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lfm5252 Asked March 30, 2024

Funding for rehab after Medicare runs out?

My husband has just entered rehab after surviving a cardiac arrest. He has had multiple issues in the past couple of years and had a few other rehab stays.
I was just told by the facility that he had used up his 100 days of lifetime that Medicare gives you for rehab. They said that they would apply for Medicaid for him but I know our income is too high.
we do not have any savings and depend on his pension and my social security to pay our monthly bills. There is no possible way we could pay out of pocket for this. I know there is a trust that can be applied for for my husband but it would leave us without enough money to even pay rent not to mention food, my medical bills, etc.
Has anyone been in this situation?
Are there other alternatives? There is no way he could be cared for at home right now.
I am going to call Legal Aid next week.
I had a free consultation with an elder law attorney before this but to continue with him would be cost prohibitive.
Thank you.

MACinCT Apr 3, 2024
I am surprised that you are at 100 days and you are asking now. Did the social workers between day 21 and 100 inform you to get this Medicaid process started? Well now you are hearing from us to see a lawyer. Bills will start to come in. Do nothing and rehab will petition probate court for the state to appoint a guardian and take this out of your hands. If you want to protect your assets, see a lawyer now to learn about your rights.

BarbBrooklyn Apr 3, 2024
You NEED to do a Miller Trust; he can be admitted to the NH as a long term resident "Medicaid Pending".

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ravensdottir Apr 3, 2024
Bad idea to let the facility apply for Medicaid; you'd have no way of seeing what's being charged and how accurate the information is that they put on the application.

You might get some insight from an article on this site, “Spending Down” for Medicaid: One Caregiver’s Personal Journey.

MACinCT Mar 30, 2024
HAve you seen an elder attorney for division of assets and a Miller trust?
lfm5252 Apr 2, 2024
I had a free consultation with an elder care lawyer a while back. He did talk about the Miller Trust and I spoke to someone about it. I just think it would take too long as this is an urgent matter. I will try Legal Aid.
Also, this is not cardiac rehab. He had a cardiac arrest after becoming septic.
He did not have a heart attack. He needs rehab for lack of mobility after being in the hospital for so long. He also has had an above the knee amputation.
AlvaDeer Mar 30, 2024
I think that there is some misunderstanding. It isn't lifetime for the 100 days. Rather it renews. However, if there are multiple stays there are certain requirements. For instance a three day hospital stay is required to qualify to inpatient rehab of any kind. And there has to be a certain number of days between illnesses requiring rehab after an initial illness.
So that, for instance, a person may have rehab after a stroke and stay in hospital for 3 days then rehab for 60 more days. This counts as one benefit "period" in the eyes of Medicare. Now if they get, say, a stroke in another few months and again require rehab there may be problems in coverage.

Medicare pays for "benefit period" which I think is 90 days starting with first day of hospitalization. Then you start to tap into "lifetime reserve" number of days that qualify for rehab payment by medicare. How many that is I don't know and once they are gone I have no idea what happens either!

Much may also depend on whether there is an advantage program in place or other supplemental insurance, and you should check with the carrier your loved one has for supplemental insurance or advantage plan.

If there is no coverage for cardiac rehab, do understand that most rehab for cardiac issues is not inpatient care. There has to be something other going on to require in facility care.

This all gets very complicated.
I would call Medicare at 1 800 Medicare and check on coverage. You will wait a long time on the phone but they are often very helpful once you get them.
I wish you best of luck. I think without coverage this is virtually unaffordable.

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