Our mother will run out of funds to pay for assisted living within the year. I recently spoke with a Medicaid specialist from the county where my mother lives.
Although we were going to apply for long-term care under Medicaid, I was told to apply for a Medicaid waiver first. It seems there may be more options for those who are eligible. Our mother is not a good fit for home-based care.
It was always my understanding that Medicaid will not pay for AL. However, I was told by the specialist that some smaller ALs may accept Medicaid. Does anyone have experience with Medicaid Waiver and Medicaid for LTC? At what point did you wait to apply for either one?
If you wait until her money is spent, it would be a miracle that an opening at a facility happens at the same time.
Your Waiver programs are probably going to be different kinds of assistance she would get if she stayed home. Unlikely enough one-on-one care to cover a lot of hours per week. Ex: Maybe someone comes to clean and bathe her and the caretaker is allowed 6 hours a week for those tasks.
I never trust information from anyone other than the direct source, or "straight from the horse's mouth". Others who are well-intentioned can give misinformation.
What I'm saying is, when you go through the Medicaid application process, don't do it online, but by phone or in-person meeting with a Medicaid worker, who can give guidance on the plan which will best fit for your mother's needs.
While it is true some AL's may not accept Medicaid, and you may not find an AL in her town which does accept Medicaid, you can ask the admissions director of the care home where she currently resides. Tell them that she is running out of money and that you plan on applying for Medicaid. Ask if she will be able to stay where she is, or if they will kick her out.
You will want to find a suitable care home that accepts medicaid BEFORE that happens.
As to your question, I do have experience with a Medicaid Waiver and LTC. And as many times as the medicaid worker has tried to explain the difference to me, I still don't clearly understand. That's why I suggest you let them guide you as to what services to apply for. They know. This is their job. Trust their judgement and just go with it.
Oh, and I did not wait at all. at the time when my husband had his stroke, he had already been unable to work regularly, and we were struggling to get by on my meager income, with no savings, and a pile of unpaid medical bills. A social worker met with us in the hospital, and again when he was transferred to a nursing home. She was very helpful and let me know that I could be paid to care for him at home, which was the best option for us. His behavior got him kicked out of the nursing home, and he required 24 hour care at home. I would not have been able to sustain long-term going to work every day, while counting on a caregiver to come to the house for that 10 hour period, then come home after a long day of work to care for him myself overnight. I would end up compromising his care and/or my job performance.
That was 10 years ago when I made the decision to quit my job and stay home with him as his full time caregiver. This unexpected journey has had its ups and downs, and has been filled with frustrations! I had thought about starting a blog, or a vlog, to share tips and information with others struggling through this. But, I didn't know how to do that. I am so glad I found this forum for caregivers to share their questions and experiences with others!
You will still need to do work and gather documentation but the knowledge an attorney provides is priceless The expense should be paid from your LO and is an allowable expense that will not be penalized by Medicaid.
State matters. Why? when Medicare & Medicaid placed into law back in 1960s, Medicare 100% Federal and Medicaid was dedicated funding Fed / State based on census data for the population a program could serve. # of advanced elderly needing a NH kinda small. Really till 1990#s AL & MC weren’t very commonplace. This really changed 1990s as so many of entering a NH still good on their ADLs, good physically but not competent and cognitive. So these folks not really truly meeting LTC Medicaid “at need” medically requirement for NH/SNf but totally impoverished so “at need” financially under LTC Medicaid rules. AL + MC fitted that population. & most MC are licensed under AL, so cost less for staffing (as opposed to NH which is skilled nursing under Medicare / federal regulations). States can ask the Feds for a shifting of their $ & it’s Federal $ for any program to go for funding to another program that also serves the same group. It’s done via a waiver. Voila! Some LTC Medicaid funding shifted to waivers!
Sticky with waivers is they are NOT DEDICATED funding - like NH LTC Medicaid - but instead run on a 3-5 yr platform with metrics + refilling to be done & over that period of time there might be another program that competes for that waiver $ (like PACE). For a provider -AL or a MC - there is uncertainty that their waiver will be for-sure $ to them for years and years, so if they can fill those beds with private pay, then why bother participating. For many States, staffing requirements plus low AL/MC interested = no waivers done. Often Waivers done in teeny #s…. which in turn created the 1-2 yr private pay waiting list that many AL/MC do OR the waiver bed is pretty well used exclusively for those who are 100% NH/SNF ready but are waiting for an open bed in an adjacent AL. (My moms tiered facility - IL, AL, NH- did this and its few waiver beds were all existing long time AL residents just waiting for someone to die on the NH side so they could move to the NH on LTC Medicaid; staff of the NH coordinated care; from a planning perspective, this was excellent but for family’s with some expectation their elder would get a AL waiver that really wasn’t going to happen).
It sounds like your State does waivers. If so, then it’s on you to find out where the AL or MC are that accept a waiver and if there is likely to be a waiting list with a private pay period before getting a waiver beds or if a waiver bed is readily available.
On application filing, this too is State dependent. For the ones we did (LA & TX) both had the applicant actually a resident in the facility. They filed the day they became a resident (not a rehab patient), were there under “Medicaid Pending” status (2-5 months application processing) and doing a Share of Cost of almost all their monthly income as a required copay to the facilities. Other States allow the application to be filed 1-3 months in advance of admission. Ask at the places you find, just how the Waiver application or the LTC application is handled. Often they will give you a sheet detailing all the items required to accompany the application. If it wants 5 yrs of banking, then you can start on that gathering now.
Personally my take is IF the elder could AT ALL be ok to medically “at need” for care in a NH/SNF, look to find a NH to place them in and you as POA do the spend down & LTC Medicaid application for them. Realistically, they eventually will get to the point of needing higher level of care than AL / MC & your back again having to find a SNF/NH and do an application on a family member who is even more frail.
Best of luck in your quest!
Here in MN, my MIL had part of her AL paid for through the county's Elder Waiver program. Once she was assessed as needing LTC then we applied for Medicaid for her. Medicaid across the board usually takes 3 months for approval (or denial) once you submit all required and current information and "proofs", including recent medical bills. So at about 5 months before she runs out of money I would apply.
You can download the Medicaid app for her home state and look at it now to see what info you'll need to supply them. It's not rocket science. If she needs Medicaid then this means she has no assets and almost $0 savings, only SS income. If she gets a small pension this could put a monkey wrench into things, but then you should consult with a Medicaid Planner for her home state (or an elder law attorney with a lot of Medicaid experience/knowlege) to discuss options preemptively.