I have a call in to an elder atty, but checking to see if anyone has used this in MA? It doesn't appear to be available in MA, rather all income is turned over to the program for private pay except an allowance.
I hope that Igloo is around to discuss a bit about PACE rules with you.
I can only say that I have seen her discuss them here with others, and the long explanations are so very complicated that I cannot fathom even the answers themselves. Often I see Igloo end her explanations with the fact that the rules are so many, so varied, so dependent on state's individual decisions that it just isn't DIY anymore.
I am glad, therefore, that you are seeking help to get the right information for your area. I would think such programs, given their complexities, would have counselors and advisors; I surely would call and try to reach one.
Did an epistle to another ? of hers couple of days ago.
in my not an atty opinion, what makes Miller Trusts work easily for those filing for LTC Medicaid for NH (in a State that allows for Miller) is that the Miller becomes the new owner of the too high income problem and the Miller pays all that $ to the NH directly. Easy! Remember for LTC Medicaid NH residents, all income $… whether SS retirement income, pension, annuity in payout mode, $ placed into a Miller… it’s all $ paid to NH every month as LTC Medicaid requires Share of Cost paid. All paid to the NH less their States teeny personal allowance, which most have at $50/$75 a mo. As long as at or under their personal LTC Medicaid limits - most States have it at $2740 income and 2K assets - they are ok for NH LTC Medicaid. Miller owns whatever pays too much so it doesn’t count for the personal anymore. Voila! & Happiness!
But PACE doesn’t do this. PACE has a capitation rate paid by the Feds and no Share of Costs, no copays, no deductible due because PACE geared to cover all services w/enrollees being on Medicare, PACE center Medicare Part D drug program, Medicaid as health insurance and needs based community Medicaid program. PACE set up 2 b all inclusive with no billing. Enrollees get one (1) new single # for all & any services. So you have to qualify for Medicare and the Medicaids to have the above system work.
CMS - the federal agency for Medicare & Medicaid - pays PACE center / organization a mo capitation rate for each enrollee.
I'm just not sure how Miller could work for this to get a Medicaid program low income requirement done as it’s more of a pass through to pay $ via its new ownership of all the excess $ & paid as a Share of Cost each month to a facility. PACE has no Share of Cost. Will be an interesting atty answer. Hope we get an update.
If you do not qualify for Medicaid but have Medicare, PACE has to allow for enrollment (if openings) but will be at a State set monthly flat rate PREMIUM to cover the long term benefits paid by PACE and an additional PREMIUM for Medicare Part D. Seems to be in the 4K - 7K range, still is less than private pay in a NH.
They have to be at need for nursing home level of care (certified as however done by your State) to be enrolled at a PACE and have to be able to live safely in their community… which realistically means someone is at their home / apt so on premises doing oversight & care needed all non PACE time. I’d be concerned that if the OPs mom & Dad are both “at need”, unless she or another fam lives with them there may not be enough in person oversight to provide the “live safely in the community” requirement. Unless they pay for in home services as well.
https://www.familyassets.com/resources/government-resources/maine-nursing-homes-medicaid-rules-information/
I can only say that I have seen her discuss them here with others, and the long explanations are so very complicated that I cannot fathom even the answers themselves.
Often I see Igloo end her explanations with the fact that the rules are so many, so varied, so dependent on state's individual decisions that it just isn't DIY anymore.
I am glad, therefore, that you are seeking help to get the right information for your area.
I would think such programs, given their complexities, would have counselors and advisors; I surely would call and try to reach one.
in my not an atty opinion, what makes Miller Trusts work easily for those filing for LTC Medicaid for NH (in a State that allows for Miller) is that the Miller becomes the new owner of the too high income problem and the Miller pays all that $ to the NH directly. Easy! Remember for LTC Medicaid NH residents, all income $… whether SS retirement income, pension, annuity in payout mode, $ placed into a Miller… it’s all $ paid to NH every month as LTC Medicaid requires Share of Cost paid. All paid to the NH less their States teeny personal allowance, which most have at $50/$75 a mo. As long as at or under their personal LTC Medicaid limits - most States have it at $2740 income and 2K assets - they are ok for NH LTC Medicaid. Miller owns whatever pays too much so it doesn’t count for the personal anymore. Voila! & Happiness!
But PACE doesn’t do this. PACE has a capitation rate paid by the Feds and no Share of Costs, no copays, no deductible due because PACE geared to cover all services w/enrollees being on Medicare, PACE center Medicare Part D drug program, Medicaid as health insurance and needs based community Medicaid program. PACE set up 2 b all inclusive with no billing. Enrollees get one (1) new single # for all & any services. So you have to qualify for Medicare and the Medicaids to have the above system work.
CMS - the federal agency for Medicare & Medicaid - pays PACE center / organization a mo capitation rate for each enrollee.
I'm just not sure how Miller could work for this to get a Medicaid program low income requirement done as it’s more of a pass through to pay $ via its new ownership of all the excess $ & paid as a Share of Cost each month to a facility. PACE has no Share of Cost. Will be an interesting atty answer. Hope we get an update.
If you do not qualify for Medicaid but have Medicare, PACE has to allow for enrollment (if openings) but will be at a State set monthly flat rate PREMIUM to cover the long term benefits paid by PACE and an additional PREMIUM for Medicare Part D. Seems to be in the 4K - 7K range, still is less than private pay in a NH.
They have to be at need for nursing home level of care (certified as however done by your State) to be enrolled at a PACE and have to be able to live safely in their community… which realistically means someone is at their home / apt so on premises doing oversight & care needed all non PACE time.
I’d be concerned that if the OPs mom & Dad are both “at need”, unless she or another fam lives with them there may not be enough in person oversight to provide the “live safely in the community” requirement. Unless they pay for in home services as well.