What do you do when your mom's monthly income is less than the cost of her care but too much to qualify for Medicaid nursing home costs?

First off, you say "she also suffers from hypertension, high cholesterol, polyarthritis, osteoporosis, muscle weakness, fatty liver disease, cholelithiasis, macular degeneration, glaucoma, incontinence, and profound hearing loss (hearing aids help but you still have to talk loudly for her to hear you). None of these guarantee that she will die within 6 months, so hospice is not an option." How do you KNOW that at 98 years old, your mom does NOT qualify for hospice? Have you looked into it via having her evaluated? My mother qualified for hospice based on her dementia ALONE, under the Medicare option of "Senile Degeneration of the Brain"; her CHF and other health conditions weren't even taken into consideration as qualifiers for hospice!

Even if she does qualify for hospice, however, that does not 'extend her finances', so one solution does not provide another. What hospice will do, however, is ensure that the MC will not ask her to leave and to go into Skilled Nursing *which will deplete her finances MUCH faster*; all the Memory Cares I have had experience with will keep the elder until death, as long as hospice care is in force; it's an extra layer of help and services that they can rely on. Not to mention, hospice covers the cost of Depends, incontinence supplies, meds, hospital beds, and all sorts of other supplies your mother is currently paying for.

Your mother has 2 years worth of money left to finance her stay in Memory Care and an awful lot of health conditions to indicate she will not live another two years. If I were you, I would not worry too much about what may happen 'after her money runs out.' The likelihood of her living past 100 years old is slim. My mother had advanced dementia and CHF, was wheelchair bound with pulmonary hypertension and a few other things thrown in, and I prayed DAILY for God to take her. The thought of extending her life, to me, was an act of cruelty, for the dementia ALONE.

My mother was acting pretty much okay when I got hospice on board, exactly 2 months and 1 day before she passed away. She was declining steadily, however, at 95 years old with all those health conditions I mentioned earlier. As it sounds like your mother is as well. One day, she just went into bed; she was exhausted and her heart was giving out. "Just like that", with no warning. She was immediately semi-comatose and passed on the 8th day after going into bed. I am extremely glad I got hospice on board when I did, b/c they were wonderful in so many ways, but especially with keeping her comfortable during that last week of her life.

Get mom's PCP involved to write an order for a hospice evaluation asap. Don't worry about 'money running out in 2 years', that's my suggestion. My mother's money was going to run out in August, and she passed away on February 22, 6 months prior.

Wishing you the best of luck.

I have not read all the responses, but if her facility is "Medicaid and Medicare" qualified, the "business office" people often can be very helpful with a Medicaid application. Ditto for your local area agency on aging, and of course an elder care attorney if one can be afforded.

When applying for Medicaid, one's total assets at the time of application MUST be below your state's asset limit. If that amount is $1.5K (for example) and your LO has $2K in the bank, write a check to the facility for an amount well below your state's asset limit (say a $1K check) and then apply. Timing is important as the state Medicaid folks looks at what is in the account at a specific time. So write that check 2 weeks before the last day of the month. Take screen shote (one has to have on-line banking for this) of your LO's bank account just before and after midnight the last day of the month; then file that first day of the month. Yes, a Social Security payment and pension (if one has that) may post the first day of the month, but that will post as "pending" for about 24 hours (that is those funds technically will NOT be in your LO's account just yet so your state's asset limit can be met.

The state Medicaid office will examine other paperwork, copies of the month Social Security payment received, ditto for any monthly pension payments or other incoming "funds/revenue." AND any outgoing expenses for health insurance (Medicare Part B premiums or other premiums). Your state Medicaid office will then calculate an amount -- the "cost of care contribution/COCC" amount -- that your LO will need to pay the facility monthly from their incoming monthly social security, pension, etc. income to the facility. The state Medicaid office will allow ONLY a minor amount from those SSA or pension payments to be kept (this year $84.00 but I believe that goes up to $93.00 effective July 1 -- your LO's facility could tell you).

Your LO's facility and her physician assigned to her at the facility will have to file their own paperwork to substantiate "the level of care" needed is Medicaid long term care. I would not worry about this part, given the age and reported dementia/health status of your LO.

Once qualified, you would need to write a check to the facility for the COCC (best done the first week of the month, so it clears quickly and well before the end of the month). AND ALSO IMPORTANTLY, keep the total balance in your LO's account BELOW your state's asset limit. If keeping that $84 (or soon to be $93) means the account goes above the state asset limit you can" 1) buy something for your LO for their personal use KEEP RECEIPTS!!!! or 2) write another check to the facility -- yes you then will have a "credit" -- but better that than exceeding the state asset limit as that triggers a disqualification of Medicaid.

Hopefully you have a POA and access to all your LOs record (bank, SSA payments, pension stuff or IRA if that exists, your are their "health agent" etc.) so you can handle all of this. Doing things on-line is best, quicker and so things do not get lost in snail mail.

I do all this for my mom who has dementia and a host of other issues and has been in a Medicare/Medicaid qualified nursing home for almost 2 years now. Medicaid pays most of her care (after spending all her assets down to meet our state's asset limit). I write a check off her account monthly for her "cost of care contribution" amount and often I write the "extra check" to keep the bank account below the asset limit.

Good luck with this. Talk with your LO's facility if they are Medicaid/Medicare qualified as they likely have LOTS of experience with this and could help you.

I would have her evaluated for Hospice.
Any one of the conditions with more added on just may qualify her.
I think you do not have to worry much if she has enough to maintain where she is for 2 years when she is 100 she just may need Skilled Nursing and that may, with the conditions she has she might be approved for Medicaid.
Planning ahead is great but at 98 I would not be planning and purchasing non refundable tickets for a trip in 2024. I might buy green bananas though.

In 2 years, mom will be 100.

I'm going to say that again. In 2 years she will be 100.

Do you really think she will live that much longer? I mean, none of us knows what span of years we're going to get--but since you have funds to cover her care for 2 more years, I wouldn't worry about this right now.

She has ALL the 'old person's illnesses. I think she's probably living on borrowed time right now (I'm sorry if that sounds offensive, I'm being realistic, not cruel).

Don't waste time worrying about it, OK? Just give her the best quality of life.

When your mom is out of money, she WIll qualify for long term Medicaid, or nursing home Medicaid. If the memory care facility she is in now doesn't take Medicaid, she will transfer to a Medicaid nursing home. You will want to start planning and looking at nursing homes that will accept her ahead of time, maybe 6 months before she's due to run out of money. There may be wait lists at the better facilities, so it may be best to start early and get on the list if you desire a particular NH.

Roxy, have you talked to a Medicaid planner or certified eldercare attorney about getting mom qualified for Medicaid?

In some States, the cost of medical care can be counted as part of the spend down to Medicaid eligibility. Some states have qualified income trusts. It's worth it to use some of mom's money for a consult.

If you have not already, apply to find out for sure if she qualifies or not. We have delayed benefits for my husband because we based our decisions on what others have told us instead of going to the decision makers. In most states there is a five year look back so it is probably too late to do Medicaid estate planning. You may be surprised though that some of the things you have done may have already helped. (Trusts, sale of home, etc.). If you are turned down, you will learn reasons why and better understand when the time is right to apply again. As others have said, qualifying for Medicaid for long term care is different from qualifying for regular Medicaid. Be sure to check on VA benefits if her husband was a veteran, there are spousal benefits too.

My husband went through this with his mom and what happened was he got an expert, not a lawyer, who handles this exact thing and his mother qualified for everything in the nursing home. Again, she was placed in a nursing home. It cost my husband about $40,000 to have this done, meaning his mom to have it all paid for and get her on medical, I believe. It was grueling and eye-opening.
I wish you the utmost best. Our medical system for elder care sucks, and is inhumane and immoral, in my opinion.
I am right now in process of finding my mom an assisted living that she can afford, and boy, it ain't easy!

If she does in fact outlive her money, there are Miller Trusts aka Qualified Income Trusts that help get public assistance for those over the monthly limit for income.

Do a Google search for your state, not all allow this, it will help you understand if it is an option. Because not all sources of income qualify I don't think this is a DIY project, you will need a certified elder law attorney to help you with this.

Moms money can and should be used for this. They will also do the Medicaid application for you, if you choose.

One thing to consider before getting to involved with this, 2 years is a long time and the rules change annually. I, personally, would only verify that it is an option in your state and is her source of income eligible. Other then that, who knows what limits and rules will be in 2024.

You can go to an elder attorney now to see what her options will be. The next step for her care (using Medicaid) is more than likely going to be a NH. There are some states that have Medicaid beds in memory facilities, other states only allow a regular NH bed.

The elder care attorney can figure out if the amount of money that is over the Medicaid income limit can go into a trust ($ that can be used for her) and the balance pay toward the Medicaid bed.

See an attorney now so you are prepared before she runs out of money: that you have documents to show how sale of house was spent, and/or other records that you need to have ready to go at the time she can no longer pay her own way. Medicaid does a 5 year look back period (in most states) and they are looking for 'gifts' or paying for things for other people besides her own care. If, for example, you sold the house and gave $5 grand to a grandchild for college - that $5 grand will count as penalty period. Penalty period is cost of NH per month divided by amt given away. Thus, NH = $5K per month, you gave away $5K, so she has to self pay for one month.

The atty is best way to go. They keep up with all the Medicaid rules and can best advise you.