How can my father qualify for Medicaid in order to get the in-home care he needs?
My parents are 88 and 89 with limited resources. Dad needs homecare; he is unable to walk, bathe, care for his meals, etc. but the resources aren't there. They have approximately $125,000 and they live off of the dividends and dad's Social Security. We have thought of spousal refusal where my dad transfers all assets to Mom and can now qualify for Medicaid; however, Mom receives his Social Security and does not receive much of her own. I understand that by refusing to care for him she loses his Social Security and without that she will not be able to support herself. Any suggestions, as they want to remain in their rental apartment? They do not own their home.
Medicaid is a joint state-federal program. Although the general eligibility requirements are determined by federal law and regulations, the states are permitted to vary these eligibility requirements to some degree. The use of spousal refusal as a Medicaid planning technique varies greatly from state to state. However, The law also permits a "community spouse" who is not receiving Medicaid benefits to retain as much as $109,560 of their assets, not including the value of a home and still be eligible for Medicaid. You should consult an elder law attorney for more specific advice for your own particular state.
Unfortunately, although it is actually more cost effective to keep elders in their homes instead of paying for nursing home care, few states have very effective Medicaid programs that incorporate significant at-home care.
Fortunately, a Medicaid sponsored program that may be available in your parents' area that can be of help is PACE which is an acronym for Program of All-Inclusive Care for the Elderly. Pace provides care that elders require in order to remain in their homes. I suggest that you look into whether PACE services are being offered in your parents' area. You can go on the internet to see if there are any PACE providers near them.
Sorry you're parents are in such a difficult situation.
In addition to the community spouse protection mentioned above (spouse not applying for benefits may keep $109,560 in countable assets in 2009)income is also protected.
In this case, your mom is protected by the Minimum Monthly Maintenance Needs Allowance (MMMNA) of $1,822 per month in 2009. This means that she is entitled to keep her income AND THAT PORTION OF HER HUSBANDS INCOME THAT BRINGS HERS UP TO THE MMMNA and your father will still be eligible for Medicaid. The powers that be will actually establish and approve of a "diversion" of income from your father to your mother; however they must apply for it.
Also as mentioned, in many states there are Medicaid home and community based waiver and diversion services available that are particularly appropriate when their is a caregiver in the home.
Even if such services are not available, Medicaid is still extremely valuable in that if they qualify, your parents will, at the very least, save a lot of money on medical expenses.
As a "dual-eligible" receiving both Medicare and Medicaid your father's Part B Medicare premium will be paid, his Part D Rx premium will be subsidized, his Rx co-pays will go to about $1 and $5, and he will have no Rx "donut-hole" to contend with.
Is dad and/or mom a vet? He may be eligible for up to $1,945 per month in non-service connected disability pension benefits. Search "pension" at VA.gov and look for "aid and attendance".
Lastly, you absolutely must contact the local Area Agency on Aging to find out what assistance programs are available from your folk's city, county, and state that may or may not have financial need tests. They will also have info on the Medicaid programs mentioned above.
I work in this field everyday and in your family's case I do not believe that spousal refusal is the route to pursue.
One last thing, at 88 and 89, and particularly with dad's health the way it is, I would urge you to check out an assisted living residence for them.
In Florida, for instance, there is a Medicaid nursing home diversion program which will pay a stipend of about $1,000 per month towards the cost of assisted living. Add Social Security and it may actually be LESS expensive for them to live gracefully, safely, and be well cared for in a venue other than home. Particularly if they qualify for vet benefits, they will fine.
I would like to know if I have any legal recourse on behalf of my elder attorney who advised me that Dad could not qualify for any assistance, even though his only income was his SS of $650 per month. Dad owned his home in California, which was on the market, and owned a commercial lot. I was told the only way to fund Dad's care was to mortgage his home IN MY NAME and take out a personal loan IN MY NAME, that I could be repaid when the home sold. Well the home sold for 50% of it's value and only covered the mortgage I placed against it. There was not enough to reimburse me for my out of pocket expenses or my time. Dad has had multiple strokes and Alzheimer's disease. He is unalbe to stand for transfers. I was caring for him single handedly in my home, lfting over 200 pounds of dead weith over 10 times a day, toileting him and bathing him. He is totally dependant except for feeding himself. I have all but lost my business, and am left over 100K in debt due to supporting him on my life savings. I have since found out that he could have qualified for state assistance, owning the properties as long as they were on the market for sale. I am a single self supporting grandmother myself and this has now brought me to financial ruin. I am now forced to file for financial bankruptcy and my home is in foreclosure. Dad's private care has now amounted to over 1 million dollars, and my attorney fees alone have exceed $250,000. I was ordered to become his conservator and guardian, in CA at my expense and that order had to be followed in AZ. No one informed me it would cost my financial future. I have no outside friends due to the constant dealings with Dad's care for 5 yars now, and no where to turn. I have returned to my Real Estate business, but it must be rebuilt from the ground up. I live on commissions. I applied for a loan modification and my monthly payments were INCREASED by $200 per month, because I did not make any commissions until September of last year, when Dad finally qualified for state care. The bank averaged my commissions from 2 months (for the entire year) to substantiate the monthly increase. I do not know where to turn for assistance for me. I now fear I will be homeless in turn for taking care of Dad's needs. Is there any source for someone like me?
Medicaid is such an entangled issue as to what can and cannot be done, and what counts as income and assets, and varies state by state. It is also the Medicaid person and office that review the claim that can cause issues.
I paid an "estate preservationist", someone licensed (state of Florida) to give medicaid eligibility counseling. It was the best thing I could have paid for when getting my dad Medicaid qualified for the nursing home. Even then it took two years, multiple appeals, and arbitration (all handled by the counselor) before it got approved. Check out who is helping you before you pay. Ask how many cases they have gotten approved by Medicaid. Ask if they have ever had to appeal. Find out exactly what you are getting for their fee. Again, this type of counseling is aimed at getting the person Medicaid qualified.
I paid a lawyer who said he dealt with elder care issues and after $150 fee for 30 minutes he told me he had no experience filing Medicaid claims and actually gave me bad advice.
I even had several insurance agents trying to convince me that buying an annuity would help the asset issues, which what they were selling would not have in my state. Be careful.
I got the name of the estate preservationist through a local rehab/nursing home administrator. Since the nursing homes have to deal with getting patients qualified (if they take Medicaid patients) they usually have resources and might recommend someone.
I agree with the first answer you got. Keeping my dad at home may have been financially easier on my mom (at first glance) but she could not have taken care of him as well as the nursing home. And in the end, him at home would have cost more. My mother was 80 and not able to take care of my dad but that had absolutely no influence on the Medicaid decisions according to the local office.
Jeanette, I respectfully suggest that you rewrite you're question,there seems to be alot of superfluos information there that made it much harder to follow. I think you'll be much more likely to get your answer if you can take it down to like 1/3 to 1/2 as long as it is leave out some of the social aspects ect. Just my suggestion as I had trouble filtering out the relivant info.
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