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My father was recently admitted to long term care at 94. Previously he was self-sufficient. I want/family agrees for him to move around me in another state. He will need to sell house and spend down (as he will need Medicaid assistance). How do I start? The facility I found advises an elder care lawyer. In your experience, can I do this without that expense?

Lita, my understanding is that Medicaid is not payable for Assisted Living. The client needs nursing level care before the State pays, and that means a nursing home. The rules vary between states, so check for yourself. You need to be clear about this before you spend down – although you can spend down by going private pay. Most AL facilities have a few Medicaid beds, and someone who has been on private pay with them for a while is most likely to get them.

Have a look at these details on the site. Click on Care Topics at the top right of the screen, then M for Medicaid or any of the other things you need to know. You don’t normally need an Elder Care Lawyer, but you do need to know your way around the system. Perhaps the facility advised one because you were getting things wrong based on not understanding it. If you have detailed questions once you know the basics, come back with them. Good luck - it isn't easy!
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funkygrandma59 Aug 16, 2024
Margaret that may be state specific, as I know here in NC that Medicaid does pay for at least some assisted living facilities right off the bat in my city, and the others Medicaid will pay after 2 years of self pay.
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The money he pays the lawyer will be included in the spend down for Medicaid. All of his money needs to go to his care until he is impoverished enough to qualify for Medicaid anyway, so paying for the lawyer makes sense. Of course, you use his money, not yours to pay the attorney.
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It sounds as though OP needs to know the rules for 2 states, her own and where F is now. She definitely needs a good basic understanding about types of facilities and the funding support normally available, even if the complexities between states mean a lawyer is a good idea. It would not be good to spend down too far when in fact private pay first would be an advantage.
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If your Dad is in a LTC facility, then he is passed the care that an Assisted Living facility can give him. Assisted Livings are not Skilled nursing. My Moms AL took everyone as long as their care was easy.

Medicaid Is State Specific. Your Dad may need to be a resident before he can get Medicaid. If your selling his home it has to be at Market Value and the proceeds only used for Dads care. If he has a car, that too has to be sold at Market Value. You may need to see an Elder lawyer in your State.
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You can start the process of moving your father to assisted living and qualifying for Medicaid by following these steps:

1. Research Medicaid eligibility requirements. Each state has its own Medicaid requirements. You should research the specific requirements for the state where your father will be moving. This includes income limits, asset limits, and the spend down process.
2. Understand the spend down process. The spend down can be done by paying off debts, purchasing exempt assets (like a prepaid funeral plan), or spending on care needs. It’s important to follow the rules to avoid penalties.
3. Gather financial documentation. You should gather all financial documents, including bank statements, investment accounts, property deeds, and any other assets your father owns. This will help in tracking the spend down process and ensuring everything is properly documented.
4. Sell the house. If your father needs to sell his house, you should begin the process of listing it for sale. The proceeds from the sale will likely need to be spent down before he can qualify for Medicaid.
5. Research assisted living facilities. You should research and visit assisted living facilities in the state where your father will be moving. It’s important to find a facility that accepts Medicaid and meets his needs.
6. Apply for Medicaid. Once the spend down is complete and your father meets the eligibility criteria, you can apply for Medicaid in the new state. The application process typically involves submitting financial documentation, proof of residency, and medical assessments.
7. Consult a Medicaid planner. While you may want to avoid hiring a lawyer, a Medicaid planner or elder care consultant can be helpful in navigating the complex Medicaid rules and ensuring everything is done correctly. Some states offer free or low cost assistance through local agencies or Area Agencies on Aging.
8. Consider timing. Timing is important because Medicaid has a look back period, typically five years, where they review financial transactions to ensure assets weren’t improperly transferred to qualify for Medicaid. Make sure all transactions are transparent and well documented.

This approach should give you a solid foundation for starting the process without a lawyer. However, because Medicaid rules are complex and vary by state, you might still want to consider consulting a professional if you encounter difficulties or have specific questions.
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Reply to HaveYourBack
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Depending on state he goes to, unlikely for Medicaid to pay for assisted living. There may be a couple of states that cover that sort of facility. More than likely, Medicaid after spending down will only cover nursing home.
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