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Medicaid lookback, etc


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Posted (edited)

At some point my mom is going to need to transition to assisted living, and eventually probably to memory care. So I'm fully expecting that to be $120-150k per year if she outlives her brain. I'm going to meet with a will and estates attorney about a medicaid trust. 

Would an alternate strategy to divest a good chunk of assets now, and then pay for elder care out of remaining savings (on the theory that gifts prior to 60 months are kosher)? Probably not the maximum savings method, but that would work in part? I don't need the money, but maybe the grandkids 529s ought to get stuffed more aggressively now.

Edited by CleverNickname
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1 hour ago, CleverNickname said:

At some point my mom is going to need to transition to assisted living, and eventually probably to memory care. So I'm fully expecting that to be $120-150k per year if she outlives her brain. I'm going to meet with a will and estates attorney about a medicaid trust. 

Would an alternate strategy to divest a good chunk of assets now, and then pay for elder care out of remaining savings (on the theory that gifts prior to 60 months are kosher)? Probably not the maximum savings method, but that would work in part? I don't need the money, but maybe the grandkids 529s ought to get stuffed more aggressively now.

 

I would divest while she can to preserve as much as possible.   Medicare will take almost everything based on what i read a few years ago. 

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51 minutes ago, CleverNickname said:

If memory care is $11k a month, at some point it don't matter how much I love her.

Texas Medicaid covers only skilled nursing, not assisted living or memory care. 

About the only thing one can do with Medicaid beyond skilled nursing is jimmy up a home health care plan that probably won't cover 24/7,but would give family caretakers the ability to work and have some breaks. 

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Posted (edited)
14 hours ago, royiv said:

You must really hate your mother if your plan is to put her in a facility that accepts Medicaid.

Tell me you've never dealt with elder care without telling me. Shit is outrageously expensive, and even when your family does shell out for a place that's "nice" you still have to fuckin hound them constantly just do do the bare minimum 

 

On topic edit: when my family ran out of money and my dad needed a higher level of care than we were able to provide him we used an estate attorney to guide us through the process and help us get our ducks in a row. 

It's a scary thing because going Medicaid is a one-way street

Edited by Captainant
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1 hour ago, Captainant said:

Tell me you've never dealt with elder care without telling me. Shit is outrageously expensive, and even when your family does shell out for a place that's "nice" you still have to fuckin hound them constantly just do do the bare minimum 

 

On topic edit: when my family ran out of money and my dad needed a higher level of care than we were able to provide him we used an estate attorney to guide us through the process and help us get our ducks in a row. 

It's a scary thing because going Medicaid is a one-way street

I’ve dealt with it, asshole. 

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12 minutes ago, royiv said:

I’ve dealt with it, asshole. 

Well it just seemed like a calloused fucking thing to say "you don't love your mom if you're not rich enough to pay for the best facilities", so I wouldn't have guessed that you had to deal with it before.

My b, dawg.

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Posted (edited)
15 minutes ago, Captainant said:

Well it just seemed like a calloused fucking thing to say "you don't love your mom if you're not rich enough to pay for the best facilities", so I wouldn't have guessed that you had to deal with it before.

My b, dawg.

The fact that I’ve dealt with it directly informs my opinion that you would never subject a loved one to a facility that accepts Medicaid. I prefer that my loved ones not be subjected to abuse.

 

ETA: OP mentioned grandkids 529s getting stuffed aggressively with mom’s assets so I don’t think we’re talking about someone that’s destitute. 

Edited by royiv
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My mom has 7 figs saved and I legit am not sure that's enough. But if TX medicaid won't pay for memory care, I don't know if it matters too much. I may have to see if another state has different options. Anyway, I have an appointment with a specialist. 

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3 hours ago, CleverNickname said:

My mom has 7 figs saved and I legit am not sure that's enough. But if TX medicaid won't pay for memory care, I don't know if it matters too much. I may have to see if another state has different options. Anyway, I have an appointment with a specialist. 

Sorry you are going thru this.  Been thru it once, and about to make a second go it seems. 

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When my old man passed about 14 years ago, my mom of her own volition decided to purchase long term care insurance. Her insurer was Mutual of Omaha, and they were a bitch to deal with when it was time to start collecting(Alzheimers/memory care). There is no way my mom would be able to navigate the hurdles thrown up by her insurer to resist the start of payments, as her mental faculties were too diminished by the time she qualified. Luckily my sister stayed on their ass like a rabid  banshee so they did begin payout. We exhausted the entirety of her lifetime maximum  benefit ($350K) in a little  over 2 years, but she was in a nice place on the east coast. She had some savings which we were just starting to tap into when she passed. Realizing exactly how much it costs to receive the standard of care that she did (and it was top  notch) was horrifying.

As an aside, the long term care insurance market must be a horrible business. I forget the exact details, but I know she paid in much less than  she received (maybe 30%). Which probably  explains the difficulty in getting the payments started. These companies are losing their ass with the spike in costs as evidenced by the number of insurers offering long term care insurance falling from 100+ to about a dozen. I'm not sure if its even worth  looking into these days as premiums to enroll have skyrocketed, but it proved to a valuable financial tool in my  mom's case. But she also had an advocate in my sister to manage the claims process which was not trivial.

And to clarify, I don't believe she qualified for benefits while she was merely in assisted living. So she paid for assisted living (around $60-$70K/yr) and only when she entered memory care did she get the benefits  of her policy. But fuck those were exhausted quickly. 

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On 3/28/2024 at 9:08 PM, CleverNickname said:

My mom has 7 figs saved and I legit am not sure that's enough. But if TX medicaid won't pay for memory care, I don't know if it matters too much. I may have to see if another state has different options. Anyway, I have an appointment with a specialist. 

I had to deal with this with both my parents, they had a decent amount of savings but it was not effectively invested. It took several years before my Dad was willing to change their investments. They decided to move to senior living in 2017, by 2019 they were in assisted living - thankfully they did have long-term (separate) LTC insurances that paid for most of their LTC costs. Dad passed in 2020 (due to medical complications) and Mom moved to a higher level of care later that year. In 2022 she was moved to the mental care (dementia/alzheimers)  wing of the facility, and the LTC policy was covering 90% of that cost. She passed in August of 2023, which was a blessing as she hadn't been able to speak for over 6 months and was not responsive.  Thankfully, money was not an issue because there savings was able to cover the insurance shortfall, but we were looking at how long that could be maintained as her LTC policy would have reached full payout by October. 
Talking with specialist is a great option, there could be things you can do that someone dealing with families making these transitions are not aware of . Also I would advise looking into hospice care, there is long-term hospice care that may be covered by Medicare. We only found this out a few weeks before my Mom passed, and only because a new medical director at her facility was pro-active in getting this started. In all honesty, no one in my family thought about it, and she could have had those services for probably the last 8-12 months. 
Good luck with this journey, it is a difficult road - stay in touch with family and close friends who are aware of what is going on. This is not a path that you need to travel alone.

And ignore the assholes who throw out hateful comments - that is a bit much, even for the assholes on this site.
 

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Posted (edited)

Following.

My mom has LTC insurance, she’s pushing 80. She’s been paying for more than 2 decades I bet. I’m also wondering if we should get it, 53/48. We will have enough to pay for shit but not unlimited and I’d like to have something left for my kids without having to chose to rot in a substandard facility. Strongly prefer to die of a heart attack while doing something I love at the opportune time but we can’t fully control that outcome. 

Edited by troph
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My mom had LTC insurance that was a blessing in allowing her to stay in assisted living near me (central.) If she didn't have the LTC, she would have had to stay in a place that was further (suburbs) from me. I found that Genworth Ins was awesome with my mom's LTC. They didn't have a problem qualifying her. They were inconsistent in payment dates so I made sure my mom's bank account wasn't dependent on the payment being received on the exact same date each month. I padded her account by a month's expenses.

As for getting LTC for us younger folks, I would love to but I worry about the benefit time coverage and the uncertainty of rising premiums while waiting to someday use the benefit. 

On note of utilizing hospice care, the answer is 100% yes assuming that the person is effectively done with curative care. And even with that, you can opt out of hospice whenever you want, and re-apply.

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One more piece of advice that I recommend for anyone dealing with parent who is entering assisted living, hospice, dementia care, etc: talk to a consultant. There are people who can answer almost any question you have. In my experience they get paid from the living facilities/services that they recommend. Obviously keep that in mind.

In Houston, I found that Lori at the following was invaluable teaching me about everything senior care/living related. http://www.seniorlivingspecialistshouston.com/

I never asked her about the Medicaid lookback but I would assume that consultants understand that very well.

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