How do we pay for my non-citizen mother's care?

A fellow caregiver asked...

My 86 year old mother is a permanent resident of the USA but has only lived here for two years. She lives in Assisted Living with care. She has dementia and wears a stoma bag and as she declines she needs more care. She has enough money to stay where she is for one more year. What happens after that time when her money runs out?

Expert Answer

It's possible for your mother to get both medical and long-term care from the Medicaid program even though she is not a citizen.

As a legal resident, your mother could be eligible for Medicaid coverage of all her medical care if and when she has low enough income and no more than about $2,000 in assets (meaning savings, investments, or anything else of value besides her personal possessions). The exact amount of income she is permitted varies from state to state, and may also depend on whether she has regular, ongoing medical bills. To find out what the income level is in the state where she lives, look at the Web site of the Medicaid program for that state or contact a local Medicaid office. To find the state's Medicaid Web site or a local Medicaid office, go to the federal government's Web site and choose your mother's state. Or you can call the Eldercare Locator toll-free at (800) 677-1116 and ask for contact information for the state's Medicaid office.

Your mother may also become eligible for Medicaid coverage of long-term care. This could be Medicaid coverage of at-home care if she were to live with family members. However, this coverage is limited and would still require most care to be provided by the family. She might also receive Medicaid coverage in an assisted living facility. But Medicaid coverage for assisted living is not available in all states, and where there is some coverage it only pays for part of the cost of care in the facility. The rest of the cost would have to be paid from some other source. Also, even in a state where there is some Medicaid coverage of assisted living, not all assisted living facilities participate in the program. That means that if the assisted living facility where she is now does not participate in Medicaid, she would have to move to another facility to receive Medicaid assisted living coverage.

It sounds like the most likely option for your mother will be Medicaid coverage of nursing home care. Medicaid can pay the full cost for someone who is eligible for the program and lives in a nursing home. If her condition continues to decline, she may need a level of care that an assisted living facility cannot provide but a nursing home does. If so, Medicaid can pay for it. Or, she may be forced to leave assisted living and move to a nursing home simply in order to get full Medicaid coverage of her cost of care. That's a difficult choice to make but one many families are faced with when the cost of assisted living becomes too much to afford. As with assisted living coverage, however, not all nursing homes participate in the Medicaid program, or have only a limited number of spaces available for Medicaid-covered residents. So, when the time starts to draw near when your mother may need to move to a nursing home, it's good to start ahead of time to find out what Medicaid-participating nursing homes are available in your area.

There is also an immigration-related issue that you should be aware of when you're thinking about Medicaid for your mother. Since she has fairly recently entered the country as a legal resident, some family member might have been required to sign legal documents with the federal government promising to be her financial "sponsor" in the U.S. If so, the terms of that sponsorship agreement may require the sponsor to repay the government if your mother receives funds from certain public programs, such as welfare assistance and Medicaid. So, you need to check your mother's immigration documents to see if such sponsorship was required. If it was, you may need to consult with an immigration lawyer to determine if the sponsor will become financially liable if your mother begins to receive Medicaid coverage.