When Medicaid looks back on my mom's finances, will they approve that she used savings for an assisted living facility before going to a SNF?

Best to move her into a SNF that accepts Medicaid for a few months before filing as she continues the spend down. If you hold off, you will not be able to choose admission to the good ones. She will be placed in the next available bed. Plus the good ones have wait lists. If she is already a resident in one of the good ones, she goes to the top of the wait list. You can hire a geriatric care manager for a few hours for their assistance if this confuses you. The costs will be well worth it.

Yes, of course. Her assets are hers. She is not spending down. She is paying for her care at present. This is by no means "gifting" of any kind.
You may want to check in your area, because some few ALF will keep on a client who enters as private pay and has then to move to Medicaid. It's rare, but there are some.
As to your mom "qualifying" that is a whole other question. You have to qualify by "need" and by having no funds and by not having gifted people during the 5 year lookback period (2 1/2 in California; Californians can also keep a good deal more income than many other states and still qualify for Medi-cal.)

As long as her money was spent on her, there will be no problem. Even if spent on her home. The problem comes if she "gifts" money. That includes a loan. She will be penalized for that. The IRS allowing gifting is not allowed either.

In my State, Medicaid may pay for Assisted Living if you have paid privately for 2 years at least. Me, I placed Mom in LTC when she was down to 20k. That got her into the facility and gave me time to apply for Medicaid. She paid 2 months and the 3rd month Medicaid started.

As others have said, DO NOT WAIT until she is totally spent down to get into a high quality Medicare and Medicaid approved nursing home (skilled nursing facility, SNF)!

Going in as private pay, where one pays the monthly rate out of pocket for several months is a "sweetener" to get a placement into the better/top quality SNF. We did this w/my mom, she had enough to pay for 6 months private pay and the SNF loved that. That got her into a private room too. After spending down and qualifying for Medicaid, they decided -- given her psychological issues and dementia, angry type -- it would be in her and other residents' best interests for her to remain in a private room. That was a awesome!

Do the research on the best quality SNF and figure out which one. Talk with the business manager folks about being private pay for several months, the longer the better as a sweetener for them. Closely review any paperwork, and DO NOT SIGN for yourself as 1) "willing to take her back" if she does NOT qualify for Medicaid (the onus needs to be on them to find a workable placement and 2) NEVER sign ANYTHING saying you, personally will foot the bill. Sounds harsh, but this is your and her protection.

Lastly, when she is close to hitting the spend down target that next month, the SNF business office folks should be able to help with the paperwork. But having a licensed elder care attorney helping can help. She should pay the attorney out of her funds, that is legit for Medicaid. ALSO, pre pay any funeral expenses as that is legit too for Medicaid as long as it is not like a $50K funeral. Something very inexpensive will pass muster w/Medicaid (my mom after she passed had a simple $14K thing, which was ok with Medicaid.

Also, there is A LOT OF PAPER work. Work on gathering all that now: 5 years back of monthly bank and all financial statements (IRA, Pension, 401K, etc) and 5 years back of ALL State and Federal tax filings. And sales of major things: like a home, and ANY gifting, loans, on and on. Work on getting on-line access to all her stuff, easier.

Regarding the gifting, yes giving large sums of money to a grandkid likely trips the wire. A $25 birthday check is NOT what I mean. It is the 3 figure or more types of gifts.

Good luck with this.

I live in NC and know that many of our assisted living facilities will accept Medicaid after one has been self paying for a while and some even accept Medicaid right away.
But if your mom is now past the "assisted" living stage and needs to be in skilled nursing she won't have any issues in getting Medicaid to cover a SNF, as long as she meets their requirements.

Yes and when she applies for LTC Medicaid instead of the usual 5 yr lookback on her financials it may only be 3. It may be shortened due to the fact that her spend down was so much used for AL in prior years.

Something to be mindful of, the eligibility for LTC Medicaid is both medical and financial. Families and POAs get all wadded on the $ part but the “at need medically” is also important. If her State has it so that it is only SNF that LTC Medicaid will cover, then your mom has to - HAS TO - have her health charts show she is “at need” for skilled nursing care. If she is doing just fine in her AL she may not have the health issues and in detail to show “need for SNF”. It will be challenging to get her eligibility just based on she ran out of $ to pay for AL so now moves to a SNF as LTC Medicaid in moms State will only pay for a NH/SNF. If this is the case, you imho have to start her on visits to her doctors to get that chart fatten up. Her internist or gerontologist can write a script that skilled care needed but it has to be backed up by stuff in her health chart and her medication list.

fwiw Majority, like 70% or so, of NH admissions are this path:
Dad 75+ living in his home or IL or AL falls and breaks a hip; EMS picks Dad up and he goes to the ER / ED; Dad admitted to the hospital and has hip surgery (so far in this scenario all is pretty much being paid by Medicare and his supplemental health insurance or his Medicare Advantage plan); Dad is discharged and goes to rehab in a SNF (still all health insurance benefits); Dad stops progressing in his rehab - tends to be btw week 3 - week 5, so Medicare stops paying; Dad cannot return to live in his old place so moves from being a rehab patient (paid by Medicare health insurance) at the SNF to becoming a custodial care resident in the SNF. Custodial is private pay, ltc insurance or LTC Medicaid if he is sufficiently financially “at need”. This Dad has a nice fat health chart and in detail from both his hospitalization and his rehab that clearly show definitely he is medically “at need for skilled care”. Dad’s POA only really has to deal with $ look back. It is way different than you drive your mom from her AL and she walks into a NH.

& also for the above Dad scenario, the NH/SNF has been paid for rehab stay @ double to triple in billing to his health insurance (Medicare) than what LTC Medicaid will pay the NH for a custodial care day rate. NH is kinda ok for this Dad to be a Medicaid Pending resident starting the day his rehab ended (he went from rehab patient to custodial resident) as they made $ from his rehab stay AND they are getting almost all his monthly income (his SSA, retirements) starting day 1 of being a custodial resident while his LTC Medicaid application is processing. Eligibility review is supposed to take 2 - 4 months and it’s a manageable float by a facility as that sweet rehab $ helped the NH overall bottom line. Pay attention to NH paperwork as to financial responsibility should something go amiss and your mom is determining to be not eligible for LTC Medicaid. Always sign the many documents as “TME in her capacity as POA for Jane Smith Jones” and get a copy of every page. Or your mom signs each one.

Contact Medicaid to get specific answers. I live in NC and in my county, Nash, we have a social security office in town. Going there and requesting an appointment, or going on line to get an appointment is better than waiting an hour on hold. Spending her money on her care is what Medicaid expects before she qualifies for Medicaid, including liquidating property and vehicles if she does not have a spouse. I am understanding that Medicaid approves you pre-paying her final expenses with her money before she goes onto Medicaid.
A doctor will need to fill out a form that proves she is in medical need for skilled nursing care and a social worker or nurse submits it to Medicaid for approval.

Yes they will. That is the whole point of the look back - they can see that she 'spent down' her assets for her own care before asking the state to pick up the tab.

During look back, if there are other sums of money paid to, let's say to a college that a grandchild attended, you would have a problem because she was basically giving away money to become eligible for Medicaid.

Her money can be used for her own care and living expenses....they just can't be used to buy you a car or gift ten thousand dollars to her grandchild as a graduation gift, etc...

There will need to be some planning involved before her money runs out. Make sure to pre-plan and pre-pay for her funeral out of her money. If you don't do this, you will be taking out a loan to pay for it because once she is on Medicaid, they will take all of her monthly income...social security, pension, etc.

TME0128: Her assets are, of course, her own.