NC Medicaid Spend, paying for burial/cremation.

Yes, it is okay to spend down below the 2K limit. And paying for burial is a good way to do this. Medicaid looks at first moment of the month. So you will need to keep her assets under by the end of every month.

I’m off the topic, but how does a resident have phone service for himself or herself with so little allowance?

charleneb83: Obtain another FH quote.

Burial and funeral expenses are accepted expenditures in Maryland. I also spent down on other things like all clothing, soaps, lotions, and blankets. Later some supplies were given to her at no cost. I got as low as possible. Medicaid allowed, and this was before 2015, $74 per month to keep out of her social security check. The rest went to the facility. The very low monthly allowance did add up over the years (13 years) she was in a nursing home. Believe it or not it was a challenge to stay BELOW the $2k but I did. I would make sure she looked her best everyday. She had a bank account that had to be reported to Maryland Medicaid. They never questioned the few dollars I took out for the items I just mentioned.
I think you are on the right track. The $1400 will begin to increase over time but you must stay under $2k.
All the best to you!!

Your prices do seem high. Try contacting these folks: https://www.funeralsnc.org/. They’re a consumer alliance for funeral services and can help advise on pricing and finding funeral homes who are more transparent, may offer discounts, and may be less likely to rip you off. The Arizona group was pretty helpful to us.

In 2024 where I live in MN we purchased a pre-paid cremation policy for my MIL this past summer for $3200 (bare bones, no service).

My Aunt who just passed away within the last 2 weeks in SE FL, the cost for the cremation from the FH is $3,350 (a very small, humble urn and does not include coordinating with the church).

I think that the prices have indeed gone up in the past 5 years. The prices may also vary by state or region.

Do I have this right? Your Mom in 2020 paid for a burial site? Bought a burial site just for her in 2020 and it’s fully paid for, right?

So this FH wants $3,395 for just their part? To me, it’s an outrageous price!

OK when she goes onto LTC Medicaid, it sounds like her income will be $2500 a month. If NC does the standard that most States use, she is under the $2829 income max allowed for LTC. So with the $70 PNA her copay/SOC will be $2,425.00 each month and from 2 resources: her SSA & the annuity.

That annuity will be looked at to see if it’s OK as to how it’s structured. If it is a federal retirement that technically is an annuity, it will be 100% ok. It’s the private insurance companies “annuities” that get looked at. Most of the time if they are already in pay-out mode, get viewed as being fine (as changing them is difficult) BUT there could be a required change of beneficiary to be done for her to be LTC Medicaid eligible. So if you right now are the beneficiary you will fall back to secondary with the State as the primary. Only - again ONLY - if the money left in the annuity at the time of her death exceeds the tally of the $ the State of SC paid for her via LTC Medicaid program will you as the secondary beneficiary get any of it. If you were thinking that $ might be there for you, that is probably not happening. If you have siblings or there’s grandkids that were under the impression that annuity would be a pay out to them eventually, well that’s not likely.

On the SSA$, facilities will press or even misinform you that mom MUST HAVE her income sources changed to allow for the facility to become her “Representative Payee”. So all her income comes to them directly and no more direct deposit to her checking account. Now some PoA like this and others don’t. I am firmly in the camp of “no rep payee to ever be done”. Why?….. well I’m somewhat OCD (I know someone reading this is laughing) so like the ability to directly control how and when I used the allowed exempt retained assets (the 2K max Kitty) & the every month building of the Personal Needs Allowance retained (the $75 TX does for PNA). For us it mattered as within the first year I moved mom out of NH #1 to eons better NH#2. Nh #1 was a clusterF for billing and administration, there would be no way they ever would have dealt with return of monies paid which would have to be redirected to pay NH#2 in the timely manner required by Medicaid. Also if you let Nh become rep payee the PNA goes into an account held at the NH. Which may have it such that the business office is open only weekdays and only till 1 PM and you have to sign off on a ledger to get PnA $ and limited to under $100. Not exactly convenient (& yeah I’m still salty about it). Leaving both of my mom’s incomes on their established direct deposit to her checking account, that I was a signature on, kept it under my watch totally. Now I did make sure her SOC paid promptly every month to the NH and did establish an at-the-NH trust account to pay for beauty shoppe and for mom to buy incidentals at the canteen. Keeping income continuing to go to her checking acct allowed me to do buys for her on the spot as could use her debit card.

Your mom at $2500 a mo income, well a NH will be giddy to have her as a resident, especially if her health chart reads she going to be a more easy care resident. Why? Well a lot of elders only on SSA & at $1200. Keep that in mind.

Also when mom moves from rehab, if she has any RX still with meds in them, be sure to take these with her. Speak with future NH DON on this and her rehab floor RN abt this in advance as how to best coordinate. Medicare is loathe to duplicate a RX so it will be out of pocket cost$ for the refill$$$.

I am in SC and your quote is almost double. Seek another funeral home. And yes you can over spend if needed.

Cremation is being done more now. Funeral homes are losing money. So unless you have a crematorium near you, the Funeral Home is going to charge as the middle man. You can have a viewing before and that will cost you. For my MIL for $1000 more, they provided the viewing and a luncheon. My ex died in 2016 and it cost $2300 and there were no extras.

Yes, you can spend down below the 2k. My Mom had $186 in her bank account when I spent her down. The Funeral Home can set up a Medicaid funeral trust. You can use all Moms money for the Funeral trust. You don't have to leave 2k just can't have more than 2k.

Mom will be allowed a small amount from her SS for Personal Needs. My State its $50. This is to help cover haircuts, clothing she may need, snacks, anything she may need personally. For my Mom, she had Dementia. She never used her money. The NH supplies toiletries and Depends. Mom had enough clothes to last for a while.

That is very pricey for a simple cremation without services.
I would look around for a better price to keep it within limits.
Call Hospices in your area. They usually have a list of the most honest facilities.

LTC Medicaid does not care if she has under 2K in exempt assets; they care if she is over resourced above the 2K asset max & care if the spend down done was an allowable expense. They care if the FH policy is irrevocable and not revocable if done as part of a spend down to eligibility.

Fwiw It seems a bit high for a cremation. Quick Google came up with $2,154 for an avg cost with viewing in NC. I find it beyond odd that she has $3,413.86 in her bank account and the FH does an estimate of $3395. Just sayin’……

If your estimate is including celebration of life type of event, be sure to clearly find out from NC Medicaid if those costs are eligible spend down for LTC Medicaid. Hard funeral costs and burial costs are but the “party” aspect may not be. She’s already in a NH (I assume) so what is allowed for a spend down is more narrow than if she was still living in her home. You don’t want a glitch in this and get a penalty.

On another note, mom still has her bank account, right? And it is getting via direct deposit her SSA income & other retirements ea month, right?
So how is her required NH SOC/share of cost going to be dealt with?
Does this NH have an expectation that they are going to become her SSA representative payee? & if so, how are you going to keep her bank account open?
What is NC Personal Needs Allowance $ amount and will it even cover twice a month beauty shoppe and any in room cable or other not-covered-by-LTC NH charges? I’d suggest that you try to find this out before getting mom to sign off on a $3400 cremation.