What is the technical name for a person who manages a LO’s transition onto Medicaid?

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WearyJanie Asked December 19, 2023

What is the technical name for a person who manages a LO’s transition onto Medicaid?

I do a lot of reading on this forum, and in an older post that I cannot find again (!) someone referenced a professional who helped them navigate the ins and outs of Medicaid. This was apparently someone who was something more than just a social worker.
My question is whether it would be worthwhile to hire someone like this if I can find one, or if the social workers who work for the state would be just as good. 
If you did hire someone outside of the system, can you give me a ballpark of how much it cost? Was it hundreds of dollars, or thousands? I would be willing to pay some, but don’t have unlimited funds, of course.
I will write a longer post later that details my situation, but I have a sister who is currently living in an AL facility. This facility allows you to transition to a Medicaid bed after being a self-pay for two years. She has 15 months to go before that two-year period is done. She is on SSDI because of physical problems, but recently some other problems are developing. It looks like she is beginning to have seizure activity, and is falling on a regular basis. She is extremely overweight, and even if she is not injured, she is not able to get herself up off the floor. So there are lots and lots of visits from aids to just pick her up off the floor. 
The facility is of course very concerned about this, and said they need to move her to a higher care level. With recent inheritance money, she would have been just able to make the two-year required self-pay. With the additional care level, she will be a couple of months short.
So, at this time it looks like she will have to be put into a Medicaid only facility. While I don’t want to jump to conclusions, the seizure activity makes it look like it will eventually have to be a nursing home, possibly sooner than later.
So all of this is now officially beyond my pay grade. To make things worse, while my sister is not incompetent of mind, she is very childish in her thinking and has very poor judgment. I just found that she has a MasterCard bill of $6000, apparently spent over just the last several months. All of the purchases are from Amazon, but I don’t know what for. I believe they are boxes and boxes of personal care items. Again, her judgment is beginning to go.
I am not interested in becoming her power of attorney for either her finances or medical. I just did that with my mother, and while it might be workable with someone who would cooperate, my sister would not. We talk about things that need to be done, and budgets that need to be kept, and she smiles and nods and doesn’t do any of it. I am several states away as well. I do not want full guardianship. While she is a good and mild person, but has a history of abusing pain medication. 
Well, that was longer than I intended! Anyway, I think it is time for me to get professionals involved. I don’t know if I just allow social workers to guide this process, as there is no money, or if it is worthwhile to get a paid professional involved. I would love to hear your experiences.
I have a good elder care attorney, who is skilled with the laws and finances, I do not think placement and such are in his area of expertise.

Care Decisions Cognitive Decline Long-distance Caregiving Medicaid Paying for Care

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score 1 · Answer 1

This is good information! This gives me a roadmap of where to start. I have sent an email to my attorney, and I’m hoping he might have names of good people he has worked with. We have been so fortunate to deal with many high-quality social workers in my mother’s situation (she passed away recently after being placed in AL). But as said above, that can be hit and miss.

I will post about this as I go, and as I find out more information. Perhaps helpful to others, just as so many of the older posts on this forum have been helpful to me!

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Good luck Weary. Thinking of you.

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score 0 · Answer 2

An elder law attorney can certainly help you with this. You say you have one. Give a call.

You might also try to communicate with a paid professional at The Independent Board Certified Patient Advocate at www.NPAF.org.

Call Medicaid itself at 1 -800- Medicare and ask for a Medicaid consultant for your state/contact info who may refer you to your state support folk.

For an aging life professional try www.aginglife.org and ask. I don't know their fees.

Communicate with the only Fiduciary Assn I know (California) at www.PFAC-pro.org and ask if California assn can guide you to a professional Fiduciary in your own state who can help in Medicaid applications. A Licensed Fiduciary costs anywhere from 90.00 to 120.00 an hour. Your Elder Law Attorney could likely guide you to a Fiduciary as well as they deal with needing them in the Court system.

Know that some nursing homes themselves will help you apply for Medicaid. You would need access to all assets information.

Call any senior centers in your area and ask for guidance. Call APS and ask for guidance. This is a time when you will be on the phone for days seeking where to go for help and what to do and I wish you the very best of luck. When one place doesn't have the answer another can guide you. Try Alz.org also, and AARP.

If you find the right kind of help anywhere here DO come back and let us know? Your input could be invaluable to others. I sure do wish you the best of luck.

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You can see if you can get a CELA (certified elder law attorney) to do an on-site visit so you don't have to bring your sister anywhere. At this appointment, the attorney would/should interview her privately to see if she has any capacity to create PoA documents. The bar is pretty low, so don't make any assumptions.

If she doesn't have capacity, this means no one can be her PoA since that ship has sailed. Someone can privately pursue guardianship, but this is expensive and also a responsibility that such person needs to think long and hard about taking on.

Or, she is allowed to become a ward of the county. She will still go onto Medicaid anyway it seems, and if she doesn't have assets to manage then the guardian will take care of all that and medical decision-making.

There is such a person as a Medicaid Planner (for her state of residence). Sometimes CELAs know something about Medicaid, sometimes an estate planner does, and as far as social workers, very hit or miss as to getting a knowledgeable person.

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What is the technical name for a person who manages a LO’s transition onto Medicaid?

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