Asset pay down before Medicaid.

Just reading what you wrote overwhelms me. Why not take that 100k and place her in a nice LTC facility that takes Medicaid. When the 100k is almost gone, apply for Medicaid. I took 20k Mom had and placed her in LTC. The 20K paid for 2 months of care. That gave me time to apply for Medicaid and get them info needed. Paying for the LTC spent her assets. The third month Medicaid started.

Not only careful records, but agreement of an attorney in your state who can assure you that anything mother pays you for "shared living costs" is not gifting. If ANYTHING is seen as gifting then she will not be able to access Medicaid.

It is also important that "shared living costs" is used and not rental, as rental has tax repercussions.
All these things leads me to tell you that it's off to an attorney for the two of you; that's ONE way to start spending down.

Do know your mother would have to qualify for Medicaid and sleep disorder and mild mobility problems won't do that.

Igloo, below, is one of the most knowledgeable--perhaps THE most knowledgeable--on Forum on this subject, so read her carefully.

Best of luck.

Now some will say that getting mother into care as self paying with an agreement with an ALF that DOES take Medicaid is a much preferrable situation.

I am curious why your mother is currently having so many problems with health at 77. Can you tell me?

It’s not that simple….. several issues:
- No 1099. You are NOT contract labor. You are household employee paid by mom; so taxable income, Form 1040 & maybe SE taxes paid. To be CL you need to be a legit biz or have others you do caregiving for as clients & get paid via 1099 in addition to mom. IRS Topic #756.
- Rental income needs Schedule E IRS reporting.
- 1K FMV rent in an apt will not be comperables for use of a room maybe with shared bath in a private home.
None of these are DIY. It’s elder law and CPA work to do correctly.

- LTC Medicaid has BOTH medical AND financial “at need” requirement. Folks get all fixated on $ part HOWEVER medical is equally important and may be way more difficult to establish for an elder living at home. Your Mom must be assessed to be at need for skilled nursing care and documented in depth in her health care charts on this. Doctors note will not be sufficient. A mom who has some issues w/ADLs, dementia, medication management, heart condition, diabetes will not necessarily be “medically at need” sufficiently for SNF care. If mom not assessed medically “at need” does not matter she’s financially impoverished for financial “at need” for TX LTC Medicaid, as won’t be eligible. Reread what Geaton posted too!

Please realize majority enter NH via post hospitalization discharge for rehab. Both hospital & rehab paid by MediCARE as health insurance benefits. & as MediCARE pays more than State daily room&board LTC Medicaid day rate NH is happy. NH rehabilitation patient w/Medicare paying 100% first 20/21 days & 50% up to 100 days if progressing. If cannot return home, segueway from rehab PATIENT to long term custodial care RESIDENT. Custodial is private pay, LTC insurance or LTC Medicaid if eligible.

Typical scenario: 84 yr old dad falls; breaks a hip; EMS takes him to ER; fully hospitalized w/surgery; discharged to rehab at SNF; then abt rehab Day 18, dad determined not be progressing by rehab team - which enters data to CMS in real time; CMS issues rehab terminated notice to patient & facility Day 20; NH has health care charts, so easily determine IF Dad “at need” for skilled care or lower level of care; Day 20/21, NH admissions & SW ask POA / family what they plan on doing and how it will be paid. If ltc Medicaid, date application filed starts Day 1 on LTC Medicaid process.

For LTC Medicaid, TX nonexempt asset max 2K, income max $2829. NH will have document list State requires for lookback. NH can decide whether or NOT they will take a resident as “Medicaid Pending”; imho dependent on health chart & document list info & if Medicaid bed open at the facility. NH can require financial responsibility document signed off on. TX NH do LTC Medicaid SOC aka Share of Cost requirements starting date LTC Medicaid filed, which means ALL monthly income (eg SSA$) required as SOC payment to NH less only $75.00. $75 is TX PNA personal needs allowance and once dealing with LTC Medicaid, will be only $ mom will ever have for her direct use. Fwiw twice a mo NH in-house beauty shoppe & cable will use entire PNA $. Fully expect NH to lean to be representative payee for SSA & other monthly income.

If gifting / transfers found, will surface abt month 3 in the process.
NH gets notified too.
Mom will owe weeks of private pay rate to NH less SOC.
If you fail to pay her bill and sign off p.p. contract, they will find a way to have her moved out. Remember Mom is impoverished so no $. Will be your purse to solve.

As an aside on this, as you were thinking abt mom buying a new car which y’all keep till beyond death, all costs on car - in her name- is 100% yours once LTC Medicaid filed. Exempt only while she’s alive. Becomes nonexempt asset of her estate after death. If sold while alive, becomes a fresh spend down unless BBV is under $2K as 2K is asset max. TX has a value limit on cars and homes to be exempt assets.

LSS not simple & why elder law attorneys are used.

In most states Medicaid only covers LTC. The need for LTC is usually assessed by a doctor, although some facilities will be more flexible on this. Needing LTC usually means one is immobile plus cannot do any ADLs, or so profoundly ill that they need a lot of daily medical oversight. This mostly happens to elders who are very advanced in age. Then, she will also have to qualify financially and I think the look-back in TX is 5 years.

So, your elder could be very advanced in age, and have very advanced dementia and still not medically qualify for Medicaid. I had this dilemma with my nearly 101-yr old Aunt who had dementia for about 12 years. She was not ill in any way, and could walk with a walker, assisted or with a belt. Although I loved her a lot (she helped raise me for 18 years) in no way would I ever want to live with her during most of her last years. She sundowned, shadowed, was paranoid, dark and negative, had no filter so said unbelievable things about people in front of others (beyond cringeworthy), was incontinent, etc. But if I wanted to transition her into a facility at that point, she would only qualify for MC, because my Aunt was still able to get up out of a chair or bed (which is how she fell and broke her hip).

I personally do not recommend planning on being your Mom's 24/7 caregiver, at least in the future as her conditions decline. In your profile you said "we" which I assume is your spouse. Living with a declining parent is very hard on marriages and finances.

Also, you didn't mention is you are your Mom's PoA, which would be absolutely necessary if you're going to be managing her affairs and hoping to make decisions for her. In my family, 77 is young. My one Aunt passed at nearly 100 not qualifying for Medicaid. Her sister, my other Aunt for whom I am PoA, just turned 105 and is mobile with most of her mind and would not qualify for Medicaid. My Mom will be 95 this week and lives next door to me. She is mobile and lives semi-independently with my help and would not now qualify for Medicaid. The only elder who does qualify is my MIL who is in a LTC facility on Medicaid because she cannot walk and had enough memory impairment that she couldn't take care of herself (so she started in AL but then went straight into LTC when she stopped getting out of bed and walking).

It's good that you are thinking about the future, but it is even more unpredictable than you can ever imagine. Your best plan would be to know how your Mom would be able to afford a facility (AL or MC) if you and your spouse burned out or where overwhelmed by her care needs -- which is a very high probability.

You may want to consider consulting with a Medicaid Planner for your home state, as well as an elder law or estate planning attorney.

This is a good time to secure a bed in a facility that has Medicaid beds. This puts her on the top of the list instead of being placed in any facility at the state's choice. Wait too late then there may be a long wait time. As for paying you, if you already are working, you will be replacing a good paying job, ruining your health and retirement. Use her money to consult an attorney to do things correctly