guarentees.

With number 1, if your State Medicaid does not pay for MC the rest is mute. Be aware that you are bringing her from another state, Medicaid does not go over state lines. She may need to be in Minn. for a while to claim residency.

With number 2, MCs are private pay. Here in NJ you need to pay privately for at least two years before Medicaid can be considered.

With number 3, if MC excepts Medicaid it may only have a % of residents they allow on medicaid. Because of this, no guarantees can be made. If they have hit their quota when she runs out of money, then she will need to go into a NH on Medicaid. They do not make money on Medicaid. Medicaid does not pay what the private pay is. My Mom paid 9600 a month privately in a NH for 2 months then medicaid took over. When she passed, her SS had paid 1700 towards her care a month for 3 months. The Medicaid lean was for 6k in that 3 month period. Unless Medicaid doesn't recoup the whole amount, my Moms care was only 3700 a month in a room of 4. Lots less than the 9600 she paid privately.
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JoAnn29 Sep 2020
Just looked it up. Medicaid in Minn pays $2313 a month towards NH care. The recipient's SS and any pension goes towards the cost too. So as you can see, Medicaid pays a lot less than private pay.
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Ask them, but in most cases you cannot. We were told the same as Alvadeer. My MIL was in a popular chain of AL in NY. She paid $10K monthly to stay there. I asked what will happen when her money ran out as I had heard that perhaps the center would accept a Medicaid waiver and be allowed to stay but was informed that AL doesn’t take Medicaid waivers.

So yes, they would insist my 95 year old MIL apply for Medicaid and leave AL for a Medicaid NH after self paying $8-11K monthly for 3 years. My MIL passed last May @ 96, but for a while there we thought she would live forever. We were sweating bullets about the fact that after one more year her funds would be depleted.

As far as increasing the # of Medicaid beds, that requires certification from whoever regulates AL’s and the AL wouldn’t bother with it. My MIL’s AL had no Medicaid beds.

Assisted Living centers are businesses after all. Plus the overhead the AL’s must pay for employee staffing and benefits is probably high. The residents fund that as well as those “activities” for the seniors, meals, linen changes, housekeeping, etc.

Is this right? Not in my opinion but it is what it is.
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Absolutely make sure you get any promises in writing, don't ever accept verbal assurances!
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I spent 6 months trying to find a Medicaid eligible spot for sis-while at the same time only searching for communities that were above average 4-5 stars on the Medicare/medicaid site. only 10 percent of the 150 available facilities in a 4 county area-50 mile range from my house. A lawyer assisted us in applying for Medicaid-while sis was not in a Medicaid facility at the time-application was then denied for this reason.

We will have to reapply-new facility Medicaid eligible placement-self paying for now with family assistance as we were desperate to get out of the bad place she was in-injuires, being unclean. We did not have time to wait to re do Medicaid as was covid start we grabbed the spot. You should get it in writing that facility will guarantee you a spot after X time or the money runs out, who will do the application-them or you time line etc. I have not done this-no guarantee it will work.

During my facility search I asked to be on wait list. None have called in the last 10 months-probably never will. Really great place says 2 year wait list. Medicaid rules say a facility can approve more medicaid beds but getting facility to actually do that?????

Most of what I have learned from my research as that the facility will want some assurance of your ability to self pay for a period of time 1-2 years worth. They wlll always give first choice Medicaid to current facility residents. I was told this a few times when we were told a bed was going to be available-but then a day or so later-poof the spot was "taken". Which sis did not have a huge amount in the bank to pay for high needs care. Sis needs full on nursing care was combative in the past-limited places will take on difficult cases. She is not combative now but having other behavior issues.
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