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Will Medicaid or Medicare help pay for my mother's long-term care?

6 answers | Last updated: Sep 24, 2014
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Q
A fellow caregiver asked...
My 70-year-old mother had a stroke last weekend. She's on a fixed income with few assets and is probably going to need long-term rehabilitation and care. I expect that she'll eventually need to move to a nursing home. How much of these expenses can I expect Medicare and Medicaid to cover?
 

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Barbara Steinberg is the CEO and founder of BLS Eldercare Financial Solutions, which specializes in helping families pay for long-term care for their...
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answered...

Medicare and Medicaid serve two very different purposes: Medicare is similar to regular health insurance, providing coverage to people over the age of 65. Medicaid, on the other hand, is See also:
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basic health insurance for people older than 65 who have limited income and assets.

If your mother requires skilled care, Medicare will cover rehabilitation and nursing home care. However, it won't cover custodial or intermediary care. For example, it won't cover an at-home health aide unless one is determined to be medically required.

To get Medicare coverage for nursing home or rehab expenses, your mother will have to meet certain requirements: She must move to a nursing home within 30 days of her hospitalization, and she must have initially stayed in the hospital for at least three or more days.

If she meets those qualifications, Medicare will cover 100 days in a nursing home. The first 20 days are covered in full with a $124 per day co-payment for the next 80 days.

As for Medicaid, it does cover custodial and nursing home care -- for those who are in financial need. This means that your mother would have to spend down her assets to roughly $2,000 (depending on the state she lives in) before she could qualify for the program. Once she qualified, the cost of a Medicaid-approved nursing facility would be covered. However, whatever income she received would automatically go first to cover the cost of the nursing home.

Unfortunately, just because a facility is Medicaid-approved doesn't mean that it will meet with the approval of you and your mother: Medicaid-approved nursing homes aren't always the best option in terms of quality care.

 

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An anonymous caregiver answered...

This was helpful but also very sad. For many caregiver's there is no place to go.

 

75% helpful
ShannonM answered...

Great summary above. Most patients will get some initial Medicare coverage for therapy, etc. after having a stroke (as per the answer above). If your Mom has a Medicare supplemental policy, that typically covers the mentioned copay for days 21-100. And, be aware, when discussing days provided...we often hear people say "What about my 20 days, or 100 days? I thought I get that."...isn't automatic, patient must have the need for skilled care, be showing progress in therapy, etc. for it to be considered medically necessary and not custodial. Here's a couple articles you may find helpful: http://www.agingwisely.com/long-term-care-and-medicaid/ & http://www.agingwisely.com/2011-medicare-fact-sheet/.

If your Mom has limited assets and it appears she will need long term care in a facility after rehab., you may wish to talk with a board certified elder law attorney about Medicaid as a payment option, if planning needs to be done (www.naela.org is one resource). You should begin to talk about these issues w/the social worker at the rehab. immediately and start your research process, i.e. looking in to options. Another resource that can be very helpful is a geriatric care manager: www.caremanager.org--though you'll have to pay a fee, you can get expertise on what the options are like in your community, an assessment of what might be anticipated in terms of care needs and referral to resources like a good elder law attorney in your area and recommendations on facilities and providers.

 

75% helpful
CatSumrs answered...

Having my dad in a so called rehab at the moment, I have to say that Medicad should be ashamed of what they dictate to these patients. My dad has suffered with prostate cancer for over 11 1/2 years now. Last month he suffered a stroke while driving to church. We are thankful he was in the parking lot at the time and no one was injured. He went to the hospital but 2 1/2 days later my mother walked into his hospital room and was told my dad was being moved to a rehab center. No one at the hospital told us anything the night before, just found his clothes stuffed into a plastic bag. They didn't even inquire as to where we might like him to go.They shoved this PT down his throat3 times a day. He could walk and talk, eat, swallow, what was affected was his left eye, his sight was damaged, along with some of his memories. We asked from day one that an eye doctor be called in to examine his eyes, that is a very important thing to do after a stroke.. 3 1/2 weeks later they tell us that my father is being released because we didn't make an eye appointment for my dad! I got him an appointment with a specialist the very next day. He got a great exam and was told he may benefit from prism glasses, which are being made for him as we speak. Now this rehab says because the glasses will take a week, my dad still has to go. They keep citing its Medicad's rule... Sorry I don't buy that for one moment but if it is true, shame on them. I may also add that my dad's cancer treatments were denied while he was there because we were told Medicare would not pay. So I guess the only way to survive in a "rehab" is to be healthy before you enter... My dad didn't require chemo or anything, he got a hormone injection every 4 months, thats it. I guess the good doctor couldn't be bothered to make the 10 minute visit. There is no help for the patient and yes as one pointed out before me, no help for the caregivers. As I spoke to my dad one day, he said two things: he never thought he'd live to see the day when medicine and the care, would become so cold. The second thing was, he prays every night that they "good lord takes hime as he sleeps".. With that said we have decided that we are taking dad home. We will go back in time as they did with our grandparents, we will take care of our own... These cancer doctors made so many promises to my dad,all of which they have turned their backs on. I hope they at leat keep one and that being keeping him pain free.

 

KarenLorenzo answered...

Great insight on how medicare and medicaid will help pay for long term care expenses. However, as stated in the answer above, medicare is only good for 100 days and while medicaid covers custodial/personal care, you will not get the quality care when and where you need it, and medicaid also have an asset recovery procedure to pay for long term care expenses incurred as explained in infolongtermcare. If you have long term care insurance, it cover the expenses based on your needs and preference, but you should have purchased it prior to the onset of any illness or disabilities.

 

 
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