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private pay for 2 years before medicaid placement?
Posted: Tuesday, January 8, 2019 7:40 AM
Joined: 4/4/2016
Posts: 153

Hi all,

Struggling with my dmil who is now I think in early stage 6 of alzheimers. The current problem we have with her is not sleeping through the night. So the thought has occurred to me to start looking into possible placements in the future. But I thought I saw somewhere in my readings, maybe here that you need to have 2 years private pay at the SNF of your choice before they will then accept the PWD on Medicaid. Does that sound right? In our area SNH runs at the low end $13,000/month.....that would be $312,000!!! Not an amount I think most people have.....I know it would be hard for us to find that amount of money and keep my dfil eating and with heat/electricity, etc. All this finance stuff is so confusing....


   Input anyone?



Posted: Tuesday, January 8, 2019 8:06 AM
Joined: 2/7/2014
Posts: 47

When our LO ran out of funds to continue living in her private pay, dedicated MC facility, we were fortunate to find a SNF with an open Medicaid bed for her nearby.  We started to look around when she was about 6 months away from running out of funds; we worked with the MC facility staff to find a place.  She was able to transfer into the SNF without having been private pay there, as they had room for her at that time.   She was probably late stage 6, early stage 7 when she moved.  

We called around, put her name on waiting lists, visited places to move her, knowing that the day would come when she had to move.  When it did, we jumped at the opportunity.  Looking back, we were very fortunate the timing worked out, but we had also been proactively looking for what was available and acceptable for a long time.  We had also been very upfront with the MC facility about the timing of everything, so they were able to help and recommend places for her.




Posted: Tuesday, January 8, 2019 8:15 AM
Joined: 4/4/2016
Posts: 153

Thank yo CCE for your quick response. I just wish I could have a crystal ball to predict how things are going to go. So many moving parts that it makes my head spin. I kinda have 2 people to care for as my dfil is still alive and living with dmil in their marital home, with a 24 hour aide. It is where we would like to keep her, if that is at all possible. Or I should say in some home BUT we do not make any promises!!

I try to be as well prepared for any possibility but that can make ones head spin....


              I will have to start doing more research but I just finished getting dmil approved for "community Medicaid" here in NYS and that took 5 months and truth be told I don't have everything set up yet or really don't understand everything yet so another big project is .....daunting!




Posted: Tuesday, January 8, 2019 9:03 AM
Joined: 3/25/2015
Posts: 539

Valerie, You should talk with a CELA about the finances. He or she can help figure out a way for both the PWD and the community spouse to have what is needed to live on. Hopefully your husband has POA.

When interviewing facilities, ask what their policy is regarding if they start private pay and run out of funds, can they stay there. "2 Years" is not a given; all have their own policies. 

Be proactive and hopefully things will fall into place.

Posted: Tuesday, January 8, 2019 10:11 AM
Joined: 6/20/2016
Posts: 1836

Not always true but you have to find the best place for your LO and work with their requirements.  That usually means looking much sooner than you are ready to and looking at a lot of places.

My mother was admitted to a SNF on Medicaid pending status, took 10 months to be approved and then the facility was retroactively paid for the months she had already been placed.  This is VERY unusual (meaning Medicaid-pending admission, not how long it took to be approved).

Be prepared also to get on multiple waiting lists and to be given a call to offer a bed suddenly - which you must accept or decline immediately (no taking days or weeks to discuss with people).

Posted: Tuesday, January 8, 2019 10:59 AM
Joined: 4/4/2016
Posts: 153

Hi all and thanks for the input. I fogot to give you all the details. My dmil (84 yo, early stage 6 Alzheimers) lives with dfil (86 yo but well for an 86 yo). They live, as I said before in their martial home (my dfil's childhood home!). We (dh, their only child and I) have gotten DPOA, Healthcare proxy and a family trust formed (money and the family home is in the trust) . The family trust is 4 years old. My understanding is that the trust has one year left to be "safe" from nursing homes. We set this up because we were conserned that dmil would "run through" all the money and dfil would be left destitute. Fast forward to this summer, dmil is hospitalized for mental status issues and we got a 24 hour live in aide, ASAP. After another 5 month struggle we got approved for "community Medicaid" which just started 1/1. they are paying 6/13 hours a day for the 24 hour aide (the other hours, as most of you know is considered sleeping or down time). The family is responsible for the other 7 hours a day. I am still struggling to get all these  payments organized, etc. It is exhausting. Not to mention keep 2 house holds going, as well as all the "problems" and behaviors my dmil currently exhibits.  But, maybe I am borrowing trouble form tomorrow but right now she is in the stage where she just has a lot of trouble sleeping. If that keeps going or gets worst or if something happens to my dfil keeping her home may not be possible. I thought, in my ignorance that we could pay (private pay) a few months and then transition her to Medicaid.....but as I said I am so confused about everything.


            Maybe I should take things more one day at a time but.....



D in law
Posted: Tuesday, January 8, 2019 2:48 PM
Joined: 4/24/2017
Posts: 523

We choose a facility that accepts Medicaid.  MIL has enough self pay funds for about a year and then she will get approved for Medicaid until tit's all over.   Sorry to say I do not know how trusts work.  You're trying to avoid the 5 yr look back w/Medicaid?   Even if/when mil would qualify for Medicaid funds, there is a protection for a surviving spouse.  They won't count part of their combined income  for it all to pay the SNF.  They cannot leave him destitute.  Hope it works out for you.
King Boo
Posted: Tuesday, January 8, 2019 3:00 PM
Joined: 1/9/2012
Posts: 2965

It would be best to speak with a Certified Elder Law Attorney to clarify things for your specific state and to review things.  Unless a CELA has done them, things could be done in a less than ideal manner.  More than one person on the boards has done the wrong type of trust and assets were not protected.  

Trusts have to be the correct type of trust, and if I can suggest a slightly different view of them, they are designed to give you the option of discretionary spending - just because it's in a trust doesn't mean you wouldn't spend the money on care if you so chose.  i mean, suppose FIL passed away and you were unable to secure a bed on Medicaid in a good facility?   

One is more attractive to a skilled nursing facility if you are private pay because you are paying the $375 a day to them instead of the $100 a day that Medicaid pays.  No facility can run on an all Medicaid reimbursement rate unless funded by other sources.    So, having money available as some private pay 'key' money is helpful.

The 3 years of private pay plan is what most of us who have assets do - we pick a community that has good care at all levels - AL, MC, SNF.  There is no blanket rule, expectations vary by community, but at ours, if we were private pay for a period of 3 years and we ran out of money, they would continue to care for our LO in the nursing home on Medicaid even though they did not accept direct from the community Medicaid applicants.  There is a very long wait list to get into the community.

You can flip this around, too, and find a good state run or county nursing home who doesn't really care if you are private pay or Medicaid.  This is rare, but they exist.

I can tell you we were on the waiting list for our first facility of choice for over 4 years, and second facility of choice for 2.5 years.  I found another excellent option that had the 3 year expectation.

View the trust as a tool for discretionary spending, not as 'safe'.  You may very well need that money for her care.

NC caregiver
Posted: Tuesday, January 8, 2019 4:46 PM
Joined: 2/7/2018
Posts: 857

I can't help with the Medicaid question, but I wanted to share that my Mom had sleep issues and 50 mg Trazadone has helped tremendously.  I'm a much happier caregiver .
Posted: Wednesday, January 9, 2019 7:12 AM
Joined: 4/4/2016
Posts: 153

Hi all, as always great information.

King Boo, we did you and eldercare attorney to do the will, POA and healthcare proxy as well as the trust. The trust was set up in such a way as the principle can not be used by my in laws. They must be given any proceeds from the trust. Our (my and my dh) thought was that yes the house could not be taken away from a spouse but my dfil would not have the funds to stay there. We are in NYS and taxes, electricity, insurance, etc, might exceed his income alone. Therefore we set up the trust to make sure there would be funds for his living.


NC caregiver- thanks for the tip on Trazadone. I spoke to my dmil's Neuro yesterday and we have upped her Seriquel to 100 mg at bed time. She said try this for a week and see how that goes. We are 2 nights into that regime and no real improvement yet. My poor dfil gets only snipets of sleep. He normally does not sleep well due to an enlarged prostrate so this is no help.


I will have to check out the nursing home stuff soon. What we really wanted was to stay out of an institution if we could. I am not against them I just hoped that we could with help keep her at home for as long as possible.



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