Question "again" about assisted living/look backs

carrie630January 31, 2013

I have several friends (including myself) who just have trouble understanding potential situations with rules regarding money, etc. when it comes to assisted living, etc.

Here's the universal question:

Suppose there is an elderly person (let's say in their 80s) that cannot live alone but not sick enough to need a nursing home. When they apply for assisted living (say it is 4000 a month), is it THEN that they do the look back, even if the elderly has let's say enough for about three years? I would imagine before they go in, there is the look back.... am I right? Or is the look back done AFTER the money runs out (applying for Medicaid)? I would imagine before entering the assisted living since where would the elderly go while the look back is investigated. Does that make ANY sense? :0) And if that elderly HAD given let's say 20,000 in gift checks, do they say "come back in five months you've been rejected by Medicaid. Not being funny, just trying to devise a scenario.

Also, what happens if they own their own home. If they need assisted living without the sale, obviously I would imagine
after the sale it would go towards the expense. But how do you pay for maintenance, etc. while they are in assisted living? This is the confusion myself and another friend have. If the elderly is IN the assisted living, how is the maintenance for a condo or whatever paid for if their money is going to the assisted living. Okay, now I am really confusing.

Please be patient with us, I've asked similar questions but to me it is all confusing. I understand what Medicaid is, what look backs are, but I don't understand how the penalties work - before you go in would make the most sense - but if you have enough money for three or so years (let's say AL is 4000 a month) with the potential for more once a home is sold - how does that work?

Be kind - still trying to understand this - not only for possible future situations but also for ourselves... Thanks

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Each state has differing regulations so my answer will be some what general. My husband has dementia and I have been looking into this subject.

Assisted living if for those that can take care of themselves either with or without help. If they need help an additional charge is added for those things they need. Some places you must pay an upfront amount. Others you just pay a monthly fee. If you become unable to take care of yourself and need 'nursing' care you may not be able to stay in assisted care. If you think you may need the additional care look for a continous care facility.

You are supposed to be able here to keep a house, car, and a small amount of money if you qualify for Medicaid. If you are married and hopefully for partners a formula is used to figure an amount of money that the person remaining in the home can live on. The rest goes for care. Some care facilities ask that any property be signed over to them before admittance. Medicaid does not require this and personally I believe this practice is very wrong. If the person dies shortly after entry the nursing home keeps the property. With Medicaid if the person entering the facility with a partner, the partner can live in the house until their death. When the person that is in the facility dies the property will be sold and the money will given to Medicaid not the nursing home. If the amount is larger than needed to reimburse Medicaid for their expenses the difference is returned to the estate.

If you think you will be needing Medicaid use the money you have to purchase things to make you more comfortable before entering Medicaid.

Each state has a website giving requirements for Medicaid that you should look at. I would also print and fill out the paperwork that you will need if the time comes that you need Medicaid. I found out that I have several income sources that I did not have the information needed.

    Bookmark   January 31, 2013 at 9:14PM
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I found a site that seems to have some good information about Medicaid and how it works from state to state. You might find it helpful.

Here is a link that might be useful: Medicaid Info

    Bookmark   January 31, 2013 at 11:15PM
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That IS a very helpful site! Thanks so much, Shambo


    Bookmark   February 1, 2013 at 6:34AM
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Do you have a place call Council on Aging? If so that helps along with Senior Centers. Some are better and/or more informed than others. Also, most hospitals have social workers and others for information. Assisted Living centers themselves also provide much help if they are as good as they are in this state.

    Bookmark   February 1, 2013 at 4:02PM
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The link from Shambo is terrific, but I will keep the information above in mind... thanks so much


    Bookmark   February 1, 2013 at 4:57PM
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I would pick an assisted living place that also had a care home. Then when the time comes the transition won't be so hard on the person. Also make sure the care home takes Medicaid. An assisted living home is very expensive and as far as I know they don't accept medicare.

    Bookmark   February 4, 2013 at 9:50AM
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Here in my area, none of the assisted living facilities accepted Medicaid. So, there is no "look back" involved with an assisted living.

EmmaR's advice is good. Many of the "better" continuous care and nursing homes only allowed a limited number of Medicaid clients at a time (if they accept it at all), and as one explained to me, they liked to "reserve" those slots for their previously self pay assisted living clients who have depleted their resources.
So, when a nursing home is required, you do have to find one that accepts Medicaid and has a spot open.

The "look back" starts at the time of application for Medicaid. In this state, if you own a home, and are single or widowed (I don't know about married couples, that wasn't what I had to deal with), your home MUST be put up for sale; and maintaining the expenses of that home is not the concern of Medicaid and they give you no allowance for that beyond the $1500 in assets that you are allowed to have (and any life insurance is included in that sum). So you either have to default on payments or hope that a family member will step in to pay taxes, fees, utilities etc. And hope that it sells quickly.

Once that home sells, (assuming that there is money received from the sale) then Medicaid stops: you must use this money to pay the nursing home until it is all gone, then re-apply to Medicaid.

In this state (Ohio) you are allowed to keep $40 per month for personal expenses out of your SS. The rest goes toward the nursing home, and Medicaid pays the remainder

As for the gifts-- if the case worker decides that the $20k in gifts was designed to deplete, preserve, or shelter assets in order to qualify for Medicaid, the application could very well be denied. But they do understand that grandma will give money gifts for birthdays etc, and if the money was gifted in such small gifts to various people over several years, it won't raise a red flag.

Hope that helps.

Oh, there is another option in this state: it is possible to receive Medicaid or other state funds to maintain someone in their own home, paying a caregiver to attend them (which CAN be a family member). I didn't look into this since my family member required too much physical care, not just supervision and assistance.

    Bookmark   March 28, 2013 at 6:36PM
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