Question for those experienced in NY Medicaid.

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Basictakes99 Asked July 2023

Question for those experienced in NY Medicaid.

Hey, been working with my wife to get Medicaid coverage, she meets the requirements that is covered. However, we have been told she does not meet the medical requirements. Her nursing assessment shows she is capable of completing her ADL and IADL tasks albeit with some prompting and or queuing.

The lack of physical need unfortunately means she is not suitable for assistance through medicaid. They did point us to a waiver but we are told the wait list is long for that program.

I am slightly confused, generally it seems for dementia it is not safe to leave them home even in early stages, yet we are being told by Medicaid safety and supervision are not covered. Isn't that some of the primary reasons People seek help when caring for dementia?

So at this point is it just a wait and see what happens?

Alzheimer's & Dementia Financial Planning Medicaid Paying for Care

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score 1 · Answer 1

You understand that early dementia is not a reason for 24/7 supervision right?

My 92 year old friend needs prompting on occasion to finish a task but, by no means does she require supervision as you state your MIL does.

Could this be a sign that she is manipulating the situation a bit or that she doesn't really need a elder sitter? It would make me question what is really going on in your situation.

Helpful Answer (1)

We were told things can go wrong at anytime with dementia, and constant supervision is pretty much the only way to mitigate potential issues.

When she went to her old childhood apartment and no idea where she went. We called the police and we got chewed out by the cops to prevent the "wandering" someone has to be present.

So that in itself means she needs someone around

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score 0 · Answer 2

Because you are taking care of her and providing supervised help, the State is not going to step in and provide in home care. If she needed skilled nursing, then it seems Medicaid may be available for in home care for her. That is what I'm gathering is what is going on here? I'm not sure how to advise you, it seems like a tough spot to extricate from. I know in my case, I couldn't afford to pay in home caregivers, but I also had to work, so my father was left alone for 8-10 hours a day. The SW knew that it was unsafe, so they placed him in a facility. The facility was the best thing for him by the way because he enjoyed being around other people and was able to socialize. There are some fairly high functioning residents in some SNF's. I also know of other people who were removed from their homes because of neglect or lack of care. In your case though, you are paying for the help. This could go on indefinitely. I don't know the answer. You could place her in memory care, but then you'd have to pay for that too. If you stopped paying, would it be considered abandoning her? It may be beneficial for you to talk to a really good elder law attorney, explain fully the financial situation and how you are paying and what would be the best way to go forward for both you and MIL, both legally and financially.

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Being as my wife is her POA, and brought her into our home we have a responsibility to her. My wife said that this was going to be a wasted effort, guess she was right.

I will speak with a lawyer and keep looking for a solution. This was the compromise we came up in trying to meet in the middle. I do not want to funding all of the care, she does not want her placed. So the idea was to get Medicaid to cover something and I would cover the rest.

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score 0 · Answer 3

It sounds like MIL is Memory Care ready, but not Nursing Home ready. Since MIL is being well taken care of now by family, the State is not going to take any action to place her in a MC facility. If she were on her own with no one taking care of her, she likely would get placement. I would still get her on that waiting list though.

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We were told that MC through Medicaid one still needs to meet the medical requirements of having a skilled medical need. We are not looking for placement at this time, just some assistance at home.

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score 2 · Answer 4

Who was present during the assessment?

Was someone being "helpful" as nd therefore MIL looks more capable?

Get on the waiting list for waivers. Right away. You never know.

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Sorry by she I mean my MIL. My wife was present, during the nursing assessment because it was done remotely.

Yeah we started the wavier process we did the paperwork waiting for the list of care coordinators so we can call around and pick one.

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Question for those experienced in NY Medicaid.

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