contact a GOOD Elder attorney.......they will help you get things straightened up for the medicaid process.........and they can also help deal with the NH or AL...........not sure where you live but we have a great elder attorney dealing with stuff right now for our mom.............wishing you luck.
It sounds to me you realize they may both have to be placed - start looking into all of the options and financial aspects. However, to the best of my knowledge, MEDICAID DOES NOT PAY FOR ASSISTED LIVING. What I would do is seek out the local Office on Aging (each county should have one) for advice. I suspect the day will come where they must go into a nursing home in order to get Medicaid help. Also contact Medicare and any social workers (such as in hospitals) to try to get more information.
As others have said, assisted living is usually going to be for people who have the money (quite a bit) to self pay for that arrangement. Medicaid is going to get them a bed in a nursing home. You might possibly live in a state where assisted living is covered, so you could call your local medicaid office and ask about assisted living.
Are you considering a move to a nursing home for both of them at the same time? Or one will stay at home while other goes to facility? If you think the placement is going to happen this year, there's no problem with applying anytime. Just be sure you have doctor information that shows they are NH medically eligible - documentation to support the need for NH care. Without it, your application will just be denied.
If you think dad will have to be placed first, Medicaid rules consider the other spouse still living in the home and will not remove all of the income from spouse - won't leave mom destitute. Two people considered where income is concerned, so if their income is low - he could possibly qualify easily. However should something happen to him, all the income still going to mom could make her ineligible because it might be too much for a one person situation.
Current income levels for 1 person is about $2300 per month. If they have more than this, this could be a situation where husb/wife might qualify for NH while both are alive with more income than that, but if dad died and mom still had same amount of income (say $2500) - she would not be eligible for medicaid NH bed.
tlyst011: You should check your state of Ohio - as a rule, as Bridger pointed out, assisted living facilities generally are not covered by Medicaid. You may have to opt for a nursing home.
It would be a good idea to connect with a local social worker or group that specializes in senior citizens and aging to find out what options are available in their state and locality. Some states and cities supplement Medicaid. Then you can contact Medicaid for an information session. If they currently qualify for Medicaid, it seems like a good idea to start having them use it now.
It can't hurt to explore options, but in reading the info at the link BarbBrooklyn posted, it became apparent what others have said in the past is mostly true. Most state Medicaid plans do not cover AL. The statement in question is:
"Federal law bars the state Medicaid program from paying for the cost of room and board in assisted living. Waiver participants, or their families, are expected to pay for this portion of the monthly fee."
Room and board is the biggest part of the cost! It appears Medicaid only covers any "medical" necessities. I knew that AL room and board was NOT deductible on Federal taxes, but MC is. My mother was beyond AL by the time we needed to move her, so she's been mostly tax free for the 4 years she was in MC. Facility costs and many supplies (briefs, wipes, bed pads) WERE deductible.
Even when NHs are required for the care, there are limited openings. But one needs to qualify for NH care as well, so there's that issue. Generally dementia alone isn't enough. It never hurts to ask though, so start asking! Now is the time to prepare.
Being very low income, they might qualify for limited in-home care. If there is a Medicaid number you can call to discuss all your questions and concerns, start there. If not or they aren't helpful, you might want to seek out EC attys who offer an initial free consult. Have all info ready for that limited visit: income, expenses, disabilities/needs, etc.
Some paid in home care will be helpful. If possible, they care hire additional help with their own income. If family members can provide some assistance as well, they can remain in their own place for now, while you sort out the rest.
It would be good, as someone suggested, to have a plan in place in the event that either has a medical emergency and the other needs care/oversight. It is best to at least start exploring and planning for the future, rather than waiting for the inevitable emergencies to happen! Be aware of all financials and medical needs, documenting changes and keeping tabs on updates to social programs. If they can get the latest big bill passed, there are funds allocated to provide more assistance for elders and caregivers. It won't magically cure the elder care crisis, but every little bit helps!
If possible, ping your Reps and Senators. You can read about the issues and find a link to locate your state reps in my post:
We have a LARGE group of people on this forum who are all in the Dementia Titanic - WE need to let THEM know where the needs are and how bad the situation really is. If WE don't let them know, they can continue to bury their heads in the sand. Rattle the cages people!!! WE the people need to speak up!
Yes, apply! Begin the application process, as these things always take more energy, time, and research than expected.
in the mean time, see if you have a local senior “Meals on Wheels” program that will deliver lunch to your parents. Take pressure off of yourself and your mom wherever possible
Do you have an Area of Aging? With some in-home services they may cope for longer in their home?
Could either of them live safely alone if the other had a health crises & hospitalised? Having an emergency plan for that scenario may be a good idea too.
It will take at least 3 months to be approved upon submission to Medicaid - and you need to re-certify every year. Even if you don't use a facility in the beginning, you can use Medicaid to get in home care and needed supplies by using a Managed Long Term Care (MLTC) agency.
Further if they are eligible or already on Medicare, you should also apply for the State’s Medicare Savings Program. This is not Medicaid, but may start the process for it because it is based on assets and income.
You may have trouble finding an ALF that accepts Medicaid. There are some but your choices will be very limited. My friend found one for her mother. Also, depending on the extent of your mom’s disability, most ALFs require a level of independent mobility. (E.g say able to walk with a walker for 100 feet; no use of wheelchair as primary mobility). My Dads ALF has those requirements. Also, if you have LTC insurance, read the fine print. My dad’s insurance required a fully time nurse on staff. My dads doesn’t have a FT nurse hence coverage was declined.
While some report good feedback about LTC policies, they do vary a lot and many seem to have too many "gotchas". To pour all that money into insurance only to have them deny when you need it would be awful! There might be good policies out there, but I've read that many companies are getting out of this business because it isn't profitable.
I recommend that you apply for Medicaid NOW to even see if they qualify. They could use Medicaid for other health insurance purposes, not just LTC. As others have written, Medicaid does not usually pay for assisted living - only nursing home care.
But at any rate, the person needs to qualify for Medicaid first. It can take time to gather together all of the necessary documents, complete them, file them, wait for approval (or not), etc.
Most assisted living facilities don't accept Medicaid. I did find one in my state of KS that does take Medicaid, but they require the resident/s to pay for one year before applying for Medicaid. So call around to different facilities in your area to see if any of them provide medicaid and what other requirements they may have. Please know if both go into AL if they share the apt, there is usually a 2nd person charge. I believe in my parents case it was and additional $150/mo. SNF (nursing homes) usually have medicaid beds, but depending on where you live and the facility they may be hard to come by so by all means do your homework.
Check your parents county for Agency on Agency (may have a different name depending on where they live) and check with them for resources that Medicaid can offer them either now or in the future.
I agree you probably need to get the documentation together now for medicaid. It's a lot of work getting all the required documentation.
ALSO, was either parent in the military and have veteran's status? If so get the veteran signed up with VA - they have a program called Aid and Attendance where the veteran gets monthly payments; there is also benefits available for a surviving spouse. I glanced over Aid and Attendance for dad but income was too high i believe, but I did enroll him for VA medical benefits - still used his regular PCP, but did get his hearing aids for him through the VA for only a $60 copayment and free HA batteries for his lifetime.
It is excellent you are planning now for their future and I wish you luck in finding resources for them now. Good luck
As said, ALs are not usually covered by Mediccaid. In my State, you have to private pay at least for 2 years before applying for Medicaid for an AL or MC.
You may not be able to apply for Medicaid in advance. My state allows 90 days from filing application to placing the recipient. In that time you spend down any money, get all info requested and line up a place for you LOs. You need to go to your County Social Service Office and talk to a Medicaid caseworker.
How bad is Dad? Maybe a LTC would be good for him with Medicaid paying for his care. Mom would become the Community spouse being able to stay in the home and have a car. She will get enough from their monthly income to live on. Maybe thru Medicaid in home you could get help for Mom. Without the care of Dad she may be better.
If they qualify, you should start the process as soon as possible. I could take some time to gather the necessary documents and information and for the approval to come by. Also, even if they are not ready for Assisted Living or a Skilled Nursing Facility, you could qualify for some in-home caregiving services covered by Medicaid.
Most places have long waitlists, you cannot wait until you need the service to apply. So the sooner you start getting things ready, the easier it will be.
Reading part of the info at that link, I found this:
"Federal law bars the state Medicaid program from paying for the cost of room and board in assisted living. Waiver participants, or their families, are expected to pay for this portion of the monthly fee."
This is somewhat in line with what is allowable for deductible expenses when filing taxes. The "medical" part of care in AL is deductible, the room and board is not. Since this statement clearly says Federal, then it likely applies to any state that has waivers for AL.
MC is fully deductible on Federal taxes. My mother was pretty much tax free for the last few years of her life. Her pension and SS only covered about 1/2 the cost, so I would feed enough trust funds into her account to cover the remainder of that cost and have sufficient left over to provide supplies and any extras. This meant no excess income, so the cost of MC and medical "necessities" such a briefs, wipes, etc offset all the "income."
That said, it won't hurt to apply anyway. Even if they can't afford the AL cost and can't qualify for SNF, they *might* qualify for some in-home assistance. My understanding is this is never 24/7, the hours are limited, but ANY help Medicaid provides leaves other income to fill in some of the gaps.
It never hurts to prepare. I would begin the application process. There are not a lot of beds in facilities that are "Medicaid beds" (a facility will have a set number, usually people that have been private pay then have exhausted funds and become Medicaid eligible will be retained by the facility.) And most Assisted Living will not accept Medicaid it would be Long Term Care facility aka Skilled Nursing facility that would accept Medicaid. If dad is a Veteran it is possible that the VA could help.
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Are you considering a move to a nursing home for both of them at the same time? Or one will stay at home while other goes to facility? If you think the placement is going to happen this year, there's no problem with applying anytime. Just be sure you have doctor information that shows they are NH medically eligible - documentation to support the need for NH care. Without it, your application will just be denied.
If you think dad will have to be placed first, Medicaid rules consider the other spouse still living in the home and will not remove all of the income from spouse - won't leave mom destitute. Two people considered where income is concerned, so if their income is low - he could possibly qualify easily. However should something happen to him, all the income still going to mom could make her ineligible because it might be too much for a one person situation.
Current income levels for 1 person is about $2300 per month. If they have more than this, this could be a situation where husb/wife might qualify for NH while both are alive with more income than that, but if dad died and mom still had same amount of income (say $2500) - she would not be eligible for medicaid NH bed.
"Federal law bars the state Medicaid program from paying for the cost of room and board in assisted living. Waiver participants, or their families, are expected to pay for this portion of the monthly fee."
Room and board is the biggest part of the cost! It appears Medicaid only covers any "medical" necessities. I knew that AL room and board was NOT deductible on Federal taxes, but MC is. My mother was beyond AL by the time we needed to move her, so she's been mostly tax free for the 4 years she was in MC. Facility costs and many supplies (briefs, wipes, bed pads) WERE deductible.
Even when NHs are required for the care, there are limited openings. But one needs to qualify for NH care as well, so there's that issue. Generally dementia alone isn't enough. It never hurts to ask though, so start asking! Now is the time to prepare.
Being very low income, they might qualify for limited in-home care. If there is a Medicaid number you can call to discuss all your questions and concerns, start there. If not or they aren't helpful, you might want to seek out EC attys who offer an initial free consult. Have all info ready for that limited visit: income, expenses, disabilities/needs, etc.
Some paid in home care will be helpful. If possible, they care hire additional help with their own income. If family members can provide some assistance as well, they can remain in their own place for now, while you sort out the rest.
It would be good, as someone suggested, to have a plan in place in the event that either has a medical emergency and the other needs care/oversight. It is best to at least start exploring and planning for the future, rather than waiting for the inevitable emergencies to happen! Be aware of all financials and medical needs, documenting changes and keeping tabs on updates to social programs. If they can get the latest big bill passed, there are funds allocated to provide more assistance for elders and caregivers. It won't magically cure the elder care crisis, but every little bit helps!
If possible, ping your Reps and Senators. You can read about the issues and find a link to locate your state reps in my post:
https://www.agingcare.com/discussions/suggestion-to-become-active-in-promoting-caregiver-help-not-a-question-463299.htm?orderby=newest
We have a LARGE group of people on this forum who are all in the Dementia Titanic - WE need to let THEM know where the needs are and how bad the situation really is. If WE don't let them know, they can continue to bury their heads in the sand. Rattle the cages people!!! WE the people need to speak up!
If they do not qualify for Medicaid now, you will need to apply when their situation changes and they do qualify.
Medicaid will not save paperwork for a "time when they may need this".
in the mean time, see if you have a local senior “Meals on Wheels” program that will deliver lunch to your parents. Take pressure off of yourself and your mom wherever possible
Could either of them live safely alone if the other had a health crises & hospitalised?
Having an emergency plan for that scenario may be a good idea too.
But at any rate, the person needs to qualify for Medicaid first. It can take time to gather together all of the necessary documents, complete them, file them, wait for approval (or not), etc.
Check your parents county for Agency on Agency (may have a different name depending on where they live) and check with them for resources that Medicaid can offer them either now or in the future.
I agree you probably need to get the documentation together now for medicaid. It's a lot of work getting all the required documentation.
ALSO, was either parent in the military and have veteran's status? If so get the veteran signed up with VA - they have a program called Aid and Attendance where the veteran gets monthly payments; there is also benefits available for a surviving spouse. I glanced over Aid and Attendance for dad but income was too high i believe, but I did enroll him for VA medical benefits - still used his regular PCP, but did get his hearing aids for him through the VA for only a $60 copayment and free HA batteries for his lifetime.
It is excellent you are planning now for their future and I wish you luck in finding resources for them now. Good luck
You may not be able to apply for Medicaid in advance. My state allows 90 days from filing application to placing the recipient. In that time you spend down any money, get all info requested and line up a place for you LOs. You need to go to your County Social Service Office and talk to a Medicaid caseworker.
How bad is Dad? Maybe a LTC would be good for him with Medicaid paying for his care. Mom would become the Community spouse being able to stay in the home and have a car. She will get enough from their monthly income to live on. Maybe thru Medicaid in home you could get help for Mom. Without the care of Dad she may be better.
Most places have long waitlists, you cannot wait until you need the service to apply. So the sooner you start getting things ready, the easier it will be.
I think you want to apply as soon as possible. There are waiting lists in Ohio for Assisted Living Medicaid waivers.
"Federal law bars the state Medicaid program from paying for the cost of room and board in assisted living. Waiver participants, or their families, are expected to pay for this portion of the monthly fee."
This is somewhat in line with what is allowable for deductible expenses when filing taxes. The "medical" part of care in AL is deductible, the room and board is not. Since this statement clearly says Federal, then it likely applies to any state that has waivers for AL.
MC is fully deductible on Federal taxes. My mother was pretty much tax free for the last few years of her life. Her pension and SS only covered about 1/2 the cost, so I would feed enough trust funds into her account to cover the remainder of that cost and have sufficient left over to provide supplies and any extras. This meant no excess income, so the cost of MC and medical "necessities" such a briefs, wipes, etc offset all the "income."
That said, it won't hurt to apply anyway. Even if they can't afford the AL cost and can't qualify for SNF, they *might* qualify for some in-home assistance. My understanding is this is never 24/7, the hours are limited, but ANY help Medicaid provides leaves other income to fill in some of the gaps.
There are not a lot of beds in facilities that are "Medicaid beds" (a facility will have a set number, usually people that have been private pay then have exhausted funds and become Medicaid eligible will be retained by the facility.)
And most Assisted Living will not accept Medicaid it would be Long Term Care facility aka Skilled Nursing facility that would accept Medicaid.
If dad is a Veteran it is possible that the VA could help.