Today’s Elder Care Question on is about the Medicaid Spend Down

Question:  My mother (who is 83 years old, blind, has lived in a nursing home for 4 months but owns a home, and cannot walk) has a $14k spend down for Medicaid.  What exactly can this money be spent on?

Answer:  As an Elder Law Attorney the first question I would have for you is who told you that your mother had a spend down amount of $14,000? Do you mean pre-qualification spend down of your mother’s resources or do you mean post Medicaid approval where the State has determined a Spend Down Amount. The distinction is important since in Illinois pre-qualification spend down is not as restricted as post approval spend down which is generally limited to medical expenditures.

You really need to see an Elder Law Attorney to discuss your mother’s overall situation. Your question indicates that your mother still owns her home. Typically if someone enters a nursing home without an intent to return home, then the home is no longer an exempt asset. In Illinois if certain steps are not taken in regard to the home, it may result in your Mother’s application being denied. In addition, there are several exceptions to rules regarding homes which you may or may not qualify for which can allow the home to be preserved. In addition, you indicated that your Mother has been in the nursing home for 4 months, but have not indicated how the nursing home bill for that period was being paid. Even if your Mother received the full 100 days of Medicare rehabilitative coverage in the nursing home, that still leaves a period of time that must be paid for privately or by Medicaid. While Medicaid will pay for nursing home care for up to 3 months prior to the date of the application, in Illinois the applicant must meet all the Medicaid qualifications on the first day of each of those three months for Medicaid to pay them.

Since your Mother has $14,000 she would not qualify for the pre-application Medicaid coverage as it is above the asset limit. So, whether you have already filed the Medicaid application or not, you must consider what amount your Mother will have to pay to the nursing home which Medicaid will not cover. You need to address that issue prior to making any decision as to how to spend down the balance of the money. These are all complicated questions and issues, and you cannot expect to get correct information from anyone other than an Elder Law Attorney.

I would highly recommend that you pay a portion of that money to an experienced Elder Law Attorney to do an overall evaluation of your Mother’s qualifications, whether her home can be preserved, whether there are any other planning strategies she might be able to take advantage and to make sure that the allocation of her monies is done correctly so that it does not result in either a penalty period or a denial of benefits. Good Luck.

If you need additional information about this or other Elder Care Matters, go to – America’s National Directory of Elder Care / Senior Care Professionals.

James C. Siebert, Esq., An ElderCare Matters Partner
James C. Siebert, Esq.
The Law Office of James C. Siebert & Associates
An ElderCare Matters Partner

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