How long does it take for Medicaid to kick in when you’ve been admitted to a NH?

We started looking at medicaid 12 months before we needed it. We applied 6 months later after Mom's spend down was completed and her assets depleted. Even while in a "pending" status and not approved yet, we definitely paid her mandated share to the nursing home each month - it's called Patient Liability in our state. And it's due each month - even while the Medicaid application is only pending. Mom is only allowed to keep $50 of her Social Security each month and the rest is her Patient Liability and is paid to the nursing home. Medicaid mandates this and they don't want to hear about anyone's reason why it shouldn't be that way or why they don't have the money or whatever else it got spent on. Medicaid doesn't care about other expenses and costs. If Medicaid is paying for a nursing home, that Patient Liability amount is required and it's no joke. We sold Mom's house before we applied for Medicaid because we knew it was getting sold eventually anyway & we didn't want to worry about taxes, maintenance, etc. We used the proceeds from the home sale to pay the nursing home until those funds ran out.

you mention that you're waiting for Medicaid to start "taking" your mom's social security & leaving you unable to pay her house bills. In our case, Medicaid never "took" Mom's SS directly from her, but rather POA writes a check for that Patient Liability that's due each month after her Social Security is received. This process started as soon as Mom's Medicaid application was pending and it was very clear that this money was due to the nursing home and could not be spent on anything else. It does not sound like anyone clearly explained any of this to you and I'd think someone should have.

For starters, check with the business office at the nursing home. Find out what money is due and when. They will be happy to tell you. Ask how to find out about the status of the Medicaid application. Please don't delay. It will not get any easier if you wait.

RMs can allow for up to 1 yr before loan is called in.
BUT you do NOT have to wait that long.
Mom could walk on the RM tomorrow.

The harsh reality is that there is no-zero-nada of $ for her to pay on anything from her preNH life due to the required copay / SOC / Patient Liability (thank you Edge17!). You don’t have the $ and there’s no other family who would step up to do so. House is underwater, there no point in spending another dime or time on it. Mom will default on her other debts whether it’s this week or later on this summer. LTC Medicaid requires them to be impoverished. She needs to be in a facility and needs Medicaid to pay for it. 

Medicaid does not care about debts. 
Medicaid is all about income & assets. 

RMs require that the property owner pays the insurance on the house. If mom does not pay the insurance - which seems to be due soon based on your posts - shes then in default of the RM contract. Let it happen as it will trigger the default so that the RM can takeover the house. Make a copy of the insurance bill and send a short letter as her dpoa that due to Medicaid Patient Liability requirements she cannot pay the insurance and is effectively defaulting on contract. Let the house and all attached to it to become their problem. RMs are used to dealing with these scenarios.... it’s their monkey now.

If utilities get shut off, what does it matter now. She in a NH.

And Hanging, really really you have got to pay the copay to the NH and have mom current for Medicaid’s required copay. Personally I think you should like manana go to the NH and have them become the representative payee for mom’s SS so they know their getting paid and it’s nothing you have to deal with for the future. You really don’t want any ruffles with either the NH or Medicaid if you can help it. In your prior posts you’ve written that mom has paid your car note and other expenses. That is gifting and not allowed by Medicaid. You don’t want anything at this point in time to cause Medicaid to delve deeper into a lookback for your mom’s finances as her “gifting” will surface. 
I’d bet that as she was already on Medicaid for 20 years that the state did not do a deep dive on her finances; that your state did a simpler transition from in-the-community Medicaid to LTC Medicaid without the heavy documentation that new LTC Medicaid applications requires. The state didn’t require her / you to submit 5 yrs of her bank statements, now did they? The state didn’t know that she was getting $ from a line of credit RM either I’d guess as well. You don’t want anything to make the state or the NH be concerned about now. Pay the patient liability due till now and let NH become payee for the future. That’s my suggestions. The gifting & RM proceeds may surface anyways - which will be it’s own hot mess - but by her being current on her copay it at least keeps the NH happy in the interim. 

Mom defaults on all debts.
Anything house is a loosing proposition at this point in time. 
Let go of house stuff so you can be with your mom without those worries looming over you. You don’t want it that every time you go into the NH that someone from billing is behind you asking about when your paying the past due. Stuff like that snowballs and NH can contact Medicaid & APS if nonpayment persists. You don’t want to go there....

Medicaid does NOT take her $ directly.
But as of the day that she applied for or transitioned to LTC NH Medicaid, she is REQUIRED to have all her monthly income- like her SS - be paid to the NH as her copay or SOC (share of cost). The facility has told you this. That $770 each mo less the $30 (her personal needs allowance) should be / must be paid to the NH. So every mo NH gets paid $740. In order for her to be within compliance for Medicaid that monthly income must be paid. 

If she’s been out of rehab and in the LTC part of the NH for May & June, she owes $1,460 as her copay. 

Often a NH is made their representative payee, so the NH directly gets her SS/SSDI and the $30 is set aside in a Trust fund account at her / DPOAs disposal at the NH. 
But it sounds like that didn’t happen and her SS/SSDI is still going to her bank account. And you are using that $ to pay her bills and not doing the NH copay. That’s it, isn’t it? This cannot happen under Medicaid rules. It could be viewed as a breach of the required fiduciary duty required of a DPOA and cause APS to get involved. 

Medicaid has no concern about debts.
Medicaid is all about income and assets.
Either you or other family will need to pay her property costs & other bills or she defaults on them. That is the harsh reality of Medicaid. The $740 to the NH must be paid. Otherwise she’s out of compliance for Medicaid and can be suspended. Or the NH as they have not been paid can issue her a 30 day notice to move out or they contact APS to get her made a ward of the state as her DPOA (you) is not doing the copay. Really you don’t want APS to get involved.....

Isn’t it the situation that she has a reverse mortgage? Why not have them take over dealing with the house. She needs to stay in the facility to get the care needed. She cannot find herself ineligible for medicaid because you did not follow the rules.

Hanging, have you been paying the share of cost to the nursing home? Please don’t be paying the house bills for your mother with money that should be paid to the nursing home as her share of cost. Your mother still owes the money due to the nursing home for her care from the date she was admitted even if the money is still being deposited to her bank account. You CANNOT spend the money that should be paid to nursing home for your mother’s portion of care even on her bills. You can’t just wait for Medicaid to start taking it or you could end up owing many months of payments with no money left in bank. Please check with the admissions office to find out how much money should be going to the nursing home.

SS will do a clawback & pull the $ from the account deposited into. NH likely has quite a few residents SS going into a single account so there’s $. No NSF.

When my mom died it was almost at the end of the month, so the following month she got both her SS and federal civil service retirement paid. SS clawed back maybe within 15 -20 days. Yet civil service took almost 3 months. I just left the $ in her bank account. But the account - I was a signatory on it - switched over to my name & SS upon her death and I used it as the “estate of” account. Mom was on hospice in the NH so death expected. It was the bank that suggested to do this. Nice & seamless plus easy for record keeping.

Also for those interested, Hangingon61 old posts well are insightful backstory.

I'll try to give additional info based on what happened in our case. Hangingon, I know you're very upset as the process is stressful but try to calm down. Most people (myself included) would not know how this all happens until it becomes an issue in their own family. You seem to be a very bright person, but I worry that you're getting bogged down & are missing the big stuff - like paying Patient Liability.

If NH said her SS would go "directly" to them, they might not have meant that as literally as you took it. If NH was going to deduct directly from mom's bank account, I'd think they would have had to have told you that & you would have needed to authorize. In my case, I believe the word "directly" was also used, but what it meant was that we were to write our Patient Liability amount out to the nursing home within the same month of getting the SS. It was "directly" as in we should not delay writing that check. It was not literally a direct withdrawal from mom's account to the nursing home. At no time did Medicaid or the NH "take" Mom's SS. We have written a timely check each month.

If her bank and utility companies won't talk to you, then who's got POA?

What we were told regarding the house is this: Since Mom was a permanent NH placement with no hope of returning home (ever, ever, ever, never), she was not allowed to keep the house as an asset & it needed to be sold. If there was any delay in selling it, you are correct that the property tax, utilities, emergency repairs, homeowner's insurance, etc would still be coming due. BUT, Medicaid does not care about this at all. Either the house-related bills fall behind and get paid with the proceeds of selling the house OR someone else would need to cover those expenses. We sold the house quickly to avoid the drama. I think her cable bill went to a collection agency, but Mom will never again need good credit - and I know this from working in the industry for years. Don't let anyone pressure YOU into paying HER bills. She's a permanent nursing home resident on Medicaid. She's not going to be cosigning, renting an apartment, or buying anything where her credit would be checked.

I had the same concerns you have about telling Mom she wasn't ever coming home. Mom would rant and rave about there being a conspiracy to put her in a nursing home, etc. But, on some level, ours already knew she could no longer live alone. She would carry on and get emotional to us, but had already told at least one other person (close family friend) that she knew she had to leave. Maybe yours also kind of already knows she can't go home? If you're sure she's clueless about that, then my advice would be to have someone with you when you tell her & let the staff know in advance that this is going to happen in case there's a scene or problems of any kind.

Regarding the house and handing over the deed, they might be talking about a deed-in-lieu. I am really not sure, but Google deed-in-lieu and see if that matches what was said to you.

This is how it worked with my Mom.

First, once the person is in a NH and Medicaid is in their future or they are receiving it, you cannot use their money for anything other than their care. So paying bills with her money is a no no. Mom paid two months privately (used up her money). I applied for Medicaid in May, she started Medicaid in July. At the time she entered the NH "they" started the process to become payee for Moms Pension and SS. So, when Mom passed, it was their problem if SS paid or pulled the money.

Yes Mom had a house. The caseworker chose not to deal with the nephew living there just wanted proof I had the house up for sale. I stopped paying taxes. My nephew pays the utilities out of his SSD check.
I would not pay out of pocket that I couldn't afford to do. There is no guarantee you will ever get it back. If you don't live in the house, then sell it for her care. Speak to admissions or financial and ask if a Medicaid application has been done. I have heard a few people say that the NH helped them with the application and some say the NH gave them the wrong info. Me, I chose to go to Medicaid. I like the one on one with no middle man. Because of previous conversations, I chose to have a lawyer (Medicaid allowed Moms funds to be used) because of the house and someone living in it. I had 60 days from application to find a NH and have all the paperwork to them. If this had not been done, I would have had to start over.

Hope this helps

Hanging - under the terms of the RM it is required to be current on property taxes and all required property insurance (homeowners plus if needed flood, windstorm, earthquake). IF property owner is not current on these then their RM is considered “delinquent” or in “default” of the terms of the contract.

If this happens one would need to “cure” or fix the default by paying taxes or insurance ASAP. Otherwise the RM will go into foreclosure as you’re in default on. When a property goes into foreclosure there will be paperwork in which your ownership is relinquished. Usually for foreclosure it’s done via a “Deed in Lieu”. There’s a bunch of other things that happen with foreclosures, like notices posted in paper, and at the courthouse, eviction letters sent, etc. I wouldn’t worry about those as mom’s moved in a NH so the eviction drama doesn’t matter.

But imo for your mom being in a NH is good as she wants to get her home foreclosed on; she wants to get on with this and not wait a full year of being out of the house for the RM to call in the loan. By her NOT paying her property insurance taxes it places her in default of the RM. it moves up the eventual process of turning back the house to the RM. Let the RM do a foreclosure.... let them deal with property maintenance... utilities, just whatever on the frickin’ house. Make it their monkey do deal with. As RM are sold to old people, lots of these are going to have cognitive issues and be exactly in the predicament that your mom is in, believe me the RM is used to dealing with this and knows what to do to get the property. But they will try to shift some of this onto you to make their legal life easier. You do not have to do anything..... make it their monkey.

House is underwater. There’s is no equity back to mom from any sale of the house. RMs cannot make mom pay for any difference between loan proceeds paid to mom and what it eventually sells for if it’s less (if it’s a HUD backed RM so a HECM). Don’t let the RM buffalo you into you paying or doing anything on the house. It’s their monkey and it’s not a cute lil baby Capuchin monkey but a old Orangutan. Make it their problem. To me dealing with RM is a lot like dealing with a in a NH Medicaid parent keeping their home and knowing family will eventually deal with MERP.... for family you do whatever to have property secure but do not spend time or $ beyond that.

There are free resources on RM you can contact to understand all this better:
National council on Aging 800-510-0301
Neighborhood Works America 888-990-4326
You may need to clearly state that you want the foreclosure done as your trying to move up the inevitable as mom is in a NH and has cancer and dementia. Whomever you speak to is probably way way more used to speaking with families who want desperately  to keep the home. But that’s not your mom’s situation.

And yeah pay mom’s copay for May asap and if there’s a late fee see if it can be waived. Then try to get June paid ASAP or pay a portion of it.

Is there anything at mom’s house that can be sold? Your shortfall is abt $200. I am constantly surprised at the stuff my college kid sells on Craigslist that I had ready to go to VOA & Goodwill or he curb shopped and sold. You may be too overwhelmed to do Craigslist but if you have a younger niece (especially if mom has vintage wardrobe stuff) or nephew or cousins they might could do this for your mom to raise $. 

Hanging, I’ve never dealt with hospice nurses, so I don’t know if this is some sort of psychological purging they recommend? My Mom is on a version of hospice through her NH but it’s the same staff she always had. They wouldn’t say anything about finances. Their and my goal is all about keeping her happy:
How’s so and so. Good! Not.
Are the grandkids doing well? Yes! Not.
How can I afford this nice place? SS and your pension. Not.
What is this bump on my face? Pimple. Not.
I even get her out of the room when the recreation people start reading the newspaper and obituaries (!?) to everyone.
She wants everybody to be happy, so telling Mom the truth about some things would make her worry and she’s be upset. To me it would just be mean and serve no positive purpose. If you are seriously concerned about her health after hearing the news, I would think hard before telling her.

Rocketjcat & BarbBrooklyn I’ve decided to NOT tell my mom what’s going on w/her house.
I’m just going to continue “telling fibs” as long as I can or until I’m backed into a corner & she comes out w/the question “did they take my house yet?”..
I’ve thought about how very hard this whole ordeal has been for my mom, the anxiety it has & is causing her, her declining health has taken a rapid turn & I agree it would serve no other purpose to tell her she’s not going “back home” then to be mean & cause her extreme worry.
So I won’t do that.
I’m really not lookin forward to dealing w/the RM bank either..
Even when I do get the doctors letter, to tell the honest truth, I’m totally exhausted at this point (physically) getting all the stuff cleared out of my mom’s house & I’m still not 1/2 way finished.
I’m only concentrating on what else I can sell & what personal items I need to get out of there and/or destroy (banking statements, IRS returns from the past, etc) so I’m not really concerned w/the RM.
When & if I do get everything cleared out, and if THEY contact me sometime in the near future, I’ll respond then..
There’s really not much they can do to me legally anyway is there?
It’s not like they can withhold any profit from the sale of the house because there is none.
So they can coordinate what needs to be done w/out my participation.
I guess they would need to get the house keys from me to enter or maybe they’d get the police to break down the door??
I don’t know.
Can they (legally) force me to have anything to do w/them on my mom’s behalf??
I don’t know & @ this point, I don’t really care.
I’m too damn tired to care.