Why is it so hard to find a memory care facility that accepts Medicaid?

What I plan to do with my mother who currently resides in private pay memory care is this: apply for Medicaid about 6 months BEFORE her money runs out and get her into a skilled nursing facility (at that time) that takes Medicaid. I'll private pay her money down while awaiting approval. That way, she'll already be in the facility (they always accept private pay) and when Medicaid comes thru, we're all set. We are not responsible for paying their monthly fees for care, but if we don't do our due diligence, we may wind up taking them into our homes! That thought keeps me awake at night because there is NO WAY I can handle my 92 year old mother's issues at home......she can barely take a shower without falling and that's with caregivers helping her!

As far as getting your mom into the hospital goes, YOU can have the facility call an ambulance for her if you think (or they think) she's having a health issue that requires more attention. Ie: pneumonia or a UTI infection, vertigo or extreme dizziness, etc. She can be sent to the ER for evaluation at which time a social worker gets assigned to her case. You then tell the SW that you CANNOT, under ANY circumstances, take mother to live with you and she needs placement in a Skilled Nursing Facility (SNF). The social worker can help you find placement and apply for Medicaid as well. You may also want to consult with an Elder Care Attorney now and he can help you cover your options.
This is a VERY stressful situation, I know, as the only child of a 92 yo mother with tons of issues and running out of money herself. Rarely a day goes by where I don't worry about her future as well as my own. The elder care crisis we face in this country is REAL, and it's scary as hell. Modern medicine wants to keep us alive for a century or more with no plan in place for how to care for us with dementia and 14 other age related health issues. And our "golden years" are getting ruined with all the worrying and stress that goes along with managing THEIR lives and finances. A real mess, isn't It?
Best of luck

You are responsible to pay only her own money, if you have POA for her finances. If she is completely out of money she will, sadly, have to go onto medicaid. The reason of course is cost. But you are not responsible for the debts of others unless you sign that you will be responsible for them. You need to make it clear to the facility that her funds are running out and you need to see what the process is. She may need to be hospitalized just to find Social Worker care to help with placement as you can spend months looking for what they can find on their list in no time at all. So sorry. We are all outliving whatever we managed to save and it is hard to imagine where all this goes. Perhaps see an Elder Care Attorney to see what minimal amounts can get protected, how to start applications for medicaid.

Key issue imho is your state legislature, gonna be a long rant....
Last millennium, MediCARE & Medicaid went into law. Medicare was totally federal for support & availability to almost all the US population over age 65. As it’s federal, it’s portable, so Medicare works whether your at home or fall & go to ER while @Disney with grandkids. As long as provider takes MediCARE, coverage assured in US.
We pay into Medicare via FICA while working or from SS once retired.

- Medicaid was federal “dedicated funding” for “at need” (both medically & financially) for specific health programs with joint state funding alongside federal $. Medicaid programs are term limited, like CHIP for kids or WMH for pregnancy & relatively routine care & w/controlled costs; & a lot fall into preventive services which feds pay a higher % of.
Included in Medicaid was funding for skilled nursing care in a facility with the states paying a required % share of those costs as determined by their populations demographics. Basically means federal & state $$ assured to pay for care in a LTC facility that is a NH as that’s “skilled”. Medicaid LTC covers all ages who need skilled LTC in a facility.
BUT
- medicaid as it’s a joint program, has it set up so guidelines are under a overall federal umbrella but administered uniquely by each state. So each state can determine what criteria is for financial “at need” but based on federal poverty guidelines; and state determines what they will pay for daily room & board, & some states pay very little, like under $150 a day; and state is who reviews application to see if the applicant is medically “at need” based on chart or an on-site in person evaluation; for couples, state determines what degree of $ the community spouse can have; state determines how MERP can happen.

AND more importantly
- state decides if they want to divert or “waive” federal $ from NH to instead go to others like AL, or MC or community based program, like PACE.
Most states don’t see any need to deal with waivers at all as they have to have their own management & waivers are NOT permanent $. You gotta go every 3,5,7 years to get $ for your waiver program to be renewed or approved by state legislature. You gotta show cost benefit, yada yada.... Waivers are a bother as $ can just go into well established NH system. & NH have long existing lobbyists as for ages it was only NH in the aging care game.

For states that do waivers, the impermanence & uncertainty are a reason why a lot of facilities flat will not have waiver set aside beds. If you can fill your place with private pay, it’s not worth dealing with waivers.

Other states, like AZ, are more realistic about incoming tsunami of over 65 needing care & have heavily shifted to AL & community program waivers.

Right now, feds are encouraging (by add $) waivers to be done but to go for PACE. So elders stay at home but picked up by PACE staffed handicapped van then go to PAcE center 2-4 days wk w/all medical care being done at center or participating hospital group. For those more infirm, weekend caregiver visit(s) done. But they stay at home & family or private pay caregivers hired fill in as needed. If you have PACE, your elder may need to be evaluated for it before they can go into a NH or apply for another waiver, like AL or MC. We have one nearby (Benson Center) & it’s got a waiting list as super popular; it’s administration provider is Catholic Charities health care system & they do 4 PACE statewide.

Really it’s up to your legislature to do waivers.
Get politically active, find legislators who understand aging issues & support them.

As others have said, get mom “at need” medically for a NH. There’s gonna be a Medicaid bed in a NH somewhere. It might be a good idea to have your mom become the patient in private practice of the MD who is also a medical director of a NH or two. They will know what needs to be in her chart. Good luck.

Genita, may I ask a few questions? When she initially was admitted to this private facility did you sign to be financially responsible for her? Also, did you realize at that time that she only had funds to cover a certain amount of time? What has the private care facility told you as far as what they plan to do with her once the money runs out?

Hopefully you can find a nursing home that they can transfer her to that takes Medicaid. Maybe the private facility can help with that. You can spend the remaining amount of her money there and then they will help you get her on Medicaid. If you are somehow financially responsible to the private facility based on what you signed upon her admittance you should get her out now. If only she is responsible, I would assume the facility will start looking for places to send her, make sure you don't feel the need to pay her bill out of your money. Also make it clear you don't have a safe place for her. They will likely send her to the hospital but that's OK, the hospital is efficient at finding placement.

If your mom has some money left, you should look for a nursing home that accepts Medicaid now and get her admitted private pay. After her money runs out, she'll get a Medicaid bed.

Be completely transparent about your plan. They will help you with it and take on the arduous task of applying for Medicaid.

Genita, sorry you are having trouble finding a Memory Care that takes Medicaid. It is my understanding that Nursing Homes will take Medicaid, if they have a bed opened. There might be a waiting list.

The reason why it is so hard to find a Medicaid open bed has to do with cost. An Assisted Living/Memory Care needs to make a certain amount of money to keep afloat and they can do that if the residents are mainly self-paid.

Some States will offer a waiver where the State pays a certain percentage, and the patient pays the rest, thus they can get into Assisted Living/Memory Care.

Otherwise, you will need to check your local nursing homes as they are more apt to accept Medicaid. There will be a mix of residents who are self-pay, and those who use Medicaid to pay for their room/board and care.

Have started the Medicaid process for the second time. DSS has informed me that my mother must be moved into a Medicaid-approved facility as well as monies spent down before she is approved!

Medicaid doesn't pay for memory care, as you found out. Even though it's probably way too much care, a nursing home/long term care facility is where you will need to place your mother to get Medicaid assistance. This is one of the "holes" in elder care -- Medicaid rules need to change to include coverage in lesser-care (and less-expensive) facilities! My mother is in a nursing home, but there are folks there that (it seems) should be in an assisted living facility. I'm sure they are there because this is the only place Medicaid will pay for them. So nursing home beds are taken by people who should otherwise be in AS/MC. Sitting down with a Medicaid attorney and also an organization that assists with Medicaid applications was very enlightening for me.

The system is so broken and there are no advocates in government to change this -- if anything, for many politicians Medicaid is a system that needs to end. Can you imagine what would happen if Medicaid weren't available to the elderly?? We need to vote according to our family's needs.

What state? I have dealt with this very issue and won in 3 states.

Congress has legislated an adequate program in Medicaid, but it is thwarted by industry greed.

I have found a new respect for our Congress.

Medicaid requirements are very fair but rigorous, is why facilities will not accept.

A facility that will not accept Medicaid does so because they are not capable of guaranteeing the required, 'needed' level of care, long term, That tells me that they would not guarantee the needed care for private pay either.

Medicaid says of itself that it is intended to be equal to private pay.

Bottom line is the 'now dollar' in the cost of care.
I was facility engineer for an 80 bed skilled facility in the 1970's.
Daily, I saw the compassion for people with various needs.
I had much admiration for the workers and management until a corporation took over.

We opted to keep my wife home and Medicaid is very supportive.
This state happens to be one of the best in administration.

The bottom line is money. With all this free healthcare it's going to get harder and harder to find places. The facilites only get a very small amount compared to what they are suppose to get...I can hardly blame them. Money doesn't grow on trees and it's going to get bad. If she or you has money; admit her private pay and when that runs out they will do the medicaid thing. Remember; facilities are ony required to accept just so many medicaid clients. Save the legislation stuff. It's the politicians who are in control and they're to busy ripping our president apart to care.