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I have been trying to help my mom who is stuck in short term care with dementia. I have spent months trying to get her on medicaid via long distance. Local agencies from "Office for aging" to DFA have provided very limited assistance st best. They start out interested then quickly disappear behind unanswered voicemail and email. One example: My moms Roth IRA advisor has questions about making an "IRA payout" for her medicaid application but the DFA rep cant be contacted to clarify.
On paper it looks like there are a ton of resources but they are really ghosts.

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Ken, reading your post and responses I want to say, only a court of law can declare anyone as incompetent, period. A rehab does NOT have that legal ability, period.

You may be having a hard time with Medicaid because your mom has to many assets to qualify. So you may be applying too soon.

Have you researched what her state allows for assets to be qualified for LTC Medicaid? This should be easy to find out and might put you closer to the path that will get things moving.

97yearoldmom has given you good advice.

Oh, you are her legal next of kin, if she isn't married, that actually carries a lot of weight in these situations. I would encourage you to get thee to mom and get a POA done for her, if she can understand what she is signing it is legal, unless a judge ruled her incompetent, not the rehab.

Is rehab trying to get guardianship? Then they have total control of her assets. You can check this at the court house for her area. Look on the website for anything under her name. This is a dirty ploy these places do when no family is close.
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Reply to Isthisrealyreal
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Not sure this will help you. It’s just what I did.

The way my DH aunt’s IRA was managed was her annual draw down was divided by 12 and then each months payment was direct deposit to her bank account. It was viewed as an annuity Payment by Medicaid and was part of her monthly payment to her LTC. Each year, the annual drawdown was a little less than the year before as her age advanced. Where I got the information on how to do this was from her certified elder lawyer. You don’t spend it down, you spread it out for her life expectancy, using a formula the IRS provides. You can find this formula online, on the IRS site, etc. The company that held her IRA figured what her monthly payment would be each year.
Her IRA was preRoth. I wouldn’t expect to find help with this from the sources you mentioned.
If you use a properly trained and experienced certified elder attorney for your mom’s state, they can help you. You aren’t likely to find one of those at the area agency on aging. It was well worth the money and peace of mind to me to get the help needed. Nor will your Roth advisor likely know how Medicaid works. You need someone that understands both to advise you.
A social worker is not going to have the same skill set as a certified elder attorney and I have the skill set of neither, so just sharing a bit I remember from aunts application.
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Reply to 97yroldmom
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igloo572 Feb 20, 2025
97, we had something similar for my mom & her LTC application. She had a very very old term life insurance policy that was fully paid up ages before and it produced a dividend. So a 1099 issued on it. So it would surface in any lookback. The policy required the dividend to be plowed back, so technically mom got no $ but it would increase the eventual pay out of the policy. Although did not change the initial “face value” of the Term Life policy, which is what Medicaid looks at.

My mom had 2 income sources (SSA & a Federal annuity) which were under the income max but not too much under. The issue for the caseworker was the month that dividend “paid”, it would take mom over the monthly income maximum allowance by LTC Medicaid. Over income max = ineligible. And for more fun in this ineligiblity, it looked like income even though she did not get the actual dividend as it went back into the policy. So to get around all this, I had a CPA look into it. What he did was an on his letterhead an interpretation of the income to be viewed as amortized income over 12 unique months, attached the 1099 and Voila! all income would be under the monthly max allowed.

Basically it’s the same reasoning as that draw down you did.

What I found was that if you were able to quickly give to the caseworker something… anything from another professional - an attorney, a CPA, a registered finance advisor, a car dealership, a licensed appraiser, etc. - that was on their letterhead that made sense, that showed sound professional reasoning, the caseworker then placed it in the file and caseworker notated it as “compliant” so therefore eligible and they moved on to another application.
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When I was my Mom's Caregiver, I ran into the same problems. Especially with The Area For Agency on Aging. The only way I was able to get them to help my Mom at all - after she was discharged from the Hospital to my home - was to have the Home Care Nurse that visited to provide post-hospitalization treatment at home to request a Home Care Social Worker from their agency (private, not govt.) to come to the house.

The Social Worker was able to open doors for us that had been slammed in my face during months of trying. The Social Worker, however you find one ~ appears to be the "key."
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Reply to QuiltedBear
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Thanks. I am not a POA. I am working with her and her financial guy. He needs to know what medicaid requires so he can process this payout. Getting ahold of anyone at any agency has always been a nightmare. Emails go unanswered until I get a random call at work weeks later...or ghosted. Now I am stuck without help. It took months just to get a consultation from an attorney. I really want to get her out of the short term place to a better long term facility then spend down from there. The issue is she wants to go home. Ugggg. Sorry for the rant
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Geaton777 Feb 20, 2025
Just to clarify, a doctor or the facility admins are the ones who decide whether she is a candidate for LTC, not you. Usually, LTC is for people who are bedbound and have medical problems and cannot do their ADLs. If your Mom is in AL with just cognitive problems but is mobile and can feed herself, etc. then she's a candidate for MC, which she will still need to pay for out of her own assets. If she needs LTC at any point, this can be covered by Medicaid (medical portion) and her SS income (her custodial portion) IF she qualifies for both.
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Your mom having a ROTH will almost certainly have to spent down prior to getting Medicaid. Her assets stand to pay for her care. Funds in a ROTH are hers to withdraw at need. So I would find out first about how to access mom's funds in her ROTH for her care.
Have any of the Social Services agencies suggested to you that Mom's current list of assets (of which her ROTH is one) would preclude her currently qualifying for Medicaid?

If this is at all complicated I would contact and attorney, Elder Law, in order to get these questions answered for your state.
Good luck.
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Reply to AlvaDeer
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kenmtb Feb 19, 2025
Thanks, I just need to connect the elusive DFA person doing her application with her ROTH IRA guy. He even tried to reach her to get an explanation of what she wants but he got trapped in hold hades.
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Are you your Mom's PoA for both medical and financial? Or her legal guardian? If not, this might explain why you are not getting any responses. Financial institutions are very easily spooked so won't talk to you without you submitting your paperwork to act on her behalf.

Also, I've never heard the term "Short term care"... are you sure you don't mean long-term care? Is she in a skilled nursing facility or nursing home? It just helps to get proper context for your question.

Social agencies are currently overwhelmed by the needs of a huge, aging US population and the ravages of the high cost of care. Also, it's tax season so fiancial institutions are even busier than normal.

We can give you better suggestions if you let us know whether you are her PoA or not.
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kenmtb Feb 19, 2025
I call her current nursing rehab short term. Sorry for the confusion. The local agencies seem to start off willing to help but disappear soon after the first phone call or email.
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