He needs to be a resident for a total of 24 months before a Medicaid room is available. He is in New Jersey and the director of the facility he is in told me that New Jersey requires that a person reside in the same facility for two years then, if the resident becomes Medicaid eligible, he can move to a Medicaid established room. I don’t know what to do with him in the meantime.
How did he get into this AL? What was his situation prior? Did he have a needs assessment done so for sure AL is appropriate?
AND
What degree were you involved in his life prior to this AL? Does AL consider you 2 b legally responsible for him now? By the latter, what I’m getting at is did he self-place move into the AL? So he signed admissions contract & his banking ACH or a ck tied to payment to the the AL ea month?
OR
did you personally sign off AL admission/ financial responsibility contract? Why is AL director approaching you? & are they sending you mail? Is his account delinquent?
I ask as something abt your post comes across as you are gobsmacked by the situation… that you have no idea how to deal with Uncle Frank… he’s not your Dad or FiL…. So is it the situation that there are a whole bunch of unknowns on this Uncle? Perhaps you have not been actively involved in Franks life & finances for past decade? Personally if this is the case, I think it is going to be quite challenging for you to effectively & efficiently be a POA for Uncle Frank and deal with NJ Medicaid.
Is there no family in NJ?
Realize Medicaid is beyond huge # of programs under each State’s unique rules within overall federal guidelines. LSS NJ Medicaid DNGAF what NYS or MA does. NJ Medicaid paying for AL is a “waiver” program. Fwiw most States do NOT even do AL waiver programs at all. Waivers discretionary by State & will be a slightly different application than the “at need” medically & financially LTC custodial care in a NH SNF Medicaid application (this program all States are federally mandated to do). Medicaid LTC applications can require up to 5 prior years on all his finances (look back) & can require to show medical need 4 level of care. Realize that IF in look-back Uncle sold his home or seems to have $ improprieties and now out of $, he or whomever POA, will have to show where $ went in detail. & will need to provide this info to Medicaid caseworker in a very narrow timeframe to get Medicaid application processed. Can you do this? Are you already a signatory on his banking & can sit with him to do what’s needed online w/SSA & retirement accounts? Or are you his SS representative payee? Or does Uncle think he is still competent enough to do all that is needed for the NH & paperwork for Medicaid!?!
For Director of an AL to approach you pointe blank regarding future payment, is unusual. If this is what happened, I bet there have been issues with timely payment. AL is concerned & are being proactive. Is Uncle fully realizing his SS$ has to be a copay to AL? & has Uncle had his SS $ turned over to AL? Or has Uncle been foot dragging w/$ paid to AL?
Realize as it’s AL, they can evict him. He can be sent to a shelter. There is ZERO requirement for “like” transfer as there would be for NH eviction. It’s AL so considered able to do for himself. Will they do that??…. nah, as it’s bad optics… but what they can do - & totally legit move - is call EMS to come take him to the ER / ED as he “appears to have had a TIA” or something similar; then AL refuses a return when the hospital wants to discharge him back. AL will say they cannot meet his level of care. Hospital now stuck w/placement & you as POA will be who is called 1st to come & get him. AL will put his items in bags; you have couple of days to settle bill & get them. If not, they throw his stuff out & may turn account over to collections.
If you do not really have an understanding of Franks last decade, feel $ mishandles, or it’s beyond your ability to do from afar, you may want to give some thought (& soon) to letting him become a ward of State of NJ. Area on Aging in that part of NJ should be helpful on this. Good luck!
BUT
I’m not sure if this facility - as it’s only AL - is even required to participate in ombudsman program or have a social worker on staff. A lot of AL run right below ever having to be considered to be providing anything “medical”; instead it’s “social” or “assisting in ADLs” or “medication management” stuff which can be done by a low / minimum wage aide. So never ever truly needing any licensed nursing staff to do actual hands on work. The RN might be the administrator for the facility but does not ever work on the floor as a RN. There is no staff social worker and no required info on ombudsman.
But Nursing Homes / SNF have to have a SW & post ombudsman information as it’s a requirement for their participation in Medicare and state licensing. Almost all skilled facilities take Medicare reimbursement even if they are only private pay for room&board. Residents on MediCARE and the private pay facility in some way is benefiting from this. Usually it’s the MD medical director will bill a % of their bedside rounds to Medicare; PT will bill for 2-3 x a week “gait training”; flu & Covid shots and their administrative fees get billed to Medicare, etc. Because of all this, NH facility (even if otherwise private pay) have to obey MediCARE rules for discharge which requires a continuity of care. So they have to be discharge a resident to another SNF NH or to a hospital. A SNF NH cannot evict to the street or to a shelter as no continuity of care. Unfortunately the OPs Uncle is in AL which does not have this type of safeguard.
An elder care attorney helped me fill out Medicaid forms and obtain affordable housing for my indigent father. If your uncle can perform basic ADLs, that opens up his choices to low-income housing during the gap. Food can be delivered and in-home health aides can be ordered by docs and will be covered by SNAP/Medicaid as soon as he's on it.
If he isn't able to do ADLs, social workers should be involved because they should know the ins and outs of getting some gap help for him. I'd get them involved, either way. They can only help.
How long can your Uncle meet the private pay clause? Does he have any assets such as a house that need to be liquidated? If he is only going to miss the 24 month deadline by a few months, it might pay you to sit down with the Administrator and see if they are willing to work out a deal with you however before you do this you may want to consult a certified elder care attorney. In NJ ALs don't have to accept Medicaid so many of them allot a very small number of beds to be used by Medicaid recipients. Unless your contract (which generally renews every year with a price increase) guarantees a Medicaid bed, it is very possible that they will not have a bed for him when he does become a Medicaid resident.
If you plan to have your uncle continue to live in NJ you should speak to a CELA in that state because he will be familiar with the administration of Medicaid in NJ. If the distance becomes an issue you may want to move him to a facility in your state. Just be aware that each state administers Medicaid different. And which ever state your choice to have him live in.....get the Medicaid application going as soon as possible.
Good Luck and keep us updated please.
You can call the local medicaid office where he lives now and ask about types of care their Medicaid covers (assisted, nursing home, etc). Or call around to other facilities and explain his financial situation to see if they can take him. Or call facilities near you and move him if needed. An elder attorney (if there is money to pay one) in the state where he is now, will have the info about that state's Medicaid programs as well.
also be referred to a social worker who knows of how the housing is arranged for this situation.
If he has no assets then the state should be able to qualify him for services and housing
God Bless you, I pray everything will turn out well for your uncle.
I would get him into a nursing home where he can spend down his money and apply for Medicaid. I have done this for my BIL, we had to spend down what he had in finances to get him on Medicaid. Which happened this Dec 2022. When on Medicaid what they don't tell you is they take everything that he has in finances except for $50 that is what he can have out of all his finances the rest goes to the nursing home. My BIL has a pension and social security so out of that he gets $50 which pays for his room phone that he needs. He is in a memory care unit at the nursing home. And in my state of Iowa the cost of a room is $260 a day which provides him with everything he needs.
And if your uncle would ever need memory care I would look for a nursing home that has that in their home. We were lucky my BIL went from the hospital to the memory care unit in the nursing home no waiting. He has dementia and his short term memory is gone. I am his rep payee for social security which is a blessing for him because of his family they would steal him blind and he wouldn't be where he is now.
Prayers
He must be living in the AL and private paying for at least 2 yrs. If you want to make the two years, someone has to pay for his care. In Moms AL there was no guarantee that a Medicaid room would be available when she went thru her money. The AL only allowed a certain number of residents to be on Medicaid.
I was waiting for Moms house to sell and it hadn't. Mom had been in an AL for 8 months and was down to 20k. I took the 20k and placed her in Long-term care. I started the Medicaid application in April. Mom moved to LTC May 1st, paid May and June. That spent down her 20k. I contacted the caseworker in June and proved Mom was spent down and they had all the info needed. Her Medicaid started July 1st.
You don't wait till he is out of money to find a NH. If he has enough to pay for a NH for a month or two then I would place him and and start the Medicaid application. In NJ you have 90 days to complete the process. You need to spend down to 2k, you need to supply all info needed, and you need to place him or have a place ready to take him when Medicaid is approved. His monthly income can be no more than $2523.
I don't see how you can do it any other way if he can't meet private pay for 2 yrs.
Good Luck!