Maybe your experience will help?
Bottom line: I'm wondering how it will go in our household with my mother-in-law, and Medicaid.
Situation:
My 86 year old Mother-in-law moved in with my wife and me in May 2023. She spent 20+ years in Southern California, in Senior Housing, which she enjoyed. Her only income, currently, is Social Security, $553. At the time, she was receiving $250 SSI as well. All of this money except ~$100 went to pay for the housing and utilities.
She moved to Northern Nevada in Jan 2022 to live with a family member who had lost a loved one some months prior. Her bank balance was less than $2000. However, during the next year, since she wasn't paying rent, money began to accumulate in the bank. In addition, she had some loose cash set aside which she received from side sewing jobs. Total in the bank now is about $12,000. She has been living with us in Las Vegas since May.
Her SSI stopped (Social Security checks your bank balance) since she had more than $2000 in her account. As a matter of fact, we're expecting them to send an overpayment bill any day. I'm guessing it will be in the $4000 neighborhood.
In her mind, she was saving up for her funeral so as not to burden her children with the expenses.
Her current health: she is relatively frail, uses a wheeled walker, has aches and pains with movement (moves slowly). But she is able to get out of bed, sit in a chair, come to the living room, kitchen, go to the bathroom. My wife (her daughter) helps her with a shower. We make all her meals. Mentally, she's sharp. She has the usual healthcare problems (e.g., hypertension, high cholesterol, etc.) and the medicines that go along with them.
I think the two greatest risks currently are her falling, and a significant as yet unknown health problem occurring.
We are happy to take care of her, but have limited resources. I'm concerned on what will happen should the situation worsen & she need more advanced care than we can provide at home.
Things I've learned and thought about:
Thought about putting her money in an Irrevocable Funeral Trust. However, I read something about Nevada Medicaid not recognizing more than $1500 toward funeral expenses. She has not given away any money, but has taken out $500 twice from the ATM to use for food and personal expenses, since being with us.
I read about the idea of Spending Down her account to less than $2000--not sure how to spend down $12,000 in a Medicaid approved fashion. We recently filled out a contract to charge her rent, $430/month, leaving her $100 spending money, which she is happy with. I don't need her money, but the thought is to keep her social security from building up her balance.
It's a shame that the money she has saved was designed to be for her funeral (her wishes), but looks like that's a negative from a Medicaid qualification stand point.
I learned about Gabriel Heiser's book (How to Protect Your Family's Assets from Devastating Nursing Home Costs...) on the AgingCare website and have begun to read it, and it looks like it's going to be helpful.
MY QUESTION:
If my mother-in-law requires a nursing home in the state of Nevada, but has $12,000 in the bank, what can I expect and what actions should I take to set her up favorably for a successful Medicaid application?
Thank you for your time. I hope my post and any answers will help others in the future.
These are - in my understanding - inherently insurance policies. No matter how marketed. So State Dept of Insurance & its State Insurance Commissioner and staff is there to make sure this stuff is done & details easily dovetails to another State agency, like Medicaid.
If issues later, that’s something for the person who bought it or their POA or their Executor is stuck to deal with; not whomever sold it. They made their commission based on the premium(s) paid, there is no fiduciary obligation unless it is in the policy.
FWIW most local funeral homes in a State nowadays do their own contract funded trust funeral / burial preneed. & very much know what’s allowed for your State. Often market it via those “Final Wishes Planning / Peace of Mind” luncheons & dinners at a better restaurant. We get mailings on these periodically. I go occasionally just to see what’s the latest spin being sold.
Every state's Medicaid rules and criteria vary.
Yes to a pre-paid funeral trust. Yes to purchasing necessities for herself. Just nothing that can appear as "gifting". The rules are in her county's Dept of Health and Human Resources/Medicaid website.
As for a trust, not sure it's worth the effort for so little cash. Creating a trust is a lot of work and can cost $3500+.
Does she have a PoA assigned? If not, she needs to do this. Plus, create a Advanced Healthcare Directive as well as create a Last Will and assign an executor for it.
You didn’t mention what her health insurance is…. I’d suggested you look into having her become a “dual” if she’s not. Dual as in Medicare and Medicaid for health insurance and whatever types NV has that’s set up for duals. She’s super low income and I bet is full MAGI for coverage….
LTC Medicaid is an entirely separate program for Medicaid with different “at need” BOTH medical AND financial for eligibility. You’ve hit the big points on financial with 2K max in nonexempt assets, and sounds like that personal caregiver agreement is solid legit spend down. Spending down her amount of $ isn’t hard….. could easily spend all on dental and dental really isn’t covered for how most States Medicaid as insurance does coverage & Medicare is super limited as well.
HOWEVER, I’m super VERY super concerned that MiL will not meet the “at need” MEDICAL criteria for skilled nursing care aka care in a NH.
Just being old, some dementia, bathing help, too much for family, will not be enough to be “at need” medically for skilled. Not being able to correctly take pills, that’s medication management and in & of itself not enough to qualify for skilled (it’s an add on fee for most AL). MIL sounds really good on her ADLs, her diseases I bet all ok if she takes her RXs. Still competent & cognitive. My goodness! she does sewing! and gets paid for it! If that’s her, I don’t think she’d be found needing “skilled care” for LTC Medicaid in a NH.
$ side is what folks get all wadded about but medical is equally important & harder to move the needle on your own if that’s an issue. If NV does LTC Medicaid waivers for MC or AL, then might be able to get a waiver bed in MC or AL. But waivers tend to be alot more limited, for all kind of reasons, so smaller # of beds. I’d put finding this out and how truly feasible it will be for her to get an easily available LTC waiver bed as item #1 on my to do list & ASAP!
If NV does not do LTC Medicaid waivers for nonNH/nonSNF, you’ll have to continue to care for her in your home or figure out how to private pay for a place or she goes back into a Sr Housing program like she had in CA and it figures out how to get her services as needed.
FWIW majority NH entry’s are along the lines of this scenario:
mom falls & breaks a hip; EMS called and mom taken to ER/ED and evaluated (Medicare coverage); mom gets hip replacement surgery (again MediCARE benefit); discharged for post Hospitalization rehab at a SNF with a rehab program (again MediCARE benefit); at some point she stops progressing in her rehab and determined cannot return home.
Goes from a rehab patient (MediCARE) to custodial care resident. Custodial is paid either by private pay, LTC insurance or LTC Medicaid. This mom will have a nice fat recent health chart that clearly shows “at need” for skilled nursing care.
You can get a “needs assessment” done on her. Usually done by a duo of geriatric RN and SW done in your home & 1-on-1 with her. You & wf will be asked not to be in the room or shadowing her as they ask her to do things. (No coaching!!). I bet it will show, based on how you describe her, she’s AL or maybe even OK in a really good IL. Not NH.
personally till you know where she might be able to get to live, I would not spend too much of that $. She may need it all to private pay.