Has anyone come across assisted living facilities that have a $4,000 entrance fee (part of which is used to assist residents applying for Medicaid)?

No, we were charged $300 by an elder lawyer to apply years ago for Medicaid. The assisted living that my MIL went in charged us $315 for rent insurance which I later found out was not needed.

My mother’s NH had a fantastic business manager who walked our family through the Medicaid application process at no cost whatsoever. She was well versed in all the rules. That may not be the case today but $4K sure sounds exorbitant to me

Are you talking an Assisted Living facility or a NH/LTC facility? Two different things.

No, the application for Medicaid is not the facilities responsibility. On this forum people have allowed the facility to do the application only to find they didn't follow through in the timeline the State sets for applying and supplying the info needed. My State gives 90 days from date of application to spenddown, get info needed to them and have the person placed if not already in a facility.

Its been 6 years but I do think Mom paid 2k to the Assisted Living she went to. It was to cover the cost of getting the room ready and some other fees.

Longterm care, Skilled Nursing, Nursing Homes facilities do not usually charge entrance fees. By the time u need to apply to Medicaid you have nothing so the application is fairly easy. The facility can help but you still need to get them the info needed. I made an appt with a Medicaid caseworker. I took with me everything I thought they may need. The caseworker took me through the application entering the info into his computer. Mom had kept 5 yrs of bank statements so I did not have to request them from the bank. I was given a list of info that was needed that I was not able to provide. Mom had paid 2 months privately which spent her down. I provided all info needed and Medicaid started within the 90 days allowed.

Moms application was simple because her monthly income of SS and pension was under the income cap of 2300. She was under the 2000 asset cap. If the monthly income goes over the cap allowed, then a lawyer is needed to set up a Qualifing Income/Miller trust. This falls on you. So, what part of the 4k goes to applying for Medicaid?

Medicaid rules vary by state, as do NH regulations and oversight. I would never make the assumption that a NH will automatically do it, since they would need private financial info that they don't have access to, unless they are guardians of a resident.

If your LO has no income other than SS and no other assets, then (in my experience) the application is very easy. You will need to provide copies of any medical bills for the 3 months prior to the application date, a copy of bank statements, whether they own a home, a car, or other property. Also SSN, marital status, etc. In my state you do not need to be the PoA to help someone apply but I don't see how anyone could do it if they don't have access to the required info.

The application review usually takes 3 months, so application should happen just before the person runs out of funds.

?! Is this a way to recoup some of the lost revenue when they have a Medicaid resident? I would be very annoyed to be a private pay resident and have to pay this $4,000 entrance fee, part of which would be of no benefit to me. They shouldn't be charging anything to help with Medicaid applications.

What exactly are they calling the fee and is the Medicaid application “part” a small or large percentage?

As described here https://simplyseniorliving.com/knowledge/faqs/what-is-a-community-fee/
In my area the trend is for an AL to charge a “community fee” that mostly covers their turnover costs (initial assessment, vacancy between tenants, new carpet & paint, etc.) but might include costs for something like Medicaid application assistance if someone eventually runs out of money for private pay. If they already have vacant units they may waive much of the fee to get someone new to move in quickly.

Is this an assisted living facility or a nursing home?

Nursing homes here are generally willing to help with Medicaid applications, usually including making themselves Social Security payees as part of the process, with varying degrees of competence and timeliness. If you want someone focusing for your best interests, you may prefer to pay for an appropriate professional.

Few AL facilities here accept Medicaid. Those that do, require private pay for a period of time first.

CMotta - 4K sounds like 1 mo AL rent. Perhaps it’s a bed “hold” fee?

I’d suggest as a 1st step in the mice maze that is Medicaid & Medicare, please clearly find out as to just what your States Medicaid in a facility programs will pay for and what the availability is for AL. This is beyond mucho importante!

Hang with me on this as it is confusing….. Medicaid as a dedicated federal program provides to all states funding for custodial care for those (in theory this group would be over 65 so also have MediCARE so the residents are “duals” for how health care costs can get billed) who show to be “at need” both medically and financially for Long Term Care in a skilled nursing care facility (LTC SNF/NH). Funding for LTC custodial costs shared by the state and % is dependent on demographics (& why that every decade census is mucho importante).
HOWEVER
Feds do not pay 100% on any Medicaid program; it’s more 50% with your state coughing up the other 50%. Your State administers all Medicaid programs. So state determines income and asset limits, if waiver programs are done, how estate recovery gets attempted, sends out medical needs assessment teams if needed, yada yada etc but within federal guidelines. Due to this, majority of States only do NH/SNF with Medicaid LTC $ and no AL programs.

States that decide to do AL are able to do this via by filing a “waiver application” to the feds. It basically asks to allow a % of SNF/NH $ to get diverted from LTC Medicaid NH program to instead go to pay for AL, MC or other community based Medicaid programs - like PACE.

Issue imo is that most AL can fill beds w/private pay residents. So no need to ever deal with paperwork & uncertainty of LTC Medicaid waiver $. Waivers are NOT dedicated funding, but on 3-5-8 yr program cycle. Like the State decides waiver $ better used to pay for PACE centers so AL waivers stop. AL stuck w/residents with no $ and too fit to go into a NH. So because of this the AL who do participate in a LTC Medicaid waiver program will limit the # of beds to a few and place some sort of guidelines / restrictions as too how long the resident needs to be there as a private pay resident or have a bed hold fee held in reserve. AL tend to do 2 yrs private pay b4 the elder will ever be able to get into a AL waiver beds. 2 yrs tend to mean that a lot on the list will either get sick enough to move to a NH or die or will move elsewhere closer to family. My mom was in a tiered facility (IL to AL to NH & a hospice sector). AL in theory had Medicaid waiver beds but they really were placeholder beds for AL residents of many years who were totally medically ready for SNF and just waiting for a bed to open on the SNF side. Many couldn’t wait so moved to a NH with an open bed,

Ask clearly & in detail just how this place does the Medicaid waiver.
&
what they expect for copays & how payment to be guaranteed. Like to make the AL their representative payee for SS and any other monthly income. If you need to sign off to be financially responsible.

As far as doing LTC Medicaid application, for my mom & MiL, application filled out at and filed by NH (& submitted by them along with their bill for room&board charges) but we as POA totally responsible to give all the documentation needed for the financial “at need” part as per a list the NH gave us. Caseworkers assigned to the NH & got paperwork from the NH. For my mom, documentation abt 130 pages & I did it as a single document dump to the Medicaid liaison at the SNF. No fee charged. Took 5.5 months.
SNF responsible for the medical “at need” documentation. POA or residents signs off for NH to get all health info. Most come into a NH via rehab so all that is in discharge notes.
Have no idea how medical “at need” aspect is dealt w/4 AL or MC.

Be sure to get a copy of all pages of every document done at the AL. Let us know what that 4K is actually for. We do all learn from ea other.

I have most at $3000, 1 at $2000...at facilities that don't take Medicade.

Most of the ones in Virginia charges a $2,500 entrance/activity fee.y mom was in a wonderful one that had a benefactor that cut the fee to $1,500. I think every place does this.

Since most people in assisted living are subsidized by insurance/Medicare why not charge everything you can to make money it’s not like the person is paying for it. But consider the level of care you will get if the place is all about money and not the person.
for 4k you can hire someone full time to fill out paperwork (40hr) and make phone calls many insurance companies do this anyway.

the facility my dad is on charged a $6000 entry fee. It'a standard. It's like the 'resort' fee you pay on vacation.

Given the complexity of this and that it varies by State, IMHO getting with an elder care attorney familiar with Medicaid long-term care in your State would be key. As others have said there are MANY variables here. Which State, what are the State rules and then the myriad of issues for your Loved One (LO). Going in as private pay at first from where (home, hospital, other?). If this is part of a hospital discharge (for example your LO needs IV antibiotics post a hospital stay, and is being discharged to a "Rehab post acute care -- aka hospital -- setting, that ALSO has a Medicare/Medicaid qualified skilled nursing facility with long term care; THEN Medicare may pay for some of the stay and then the LO goes private pay. Is your head spinning yet???

If going into a Medicare/Medicaid skilled nursing facility with long term care from home, one likely may be private pay at first and after spending down; then the LO applies for Medicaid coverage of long term nursing home care. As a "private pay" patient some facility "like sweetness" some up front "donation in some cases, if the facility is run by a non-profit entity" or the "entrance fee" to later help with the Medicaid application.

But as others have indicated, it is NOT the facility's responsibility to handle all the Medicaid long term care application. Their responsibility is with regard to the State required "level of care" paperwork whereby the assigned physician and medical providers (could be a PhD psychologist, physical therapist or others, depends on the condition that might necessitate long term nursing home care). The family, the LO or their attorney (if one has one) handles the other side of the application: the asset and income paperwork GOING BACK FIVE YEARS. This is all bank records, all retirement account (Social Security, IRA, 401K, and pension/annuity payments); all assets valued (home, valuable art work, car, other tangible assets) and receipts for any "cash" or "asset" distributions (not like $25 to a grandkid for their birthday, but if the LO gave $10K away, that can trip a wire unless there is a clear explanation like it is a loan, it was to reimburse person and there is a receipt). ALL going back 5 years, that is a huge amount of paperwork and lacking access to on-line banking; tax records, on and on most facilities cannot obviously gather this information. They may help answer questions, review or make recommendations about what is needed or how to gather all this paperwork, but they realistically cannot do it unless they are the legal guardian for the LO.

If there is a house to sell and no spouse involved (no need to utilize the spousal impoverishment protections), then there is more work to do as the proceeds from the sale of the home would be part of the spend down. If there are visually no assets and little income; then this is easier and takes less time. But all the paperwork nevertheless is still required.

Hope there is a durable financial and medical POA already executed AND all financial accounts are on-line so someone can easily pull all the records needed.

Good luck

Yes, it is standard for assisted living facilities. It’s often called a community fee or initiation fee. I’ve been told it goes toward the facility understanding the new residents’ medical needs (paying the facility’s nurses to spend time going over Physician’s Report form 602), understanding their meds, and their need for help with ADLs (activities of daily living), and probably just generally ensuring they have sufficient staffing. When my father moved to an AL place in 2016 it was $6k; his move to a facility with higher acuity (like skilled nursing) costs $9k in 2022. This is in San Francisco Bay Area. It is in addition to first months rent/care costs, but you only pay it once. Best to find a facility that you don’t have to move from to avoid paying twice.

cmotta: My late mother's proposed assisted living wanted one month's payment in advance. She suffered an ischemic stroke and never moved in.

I paid $3500 as a "move-in" fee at a Sunrise facility outside NYC.

Can you clarify/give more information on the responsibility of the nursing home? In what circumstance do you refer?

The facility we moved mom into several months ago does not assist with the Medicaid application. They referred us to a firm that handles that. We chose to go back to the elder lawyer that helped us set up a trust and create all of the POA paperwork. I figured they already knew her situation and could advise us the best. They charged us $5,000. My mom needs a Miller Trust because she makes $500 over the state limit. I didn't feel comfortable navigating the application process with that being the case.