Ruthroll Asked July 2019
Is there a NJ law saying you can't ask a senior who's self-paid over 3 yrs to move out of assisted living cause there's no Medicaid beds?
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My Mother's long term health care will run out in December 2019 and she will have another 4 months of cash for self-pay in the assisted living program where she lives before she must go on to Medicaid. Her assisted living program does have medicaid rooms, however they are few. There is a new director who said he will not keep a waiting list for these rooms, though other directors there did. He told me it is time to find a nursing home for my mom. She will be devastated. I was told that there is a law that says if she has self paid for two or more years they can not ask her to leave. I would like to know if this is true. Please help.
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Here in MN, when my MIL went from private pay (just 3 months) to Medicaid, they didn't have a Medicaid room available so we paid the difference for the cost of private and she stayed in that room until one opened up.
In my experience existing residents gets dibs on Medicaid rooms in their facilities over outsiders put on a list. Unfortunately, confirming that a desired facility accepts Medicaid is a critical question that most don't know to ask. If you mom winds up moving, make sure she goes somewhere that has a continuum of care (meaning, from AL to LTC to MC to hospice) so that she'll never need to move again.
If you don't get a clear response in this forum you should spend the money and consult an elder law attorney so that you know what your mom's exact rights are. But if she's in someplace that has no continuum of care, she will eventually have to move anyway, right?
FYI if she does move, do it before her insurance runs out so that she's not on an "external" waiting list as these are usually much longer. We chose to pay from our own pockets for a few months of good health insurance for her that got my MIL into a decent place before this happened. Wishing you a happy outcome for your mom!
AL are not required to go through state surveys using Medicare/Medicaid guidelines as they don’t accept those method of payments. The AL probably doesn’t accept M/M reimbursement as a choice so they don’t have to succumb to state surveyors inspection.
An AL can’t just decide to have Medicaid beds without applying for certification which is arduous. That’s “why”.
I think consulting with a certified Eldercare attorney would be a good use of some of your mother's money.
Is it possible that what the facility is telling you is that you mom is in need of a higher level of care than AL can provide?
The ALs near me require at least two years of private pay before they will except Medicaid. They have a % of Medicaid rooms that they will allow. If that quota has been met, than the resident cannot stay. ALs are private own and need to make a profit. Medicaid does not pay the amt that Mom pays. So the AL loses money when a person is on Medicaid.
I don't see where a waiting list would work here. Its more like who runs out of money first and how fast the application for Medicaid comes thru. And who is to say a Medicaid space will be available when Mom runs out of money? You may need to place her in LTC anyway.
The director told you "its time to find Mom a Nursing Home". Maybe he sees that Mom may need more care in the next few months than the AL can give. It is an "assisted" living. The residents need to be independent to a point.
I asked what happens with her bed there at AL when she spends all her money and can no longer be private pay.
The social worker told me they have no Medicaid beds and that once her private funds run out she would need to apply for Medicaid and move to a SNF. This is in NY. Per the SW NY state has a program where you can apply for a “Grant” that may pay the balance from whatever pension/SS income. The slots are limited and the person has to have less than $110k in the bank. So unless you knew of the program and applied, chances are most people did not know.
I was surprised to hear this as that AL has been receiving almost $10k a month for MIL to stay there. To even think they would kick a 95 yo out to a SNF is pretty heartless. But that’s NY & NJ. Those 2 states suck the life out of everyone whether the person has money or not. Equal opportunity money suckers.
The bottom line for self pay AL is money. No altruism at those places. In order for them to have Medicaid beds the AL would have to function under the Medicaid rules & regulations which are many. They would then open up themselves to state surveys, etc. They don’t want to do that.
Sorry you are disappointed. I know exactly how you feel.
It's the website for the NJ Long-Term Care Ombudsman's office, and will have lots of useful information for you even if they can't have that particular new director taken out and spanked. If I were you I'd call their advice line and talk the situation through.
I don't know, but I would expect them to get especially excited about the length of time your mother has been a contented resident in a facility that is established as a Medicaid-approved supplier.
And you deserve to be patted on the head for thinking about this in good time. Six months to ten months is ample notice for the Director to work out next steps with you and your mother.
Is the new Director just a new Director, or has your mother's ALF been taken over by a different organisation? - but I'm just being inquisitive, and the ombudsman's office should ask you all the relevant questions.