The Biggest Misconception about ALFs and Medicaid (Part 3)

       The last two weeks I have been talking about the biggest misconception about assisted living facilities and Medicaid so let’s continue.

       I explained to Carol the issue with level of care – that her mom must establish the need for nursing home level care even though she is residing in an assisted living facility. There is, however, another potential problem with getting Medicaid.

       ALFs must make at least 10% of their beds available for Medicaid. Most facilities only make 10% of their beds available for Medicaid. For that reason, the facility cannot guarantee that a Medicaid slot will be available at the exact time when Carol’s mom qualifies. It has a limited number of slots and they could be filled when Carol’s mom is approved. It is impossible to know years – or even months – in advance whether a slot will be open at precisely the “right time” for Carol. It is a game of “musical chairs” of sorts. When the music stops, -ie. Medicaid is approved – will there be a “chair” available? Impossible for anyone to say. (We have in some cases been able to get that guarantee for our clients but it is best to negotiate with the facility before the resident enters and it will often require more private pay than the facility’s standard 2 or 3 year policy.)

       Carol’s approach is understandable. She is trying to do what is best for her mom and she wants to know now that if the money runs out Mom can stay at the facility and transition to Medicaid. As you can see, it isn’t that easy to do, but so many families are completely misinformed.

       When I explained this all to Carol she became confused. “So, does that mean Mom can’t move to an assisted living facility?” she asked. No, not necessarily. It just means she has to understand when Medicaid is and isn’t part of the picture and what meeting the facility’s private pay requirement will and will not guarantee. Planning ahead and putting a long term care plan in place will give her the certainty she wants. For example, if Carol’s mom or dad was a wartime veteran, then VA Aid and Attendance benefits, in addition to Medicaid, ought to be the focus.

       By the end of our conversation Carol was beginning to understand what I was saying. She was not asking the right questions of the right person. I told her that, as elder law attorneys, we could put a plan in place to help guide her on how to get the best care for her mom at an affordable cost. We can also talk with the facility to make sure that there is no “disconnect”. Both Carol and the facility will have a clear understanding that her mom can afford the cost of care so she won’t be asked to leave because she has run out of money and can’t qualify for Medicaid. Carol was grateful that she found us now, before she spent all her mother’s money. As I frequently tell our clients and prospects, “when you run out of money you run out of options”.

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