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My mom is low income on medi cal and currently receiving IHSS benefits as well as within a month of her name coming up on MSSP program in San Diego county. I am near Sacramento, Solano and San Joaqin counties (centrally located) in northern California and would like to move her preferably to a assisted living facility near me.
As I understand it the ALWP is on hold and the wait list is possibly 4 to 5 years (way too long for my mom in her condition). My question is can I move her near me and keep her benefits plus transfer her upcoming MSSP benefits without a problem? Are there other options to the Assisted Living Waiver Program? Her doctor has already said she would approve her for nursing care facility but we are trying to avoid that for her sake as long as possible. Are some counties better than others for providing benefits for seniors? Since I am centrally located I would like to move her to a county that would have the best support structure for her. In know lots of questions but this really is so confusing.

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If the MD says she is ready for a nursing home, it is time for that. If she can afford to go in as private pay, many doors will open for her. If she is strictly Medicaid, you go on a waiting list, no matter what the level of care is. MSSP is only available in areas with an MSSP site, so check around for available sites in the county you choose.
Crossing a county is not as bad as crossing a state line.
You don't say if she has a house or not, but if she does and she sells it to make the move, the money she gets will cause medi-cal to stop until the money is spent down.
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.... changing states is when her (or anyone's) benefits change, changing county within the state does nothing regarding her benefits excepting changes her case workers within HHS depts and immediate need entities contact info of course will change the same. (possible change of dates of recieving benefits may alter a little bit or may not) .. and yes many counties within the same state have degrees of difference of quality so your selecting the county per their resources and quality level is always wise. I moved my mother across two counties within same state, nothing changed excepting what I've mentioned above. (Oddly my mother also previously lived in a mobil home, it was sold before I moved her, so if you decide to sell make sure the home is titled in someone else's name or the state will likely want to gain access to her income from the sale.

  If you decide to change counties within the same state all entities regarding your mother will need to be notified and of course the standard notifying of mailing address change to any bennificiary entities and credit & banking accounts (if she has any)... even opening a new checking account close to her new location makes things easier, but if you change banks and if she has auto deposit of any benefits already linked to her current account, you will need to change all of that associated. Contacting entities of a change of county includes contacting food assitstance benefits. Usually food and energy assistance connects to new location but make sure you contact each entity of and "before" the move to cover all basis, if you don't do it before the move you will have a laps of time for her receiving food and energy assistance.  

I were you I would consider going ahead and placing her on a few waiting lists for skilled care facilities, you can always reject the bed if one comes available if you feel she's (you) not ready to make the move to the facility.
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We moved my mother to an adjacent county from where she had been living when she entered AL. She was already on Medicaid so that aspect of the paperwork was relatively straightforward. As Pamstegma says, if there is an ability for your mother go to into a facility as a private pay for a period of time, that is very helpful and provides more possible options. For instance, although my mother is on Medicaid, the AL that she ultimately entered provided for a supplement to be paid so she didn't have to share a room and has her own efficiency. We'd kept enough aside from the sale of her small condo in Florida some 10 years ago that we were able to pay this supplement for a couple of years. Mom was able to go into an efficiency immediately as there were some available as opposed to having to go on the Medicaid-only shared room waiting list, which was about a year a couple of years ago as I recall. The supplemental money just ran out a month ago but they aren't moving mom as it would be more disruptive to both the facility and my mother, who has moderate dementia/Alzheimers at this point. If she lives long enough, we'll be looking at nursing home placement although the AL is setting up a secured memory unit wing over the next 6 months or so so if mom's memory deteriorates enough, she may be moved there before NH. Hope some of this info helps.
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Some counties are better than others strictly due to the number of people that live within the county.
The more people there are more that require services.
If there is a Senior Services Counselor that you can work with they might be able to get you better information. (If you have not talked to the Senior Center near you give them a call or go in and ask about services. Or if you are dealing with an Eldercare Lawyer they might be able to provide a better idea as to what county might be easier to get the services your Mom needs.

I moved from Cook County in Illinois to a smaller County just 10 minutes away and the difference was amazing in getting services for my Husband.
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The benefits you are discussing Medi-cal and IHSS specifically are state programs administered by the counties. If your mom moves the benefit transfers from one county to the next. For eligibility purposes for both programs there is a $2000 asset limit with her house being exempt as long as she lives in it. When she moves out it will be considered an asset. When you sell the house she will need to spend the money for her care until she reaches the asset limit and will then become eligible to benefits again. I would recommend you call Northern California Legal services in sacramento and they can give you a better picture of those benefits. There should not be a charge for that consultation. As stated by others services are typically better in high population areas, it is based on economics. The assisted living waiver in California is a pilot project and only 7 counties participate. Have you considered a board and care? A 4-6 bed residence with 24 hour staffing rather than nursing home ? They are less costly and not medically based. A geriatric counselor would be able to assess your mom and help you make decisions. If you are I placer county you could call Seniors First to discuss options.
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Thank you for the reply.
She has a mobile home in a rent control senior park and we had talked about either selling it to pay for assisted living or just letting medi-cal/caid take the mobile and would do whatever will work out best for her. I doubt it is worth much and would hate to have her mobile to cause her not to get the care she needed.
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One can use their medi Cal benefit anywhere in California. There is a list on medi Cal web page of all facilities in all counties that accept medi cal .
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Such a good question! I've wandered this myself. I know from personal experience that there really is a difference in services provided between states, and counties within states. But I'm not sure how to find that information other than contacting the human services departments of each county and compiling your own list. (Please share if you do). Mom was living in Sacramento county when she went through all of this. They have some of the best services but... they're grossly over burdend. So we're back to the waiting list scenario. A centralized list would have really helped. But I'm sure the counties in question wouldn't want that info getting out. The whole world would be moving to the good counties. Lol! It would be a worthwhile endever though. I'd start with the health and human services departments (or whatever each county calls them). The local senior centers, elder protection services might know something. Local hospitals patient aid/assistantce departments. Or even just searching online for services listed for each county. There may be a federal welfare department that has rating information on these areas. Good luck👍 I know how overwhelming all this can be.
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IHSS does transfer between counties. There are some groups on facebook that can answer specific questions aboit how too. But generally call the worker of the day in your new county and provide the new address and have a new home visit and hire a new worker within 30 days of moving...generally. but call and ask for specifics. Also...if it was me I would get some advice feom an estate planning attorney regarding the mobile home. Getting a trust and placing the property in the trust may be an option to avoid probate which might have the naturaral consequence of allowing the property to legaally transfer to an heir of your parents choosing without medicaid recovery. But if it was me i would consult with a lawywer about that...there are some websites in sacramento that may be useful in researching housing options...one is called resources for independant living and another is called one fathers love. They both list independant and assisted living options. Dignity health has a geriatric care management program in their downtown office but it takes several months to get in and is by primary care referal only. Probably the other major medical groups have similar. Good luck!
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Thank you everyone for the information and advice. It really is very helpful! I found quite a bit of information from California Advocates for Nursing Home Reform. They seem to be very well versed in the laws as they pertain to my mother and Medi Cal. Unfortunately with the value of her mobile home our options for long term care are looking pretty dim. If assisted living turns out not to be a option for her then she will probably need to come stay with me.....a discussion for another day.
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