I’m looking into a specific nursing home for my husband since he is already part of their daycare program. How do we pay while on community Medicaid?
It’s me again. Someone told me they were asked for $54,000 up front until Medicaid kicked in. Is this possible??? We’re on community Medicaid they already know we don’t have assets of 54,000 hanging around.
You need to talk to the Administrator at the nursing part to get info straight. They may not take Medicaid until the person has paid privately for a length of time. My Moms AL wanted two yrs private pay before they would consider Medicaid. Then there had to be a spot open. If this is how they work, then you will need to look around. Make an appt with Medicaid to see what you need to do to set up Medicaid for husband. Take bank statements along and proof of any other assets, like bonds, shares, stocks, CDs, IRAs. SS info and pensions. This will give them an idea of how the assets can be split so you will get enough to live on. Oh, cash value insurance policies not provided by the employer. If you feel after talking to a caseworker its too overwhelming, then consult with a lawyer.
Is the facility one that has an inital buy-in and they also have a open to the community a day program that anyone can participate in? If so, that’s 2 totally different programs and tracks for how things are paid for.
I’d bet the day program is part of a community outreach that has state, city, county or religious organization funding that between all those covers operating costs for the day program. The residents of the facility likely have a part of the $ they pay within thier monthly bill that goes to the day program. If your hubs as a community participant pays a small fee or goes for free, it doesn’t really affect the bottom line of the day program. A lot of the services (flu shots, blood pressure checks) are billed to Medicare and the place likely get a management fee for hosting these. It’s a win win for all as less Medicare billed for a MD office solo visit for those in the community program; the facility herds their residents over for health screenings so less facility staff time for routine stuff.
Medicare likely has a shared billing to Medicaid for anyone in the day program that’s a “dual” (on Medicaid & Medicare). If this the system then it’s not the facility taking Medicaid but the day program taking Medicaid.
The distinction is important cause if he were here to become a permanent resident he would need to meet whatever requirements they have for entrance. If they don’t participate in LTC Medicaid, then its private pay. If this is the situation then your going to need to find a place that takes LTC Medicaid. His community Medicaid eligibility has different requirements than Ltc Medicaid does. A lot of places do not take LTC Medicaid; they only take Medicare for health services billed but are private pay for the room & board costs. Some places that have a AL & a NH only take Medicaid for the NH part and draw exclusively from a waiting list of current residents living in the private pay AL section to fill the limited # of medicaid beds in the Skilled nursing/ NH section.
If he's been going there for a while, you’ve gotten to know the staff. I’d suggest you talk with the SW ( social worker) as to what other options for places exist. Private pay places have residents run out of $ all the time and it’s the SW who often helps find a new place for them. The SW should have ideas for you. Good luck.
oh also LTC Medicaid is going to look at your & his assets totally differently than Han community Medicaid. He’s only allowed 2k in assets, he has to be impoverished. But you DO NOT yourself have to be impoverished. But you may have to move $ to establish yours vs. his. To me this is never a diy and your best having an elder law atty look at your situation before you ever file for Medicaid. You can have in most states 119k as your assets and your income is not a factor for him. If you need some of his income to make ends meet, the atty can shepherd your getting a Community Spouse Resource Allowance from his monthly income (instead of all of his income getting paid to the nH). CS stuff is not simple, really an atty is worthwhile.
As we’ve said in your other post regarding what Medicaid will and will not do, you should consult an Elder Law Attorney who specializes in dealing with the tangled webs of Medicaid and knows the laws of your state.
Even if Medicaid has all your facts and figures, I’m sure you’ll still have to fill out reams of paperwork for a transfer from long-term, in-home care to Nursing Home Care.
I never heard of a facility asking for what could amount to almost a year’s board and care up front. Who is the “someone” who told you that? My mother was admitted to the Nursing Home Medicaid Pending. She was self-pay until Medicaid kicked in.
If you don’t want to hire an attorney, call or visit your local Medicaid office. Take any paperwork you have regarding the Community Medicaid. Don’t leave until you are absolutely certain you understand what they’re telling you.
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I’d bet the day program is part of a community outreach that has state, city, county or religious organization funding that between all those covers operating costs for the day program. The residents of the facility likely have a part of the $ they pay within thier monthly bill that goes to the day program. If your hubs as a community participant pays a small fee or goes for free, it doesn’t really affect the bottom line of the day program. A lot of the services (flu shots, blood pressure checks) are billed to Medicare and the place likely get a management fee for hosting these. It’s a win win for all as less Medicare billed for a MD office solo visit for those in the community program; the facility herds their residents over for health screenings so less facility staff time for routine stuff.
Medicare likely has a shared billing to Medicaid for anyone in the day program that’s a “dual” (on Medicaid & Medicare). If this the system then it’s not the facility taking Medicaid but the day program taking Medicaid.
The distinction is important cause if he were here to become a permanent resident he would need to meet whatever requirements they have for entrance. If they don’t participate in LTC Medicaid, then its
private pay. If this is the situation then your going to need to find a place that takes LTC Medicaid. His community Medicaid eligibility has different requirements than Ltc Medicaid does. A lot of places do not take LTC Medicaid; they only take Medicare for health services billed but are private pay for the room & board costs. Some places that have a AL & a NH only take Medicaid for the NH part and draw exclusively from a waiting list of current residents living in the private pay AL section to fill the limited # of medicaid beds in the Skilled nursing/ NH section.
If he's been going there for a while, you’ve gotten to know the staff. I’d suggest you talk with the SW ( social worker) as to what other options for places exist. Private pay places have residents run out of $ all the time and it’s the SW who often helps find a new place for them. The SW should have ideas for you. Good luck.
oh also LTC Medicaid is going to look at your & his assets totally differently than Han community Medicaid. He’s only allowed 2k in assets, he has to be impoverished. But you DO NOT yourself have to be impoverished. But you may have to move $ to establish yours vs. his. To me this is never a diy and your best having an elder law atty look at your situation before you ever file for Medicaid. You can have in most states 119k as your assets and your income is not a factor for him. If you need some of his income to make ends meet, the atty can shepherd your getting a Community Spouse Resource Allowance from his monthly income (instead of all of his income getting paid to the nH).
CS stuff is not simple, really an atty is worthwhile.
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Even if Medicaid has all your facts and figures, I’m sure you’ll still have to fill out reams of paperwork for a transfer from long-term, in-home care to Nursing Home Care.
I never heard of a facility asking for what could amount to almost a year’s board and care up front. Who is the “someone” who told you that? My mother was admitted to the Nursing Home Medicaid Pending. She was self-pay until Medicaid kicked in.
If you don’t want to hire an attorney, call or visit your local Medicaid office. Take any paperwork you have regarding the Community Medicaid. Don’t leave until you are absolutely certain you understand what they’re telling you.