The Biggest Misconception about ALFs and Medicaid – Part 1

       I wrote about this 5 years ago, but it still is one of the most common misconceptions families have about the ability to qualify for Medicaid in an assisted living facility.  Let’s look at the following very common scenario.  Mom can no longer live at home alone.  Her daughter, Carol, is exploring assisted living as an option.  She tours an assisted living facility and has a conversation with the Admissions Director.  Carol asks the following question, “Do you take Medicaid?”

       The director tells Carol that they are a New Jersey Medicaid approved facility and then explains that residents are required to private pay for 2 years before becoming eligible for one of their Medicaid “slots”.  That time period for most facilities typically falls within the range of 2 to 3 years.  Each facility sets its own policy and requirements.  But what Carol is likely to hear is something very different.   She tells me “the facility said if I pay for 2 years Mom will get Medicaid”.

       Now, although I wasn’t in the room when that conversation took place, if I was a betting man, I would say odds are that the director didn’t say that.    There is a disconnect and I can’t count the number of times this has happened.  The director is telling Carol about the facility’s private pay requirement.  “You must private pay for 2 years before we will consider you for one of our Medicaid slots”, is what the director is really saying.  But that requirement is merely one hurdle to clear, in order to qualify for New Jersey’s Medicaid program that covers assisted living care.

       There are so many other requirements and conditions that must “fall into place” for Carol’s mom to be able to qualify for Medicaid, none of which are within the control of the facility or Carol, for that matter.  Next week I’ll reveal to you what they are.