Transfer from CA to Texas.

Also entering a NH directly as LTC Medicaid Pending can happen but somewhat uncommon nowadays. Imo to do this successfully coming in from another State will be a high hurdle as it’s challenging even if in State and in same county in my experience.

I think you would be best off if she TRANFERS via medical transpo service as 100% private pay LTC resident with you paying and then 3-4 months later as now legal Tx resident with fat health chart at the NH then files LTC Medicaid assuming NH has open Medicaid bed & hopefully will do a Pending. TX LTC reimbursement was super low forever, lots of NH closed or reduced # of beds or switched to being AL / MC so finding a great and with open LTC Medicaid bed may not be easy.

Pls keep in mind, Vast majority of NH admits are via post hospitalization rehab patients. Usual is mom living in her home / apt, fell & broke her hip, EMS called, hospitalized & surgery (MediCARE as health insurance pays) then discharged to a skilled nursing facility w/rehab unit as a post hospitalization rehab patient. Continues as a MediCARE benefit paying 100% first 20/21 days & up to 100 days @ 50% if progressing. It’s health insurance coverage. & pays more as it’s by service. Could be double or even triple paid per day that rehab patient puts to the bottom line of a facility. NH happy.

PLUS nice fat medical chart that clearly shows that this person is “at need” for skilled healthcare in detail in real time. So that aspect of a future LTC Medicaid review is good.

Then they hit a plateau in rehab and it stops cold. Cannot do ADLs so cannot go home so transitions from Medicare rehab PATIENT to custodial care RESIDENT paid either private pay, LTC insurance or if “at need” medically & financially files for LTC Medicaid. This is how the vast majority of residents end up in a NH onto LTC Medicaid.

The NH, isn’t their first rodeo, they know rehab ending so they are kinda ready for patient to custodial changeover. & ok on LTC Medicaid Pending wait time (4 mos avg TX) as made serious Medicare $ from rehab. Pretty ok on only custodial residents monthly income as a copay till the State approves & does its daily room&board reimbursement & retroactive to date of application. (Again TX LTC Medicaid custodial day rate is somewhat low so that Medicare $ is a buffer for NH budgeting)

Plus NH know they have “at need” medical cinched as all in their records. NH by now know the resident, their family and if they seem solid or scheming. That 50% due for rehab after day 21 has to be paid so NH knows what they are like for prompt payment or bs.

But none of this is there for your mom or you. Her old Medi-Cal status does not matter. She, or rather you as her POA, has to fulfill whatever TX LTC Medicaid is going to want & it is a very time line focused approach. There could be unfriendliness like You’re the reason why i35 is such a hot mess… you’re not, you’re the reason MOPAC is crazy.

As a suggestion, go to a couple of NH that seem to fit your bill that take LTC Medicaid. From each get their list of documents needed to accompany the LTC Medicaid application (system tend to be that the NH submits all this along with their bill to the caseworker assigned to their area). The list can vary by facility as the facility tend to do their own review (to decide if they will do Pending) so the list reflects how they do their in-house review. Pay attention to if there is something that will have to HAVE TO be boots on ground done or retrieved by you in CA. You imho want to have all the documents for the initial submission. TX Medicaid across the board is very time sensitive and the application can time out. It’s all on POA to keep up, not the NH. NHs responsibility is on the medical records as those are in house or go to Nh directly.

& if when you’re doing this, anyone leans into having her enroll in PACE, instead of a facility, pls do an update as to that.

Pls please reread Geatons post, you MUST clearly understand what Medicaid is vs what Medicare is (health insurance) & how each State is allowed to administer its many Medicaid programs.

California’s Medi-cal is a wider & more inclusive than anything that Texas does. CA has a big social safety net w/dedicated funding and Texas flat does not. Your mom would have to completely do new application for TX LTC Medicaid program & show eligible BOTH medically and financially for LTC Medicaid. The no asset limit that CA has, does not exist for TX; TX has it at 2K max for nonexempt assets. So if mom owns any real property in CA it will make her ineligible till sold & spent down. Something to do b4 u leave CA is get an in-depth copy of her health history….. last couple of care plan meeting notes, all medications, last “need” assessment. If there is anyway to get a fresh needs assessment done on her b4 you have to move, get one done. It will be valuable to have to give to a NH to use for soft evaluation IF they can provide level of care.

As a 1st step for TX side look at the State of Tx DHHS FAQ as to their programs and what’s needed for eligibility for LTC Medicaid eligibility. They will want her to be a resident of the State. That may or may not be easy to do. Go onto TX DPS site and it will have a list of items needed to get DL or State permanent ID. (Fwiw TX DPS is pretty strict on items needed…. if wondering why, not Medicaid related but about out of state students filing as in state as TX has a tuition cap & it’s a big deal esp for medical & dental & prof schools, plus TX resident % admission requirement). So is she competent & cognitive enough to go down to TX DPS and get a new TX permanent ID? It’s online scheduling & done at a big DPS hub but still in person. There is a way to do it for an invalid, but we didn’t ever need to go that route, apparently it can be done. TX will want birth certificate or naturalization documentation if passport is not current.

You will have to move her financials to your own new TX address as it helps establish residency. Simple if you get a bank that’s in both States. But they too will want fresh POA, either their own document if it’s not a local atty in the county with their notary seal. TX attorney to do all this. If she is again not competent and cognitive or at least appear to be long enough to get this work done on her own, then it’s going to be quite challenging. It’ll be guardianship & needs an attorney to do & heard in probate court. Fairly routine but allow 5-10K.

TX LTC Medicaid program tends to pay on the low scale for daily room & board daily reimbursement for custodial care. So fewer NH w/beds for LTC Medicaid residents. How TX NH make things work is they have 1/3 post hospitalization Medicare rehab patients (pays higher), 1/3 private pay & 1/3 LTC Medicaid. For Medicaid, a NH can choose whether or not they will admission as “Pending”. By Pending I mean that all she will need to pay is to have her income less $60 go to the NH (like she does now in CA). I do not see a NH doing that for yours as she’s coming in out of state so hard to verify data. They will probably want you to sign off a financial responsibility contract and separately pay the gap btw Medicaid and private pay with $ put into a separate account till she clears eligibility.

TX is pretty strict on HAVING to be medically fully “at need for skilled nursing care”. If could be ok for AL or MC, LTC Medicaid won’t pay as that’s a waiver program with a super long waiting list. Her current medical details will,help establish this.

Travis? Bexar? either I think will b hard to find easily open bed in a NH in the county that you will like. I think you will have to look into outlying counties. Pace of growth is crazy in the corridor. Personally I’d suggest you get yourself, family & job settled; get past your 1st summer (will be brutal) & Hurricane season and look to late Oct to move her. Gives u time to sort things out!

She is on Medicaid, not Medicare (just so that other readers don't get confused).

Are you her PoA or legal guardian? If the county is her legal guardian, this is a discussion with that person/entity.

Is she in LTC? Does she have dementia? FYI it is very expensive to hire an ambulance or medical transport for long distances, but it may be the only option.

If you have legal authority for her, and enough of your own money to spare, you can move here wherever you want, but be aware that sometimes Medicaid facilities have waiting lists since the existing residents get first dibs on those beds.

Also, Medicaid programs are run differently by each state and may have different rules. You may want to consult an elder law attorney who is knowledgable in Medicaid issues or talk to a Medicaid Planner for your home state. If you find a desireable facility you can have this discussion with the admissions person who should know something about this type of transfer.