How to pay for assisted living?

Medicaid requires for those going into LTC facility programs to do a copay, or SOC (share of cost), or Patient Liability of all their monthly income (SS, pension) to the facility. Once she applies for Medicaid, even if she’s still considered to be “Medicaid Pending” and even if she still continues to own her old home or condo, she is required to do the copay from Day 1 of medicaid application if she is a widow.

Medicaid is all about her income and assets.
Medicaid does not factor in any of her debts.
Unless your state has a waiver provision for homeowners that she files for AND the waiver allows for some of her income to go toward the property costs for a period of time IF the property is on the market with a MLS type of Realtor listing (so no FSBO nonsense). TX has this and it’s basically only for those with a mortgage and seems to be limited to 6 mos. As she’s fully expected to sell house within that period of time and then she’s off Medicaid as she has $ from sale to use in total spend down for care. It makes sense for Medicaid to allow this otherwise property gets foreclosed on and no $ to anyone and no Estate Recovery (MERP) possibility in the future. 

For those on Medicaid, if parents wants to keep their home by & large Medicaid allows homestead to be an exempt asset for the elders lifetime and the after death it becomes an nonexempt asset of her estate and subject to however MERP is done for your state. BUT due to copay, all property costs will fall to family to pay. 

To me if mom wants to keep her home, then family needs to pay for & totally be all in for whatever property costs from now till beyond her death AND family is going to have to deal with documentation to get whatever exemptions, exclusions or whatever’s for MERP and probate or whatever else to establish Heirship. I’d suggest you take pen to paper to see just what this will look like. If there’s a mortgage (horrors!) to me that’s a deal breaker as the costs for mortgage and related required will get to be beyond the budget. A fully paid off home that you can kinda close-down and get to minimal costs & it’s that heirs likely have exemptions to MERP can make sense to do if you can afford it. OR that mom rents to cover all costs but the rental income will get factored into the copay for Medicaid. But either way there’s risk as your fronting costs on a Property that you do not own and may not ever own. But it can be done. 

For AL & Medicaid, that funding is through a Medicaid waiver program. You need to clearly be sure that the AL waiver is available and a waiver bed is & will be open for your mom from day 1. You may find that that’s not gonna happen....

For VAs A&A, that imo seems to work best for AL as between her SS & VA A&A $ (maybe $1500-$1900), likely will have enough to totally pay for AL with maybe some $ to go to condo. But outside of that all costs will fall to family. Medicaid not paying for her AL room&board in this scenario. 

For VA A&A & NH & Medicaid, as NH costs run 5k-15k depending on where you live, that situation it’s better for her to totally go onto Medicaid and forgo any VA $. And there will be a shortfall by the thousands with VA A&A. She cannot have both A&A and Medicaid LTC in a facility simultaneously. Medicaid will cover all costs in a NH so it’s the better of the 2. 

VA A&A really seems to come in handy when there’s a sober diwn. As it gives them extra $ to use to pay for care. If mom is going to sell the condo, then VA will be great as 
it can come back into use after she’s got her assets didn’t down a bit and let her private pay for a lot longer. Private pay gives her more options as to facility.

One thing you may not/should know, is until Medicaid (if needed) kicks in your mom will be on self pay, unless Medicare will pick up some of the costs. Even if they do, she would still be on the hook for co-insurance if the facility decides to add that to her bill

Shads point is important.
Most facilities that accept Medicaid allow for them to come in as a application submitted resident and as “Medicaid Pending”. But a facility as far as I’m aware, does NOT necessarily have to accept them as “Pending”.

For both my mom & MIL (2 different states), their first NHs took them in under Medicaid Pending. Each NHs did review the documentation submitted with their Medicaid application & was nothing glaring or problematic with either ladies documentation. So ok for Pending & both did their required copay of income to NH. For both mom & MIl, they kept their monthly income direct deposited to their old bank account and a check was sent to he NH for the exact amount required by Medicaid for the copay. The bank account kept the monthly PNA (personal needs allowance) & so grew each month by the PNA ($60 for TX). But if there had been like glaring issues in the documentation (like 1 mo 4 years ago ended with $50k in account and next month ended with $8k, so they know there’s going to be a gifting / transfer penalty inquiry), the NH can ask for dpoa or someone in the family to sign off to be financially responsible should Medicaid get declined. I don’t think the facility can force you to do this....... but they can sent you a 30 day notice.....

Sunny, yeah it’s all a lot to digest. To me a decision needs to be made on the condo. Cause either your all in on all costs till beyond death or you have mom sell it now and before ever dealing with LTC Medicaid. If mom has already been on community based Medicaid, whatever that adds up to will likely be a future lien or claim on her Estate awaiting her death to come forward. It may not make sense to keep the place. 

I’d suggest you contact the HOA board at the condo asap to see what the future HOA costs are to be. If they’ve voted on an assessment for later on this year or next, it could be a whopper. Also ask IF mom can rent her unit and if there’s any rules on how that has to be (like requires 6 mos minimum on rentals). If your not getting the HOA meeting minutes or info, you need to be. Yeah it’s overwhelming. Try to stay organized and perhaps have someone go with you to take notes. Good luck.

Also “sober diwn” is spend down. Got to love spell check🙄✅

Thank you, everyone, for your answers. Now I need to study to figure this all out.