Back in 2013, my mother Had To go to a nursing home after several fall injuries when Kaiser would not allow her back to our residence despite her protests to return home. She paid out her own funds with only a $1,700 SS and pension income for 7 months to Medicaid level. She used Medicaid's assistance for 11 months until she passed away. I am lucky as her surviving child to still live in the residence we purchased back in 1991.
My mother is 95, lives in assisted living. Her SS is $1,158.00 monthly and she gets an annuity payment of 151.13 monthly. She took an irrevocable annuity at age 88 , it was $27,000 . Her monthly room charge is #1,297.00, Himark ins. $35.50 monthly which comes to $1,332.50. This doesn't include her copays which we are paying and her hair, phone, Tv. would Medicaid pay her copays and assist in her insurance cost?
My mother is 93 years old and lives in an assisted living facility with my father who is 89. She suffers from Alzheimer's and it is progressing to the point that she may no longer be able to reside at her present facility. My parents have been paying the over $4000 a month for their apartment, but we must now look into skilled care for at least my mother. How can she qualify for Medicaid even if we do not include my father?
Why should you be eligible? This kind of thinking just angers me. YES you assets should pay for care until you have none! Medicaid is for people who have no assets. That is why it was developed. Stop asking other tax payers to pay.
I really don't know why everyone is complaining about paying for care. Yes you might have to sell an elderly parent's home, use their savings, etc. THAT'S WHAT IT'S FOR. Oh wait should I and other tax payers pay for the care? Medicaid was to help those without other resources. We had savings etc to prepare for things that might happen in old age, or emergencies. We didn't expect the government (meaning money from other tax payers to pay our bills.
I just found this webpage. Is there anywhere else to learn about the do's and don'ts about applying for Medicaid? I need to evaluate my parents current assets status to determine if they qualify or what steps to take ensure they qualify. I ran out of time for my mother as she is incurring medical costs due to liver failure at 66 and I have time for better plan for my dad-71 and healthy.
Me and my siblings were devastated to learn that we should not have accepted a $4000 gift from my mother last November. (Came to $16,000 for the 4 of us.) In addition, she gave $$ to my sister and her daughter who both needed cars. ($7 - 8,000.) Mom is in the rehab nursing home with severe COPD and is terminal now. The nursing home is $7000 per month, and with her pension and SSI checks, her income is $1,700 per month, so she can't stay there. the social worker says the "gifts" will stop her from qualifying for Medicaid so we have to bring her home and hopefully find home health care that can come in. She has about $10,000 in savings and checking combined, some life insurance policies that probably have a little cash value, and she owns her home outright. I wouldn't say she's rich, but one has to be destitute to get help, evidently. I guess we'll spend all Momma's money getting her help..there is the matter of heat, lights, and property taxes on her home to pay for too. What a heartbreaking nightmare as we prepare to let go of our dying mother.
My mom only has $1400.00 from SS to live on. She has depleted all her savings. I am paying out of my savings to a retirement community,. She is now to the point where she needs to be in a nursing home - but state funded . How would she get Medicaid to help w/ living expense.
ok i understand this a little better know that you have explain this to me . I have a sisiter that over her in LA. she's very sturburn. I want hr to have the best care best service. She don't want her to move back to lehigh, she said that would not be a good idea. I feel if she had family support she would be more mtoivated to do therpy and not lay there and give up because my siister don't see her but once a month. She very strong women and family is not supportive, I can visited her evrryday if she was closer to me. I work and sh's reitred and young. I'm the youngest of all.
latri - Medicare is not designed to pay for long term care services. Medicare is about paying for providers fees (MD, OT, PT) etc and for hospital and clinic services; there is also a prescription drug benefit for Medicare. You need to see what parts of Medicare, she has signed up for & this will be on her card.
It sounds like your elder went to rehab from a stroke, so she was discharged from the hospital to the rehab. I'm guessing the rehab is at a NH or other skilled facility. Under Medicare rules, she gets 21 days of Medicare for rehab and then after 21 days she will need to be "progressing" in her rehab in order for Medicare to pay at a reduced rate with the elder paying a co-pay (the amount varies, I think it's about $ 140 a day maximum co-pay allowed). If she is not progressing, Medicare must stop paying for care. Usually this is when family moved them from rehab status to permanent resident (& Medicaid Pending if they cant pay) so they can continue to stay at the facility if it's also a NH.
Now if, it looks like she will qualify for hospice, then the facility & her doctor can write the order for hospice to do an evaluation for their services. Hospice is a wonderful benefit of Medicare. BUT hospice does NOT pay for the costs of the room & board at the facility. Hospice - like all Medicare - pays for services and not for their room & board. That will need to be paid for either by private pay from her assets, or family pays or she applies for Medicaid (and someone will need to do her application & get her documents required for it). Try to speak to the social worker at the facility to help you understand how this works.
Ag - the shower chair is not considered "durable medical equipment" so not covered by Medicare. Durable is like wheelchairs, a hoist, specialized bed, a 3-in-1 bedside, etc and Medicare usually rents durable equipment through set Medicare vendors which they pay 80% and you pay 20%. Rental is maybe 12 - 18 months and then if they still need it, the equipment becomes your property. So if at month 20, the wheelchair needs repairs, it's your cost. Otherwise all goes back to the vendor.
Shower chairs are considered an item of convienience & not durable. MD gave you an Rx because some community based organization provide for safety items for low-income &/or elderly with a doctors note.
Medcare will they cancel your services, if you had a stroke and you are not improving. My god she's 78 years old. You just let her lay there and die and bring in hope hopice when sh'es not dead.
Great article and great comments from Igloo to Seaglass............Keep in mind two simple facts. 1) Medicaid is for the poor. 2) Medicaid is a state-funded program with some help from the feds. The thought of "spending down" assets five years prior to admittance into a Medicaid funded care is absolutely abhorrent to me.
Seaglass - really you have to do some type of advance planning to be able to have options on the best use of your assets. If your elder is at the point of NH admission, you just have few options. Really you need to speak with an attorney to see what could possibly work for your state's approach to Medicaid. There are Medicaid compliant annuitities out there. But they are few & far between which is probably due to the fact that the market is limited for them being profitable or popular. A Medicaid compliant one would basically have the state or the State's Medicaid program as the beneficiary. Most people aren't going to buy that type of product probably unless they have no choice…..like they have to change the beneficiary of the current one in order to go onto Medicaid. I'm not sure to what degree the different states do this, but often for these type of insurance product the % commission or fees are set by the state and there is pretty specific reporting required, so it's not very profitable for insurance companies to even do this type of product.
Yes, but then isn't the annuity money going to be counted as income? If it puts someone over the Medicaod income limit that would not be good, right? If this is tru, is there any other route to protect the assets and still be Medicaid eligible? Thank you.
babs - oh geez….if it is your dad's annuity, then he owns it and it is an asset that will have to be spent-down before Medicaid can pay. It is tied & ID'd to his SS # and it will show up so no way around not reporting it for Medicaid. I bet he did not realize what exactly he was buying or it's possible issues for Medicaid. If you give the $ to Sissy, it will be viewed as gifting and will incur a transfer penalty from Medicaid. It has to be used for anything OK for his "spend-down".
Annuities are an insurance product. A "deferred" annuity means no income tax on the interest until the annuity is paid. Pay out happens when the annuity expires or when funds are withdrawn as allowed by the contract or when the annuitant dies. There are drawbacks to them - as you are going to have to deal with - like they have a penalty for early withdrawal of funds; also tax issues too. I'd basically count on loosing 10% of the invested principal if you need to take all of the funds out before the maturity date - this could be a good amount of $ that is just gone. It will also take some time for all the paperwork to be done with the insurance company too and you will have to have your DPOA that clearly states you can do financial to get this going. Realize annuities have sales commissions which typically are high, when you are going through dad's stuff look to see how much was paid in commissions, it will likely make you want to scream or have a stiff drink or both.
The fact that Sissy is the beneficiary doesn't make any difference for Medicaid. She is not the beneficiary till dad dies and it would be a non-testamentary death benefit to Sissy (so it doesn't go through probate, and that probably is the hook that it was "sold" as…to bypass probate). But as dad is still with us, the deferred annuity is his asset that will have to be cashed-in and spent-down.
If 93 year old dad did this recently and he was diagnosed with dementia, I would file a complaint with your state dept of insurance and banking for elder abuse against the insurance salesman and the company who did the policy too. It will make you feel somewhat better to have complained when you realize that 10% or so of the annuity has gone "poof". Good luck and thank goodness you are there to take care of these things for your dad.
My 93 year old father has qualified for Medicaid. We went through all the spend down steps to qualify him. We have since discovered a flex. prem. deferred annuity that he took out for one of his daughters. It is in his name but she is the bene. Does this have to be cashed in and money given to bene?
AprilC - it seems you are using this forum to sell a product. If you want to do that you need to pay for advertising like the many, many other services & companies do. Otherwise it's rather inappropriate.
Yes, the elderly should apply for annuities in order to qualify for medicaid and still receive a monthly payment. I can assist seniors further with obtaining an annuity - call AAA of Michigan ACG
Judy - each NH can set it's own daily private pay room & board rate. Some NH charge $ 150.00 a day and others 1K a day. It all depends on the facility.
Now if the NH accepts Medicare & Medicaid, that means that they will accept whatever the payment is for Medicare billed services (this is usually for the rehab days @ the NH right after they get discharged from the hospital to a NH) and that they will accept whatever your state Medicaid program has set as it's daily reimbursement rate. Like for my mom in TX the Medicaid day rate is $ 145.00 a day (pitiful low too) while many east coast states are $ 400-600 a day. Medicare - which is federally run - is uniform in costs nationwide. Medicaid - which is a joint state & federal program - is run by the states so each state can determine what they pay for and won't pay for. If your elder is in a NH, you have to clearly understand how they are being billed and at what rate as there can be a HUGE gulf between private pay rates and Medicaid rates. Good luck.
I don't understand how the amount you state can work to pay nursing home expenses for 10 months.. My mom is paying out of pocket, and the price just for a bed is $425 per day. Paying out of pocket would cost $127,500 for 10 months. Please explain.
I'm afraid that my mom's savings is only going to pay for the retirement home she lives in for another year or two. Then she's totally out of money except for the $1300.00 in social security she gets monthly. She will need to go to a state funded home. How do I get her on Medicaid to help with this? If we wait until she only has $2000.00 left, how long does it take to qualify and to get her moved into another place?
Tomatilla - have you spoken with anyone at the funeral home? I've found that most understand how to structure the policy so that it is NCV (no cash value) irrevocable for funeral/burial use only. Sometimes you can do it as a handwritten codicil at the bottom of the page of the policy and the FH will attach that to thier paperwork and that will pass Medicaid review.
You know - imho- the reality is that if they live long enough they will run out of $$ no matter if you or they do oodels of advanced planning unless they are uber generationally wealthy. Every day I am thankful that Medicaid & Medicare exists.
You are right-- the policy is a whole life policy that is paid up but that I didn't even know existed until we were in the process of applying for benefits, including Veterans (spouse). Advance planning was not possible b/c my mom has dementia and certainly never really understood the possibility that she would need assistance and how that works. She was with a sibling before I took over and evidently the sib had no idea or inclination about planning. You are right--assets must meet the state's limit and I understand that and do not want anything but to insure my mom's care after her assets are spent. It was my understanding that she had a burial policy (exempt from asset limit because it is to be used only for final expenses). Turns out that the policy had not been "officially " designated as such. It may be possible to do that--still checking into that because that is something we all end up paying, one way or another. I have paid many of her living expenses myself and am OK with that but have to be pragmatically cognizant that I am spending down my own retirement. Yes, we should all make advance plans. If I had been in the loop with her 30 years ago, we would not have this situation now. And, just in case it makes a difference in how you view my post, I do not care about an inheritance. Assets need to be used to pay for care, not saved for kids. Not everyone sees it that way.
Thank you for your comments and contributions. This is definitely something for the elder care attorney to look into. I especially like the advice of the Miller Trust.
N1 - I think Medicaid was designed to be a safety net or a refuge of last resort so that there would not be poor elderly out on the street. Medicaid is a federal/state "needs based" entitlement program (and very different than how Medicare & SS are done as they are federally structured general entitlement programs).Because Medicaid is needs based what was done with assets in the 5 yr window prior to a NH Medicaid application is central to qualifying. NH Medicaid is designed as a safety-net for low income who can show both financial and medical necessity for long term care. The monthly asset ceiling and how assets are dealt with after death is set by each state as the state's administer the program.
Because NH Medicaid is needs-based, doing a 5 yr look-back on the applicants assets is critical for the states to operate the program. If everyone was able to transfer all of our parents assets, empty out their accounts today, spend monthly retirement and SS on nonNH stuff and put them into a NH tomorrow paid 100% by the state, the system couldn't afford it and they wouldn't have any NH to go to.
Medicaid compliance is all about either doing very advanced planning; spending your share by paying all your income to the NH less your states personal needs allowance; spending down your assets to qualify for impoverished.
If you don't want to spend down your assets to qualify for Medicaid for NH you don't have to but you have to private pay for the NH care.
Medicaid gets to the heart of the issue of who should pay for long-term care for the elderly and those others who need it -- the public through the tax-supported Medicaid program, or users of long-term care through their personal resources, including those remaining after death.
Tomatilla - although I don't know the specifics of your mom's situation, I bet she owns an whole life insurance policy that has a cash value? If so,that cash value has to be spent in order to have her qualify for Medicaid. Although this can't help you now, but maybe can help others.....if the policy was "owned" by someone else and not your mom, it would not be an asset. Advance planning is the key.
Straight - just re-read your post. Does your mom's memory facility take Medicaid in the first place? If they don't, then you probably have to private pay it. Some places do not take Medicaid and others won't even take those with a long term care policy because the insurer's often require too much documentation for NH to deal with. I think some states have Medicaid waiver programs that allow for more self determination for where the waiver goes so you really need to find out what in your state are the guidelines. Medicaid is a joint federal and state program and each state gets to set up their guidelines for how it's run. This gets to be especially mucho importante when you are dealing with any post death Medicaid claim or lien as the states probate, death and estate laws matter.
N1 - I bet the state makes a big difference. My mom - who really is a minimal needs type of NH resident as she has no chronic diseases other than dementia for them to manage - would be $ 5K a mo for her wing and the locked down memory unit is $ 7,500 a mo at where she is, if she was private pay. This is in TX and the state reinbursment on Medicaid is about $ 145 a day no matter what the unit is. I think TX is very low reinbursement rate.
Straight - I'd speak with the NH on this and specificically ask how they manage Medicaid residents. My experience with Medicaid for my mom and my MIL in 2 different states is that the NH gets the Medicaid reimbursement directly from the state (it is based on a state set day rate) and the NH Medicaid recipient does not get the Medicaid $ to manage. Some NH heavily press on you that the residents SS or other income go to them directly and the NH places their monthly personal needs allowance in a trust at the NH. (I somehow doubt they can force you to do this as it's your mom's SS and retirement). Other NH allow the family to write them a check for whatever their income less the personal needs allowance, so you have that $ to spend on them and if you want to do a personal needs trust account at the NH you determine that and the amount in it.
For my mom inTX, it's $ 60 a month personal needs allowance. I set up a separate personal needs trust account for her at the NH from a check written from her account and this can be used for her to go to the hairsalon at the NH or if they need to buy her something small (staff and residents do shopping trips) so that they have no need to have any $ in their room. You do need to be mindful and not let the allowance (both at the NH or in their bank account) build up as if it does it could exceed their Medicaid asset limit especially if they left some $ in their bank account as assets to begin with. Annually I get a notice from TX DHHS to review my mom's Medicaid status and have to submit the current and last 3 months prior bank statements as well as other financial related ?'s, so I make sure that she spends it so that it passes review.
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How Can My Elderly Parent Qualify for Medicaid?
It sounds like your elder went to rehab from a stroke, so she was discharged from the hospital to the rehab. I'm guessing the rehab is at a NH or other skilled facility. Under Medicare rules, she gets 21 days of Medicare for rehab and then after 21 days she will need to be "progressing" in her rehab in order for Medicare to pay at a reduced rate with the elder paying a co-pay (the amount varies, I think it's about $ 140 a day maximum co-pay allowed). If she is not progressing, Medicare must stop paying for care. Usually this is when family moved them from rehab status to permanent resident (& Medicaid Pending if they cant pay) so they can continue to stay at the facility if it's also a NH.
Now if, it looks like she will qualify for hospice, then the facility & her doctor can write the order for hospice to do an evaluation for their services. Hospice is a wonderful benefit of Medicare. BUT hospice does NOT pay for the costs of the room & board at the facility. Hospice - like all Medicare - pays for services and not for their room & board. That will need to be paid for either by private pay from her assets, or family pays or she applies for Medicaid (and someone will need to do her application & get her documents required for it). Try to speak to the social worker at the facility to help you understand how this works.
Shower chairs are considered an item of convienience & not durable. MD gave you an Rx because some community based organization provide for safety items for low-income &/or elderly with a doctors note.
Annuities are an insurance product. A "deferred" annuity means no income tax on the interest until the annuity is paid. Pay out happens when the annuity expires or when funds are withdrawn as allowed by the contract or when the annuitant dies.
There are drawbacks to them - as you are going to have to deal with - like they have a penalty for early withdrawal of funds; also tax issues too. I'd basically count on loosing 10% of the invested principal if you need to take all of the funds out before the maturity date - this could be a good amount of $ that is just gone. It will also take some time for all the paperwork to be done with the insurance company too and you will have to have your DPOA that clearly states you can do financial to get this going. Realize annuities have sales commissions which typically are high, when you are going through dad's stuff look to see how much was paid in commissions, it will likely make you want to scream or have a stiff drink or both.
The fact that Sissy is the beneficiary doesn't make any difference for Medicaid. She is not the beneficiary till dad dies and it would be a non-testamentary death benefit to Sissy (so it doesn't go through probate, and that probably is the hook that it was "sold" as…to bypass probate). But as dad is still with us, the deferred annuity is his asset that will have to be cashed-in and spent-down.
If 93 year old dad did this recently and he was diagnosed with dementia, I would file a complaint with your state dept of insurance and banking for elder abuse against the insurance salesman and the company who did the policy too. It will make you feel somewhat better to have complained when you realize that 10% or so of the annuity has gone "poof". Good luck and thank goodness you are there to take care of these things for your dad.
Now if the NH accepts Medicare & Medicaid, that means that they will accept whatever the payment is for Medicare billed services (this is usually for the rehab days @ the NH right after they get discharged from the hospital to a NH) and that they will accept whatever your state Medicaid program has set as it's daily reimbursement rate. Like for my mom in TX the Medicaid day rate is $ 145.00 a day (pitiful low too) while many east coast states are $ 400-600 a day. Medicare - which is federally run - is uniform in costs nationwide. Medicaid - which is a joint state & federal program - is run by the states so each state can determine what they pay for and won't pay for. If your elder is in a NH, you have to clearly understand how they are being billed and at what rate as there can be a HUGE gulf between private pay rates and Medicaid rates. Good luck.
You know - imho- the reality is that if they live long enough they will run out of $$ no matter if you or they do oodels of advanced planning unless they are uber generationally wealthy. Every day I am thankful that Medicaid & Medicare exists.
You are right-- the policy is a whole life policy that is paid up but that I didn't even know existed until we were in the process of applying for benefits, including Veterans (spouse). Advance planning was not possible b/c my mom has dementia and certainly never really understood the possibility that she would need assistance and how that works. She was with a sibling before I took over and evidently the sib had no idea or inclination about planning. You are right--assets must meet the state's limit and I understand that and do not want anything but to insure my mom's care after her assets are spent. It was my understanding that she had a burial policy (exempt from asset limit because it is to be used only for final expenses). Turns out that the policy had not been "officially " designated as such. It may be possible to do that--still checking into that because that is something we all end up paying, one way or another. I have paid many of her living expenses myself and am OK with that but have to be pragmatically cognizant that I am spending down my own retirement. Yes, we should all make advance plans. If I had been in the loop with her 30 years ago, we would not have this situation now. And, just in case it makes a difference in how you view my post, I do not care about an inheritance. Assets need to be used to pay for care, not saved for kids. Not everyone sees it that way.
Because NH Medicaid is needs-based, doing a 5 yr look-back on the applicants assets is critical for the states to operate the program. If everyone was able to transfer all of our parents assets, empty out their accounts today, spend monthly retirement and SS on nonNH stuff and put them into a NH tomorrow paid 100% by the state, the system couldn't afford it and they wouldn't have any NH to go to.
Medicaid compliance is all about either doing very advanced planning; spending your share by paying all your income to the NH less your states personal needs allowance; spending down your assets to qualify for impoverished.
If you don't want to spend down your assets to qualify for Medicaid for NH you don't have to but you have to private pay for the NH care.
Medicaid gets to the heart of the issue of who should pay for long-term care for the elderly and those others who need it -- the public through the tax-supported Medicaid program, or users of long-term care through their personal resources, including those remaining after death.
Tomatilla - although I don't know the specifics of your mom's situation, I bet she owns an whole life insurance policy that has a cash value? If so,that cash value has to be spent in order to have her qualify for Medicaid. Although this can't help you now, but maybe can help others.....if the policy was "owned" by someone else and not your mom, it would not be an asset. Advance planning is the key.
Straight - I'd speak with the NH on this and specificically ask how they manage Medicaid residents. My experience with Medicaid for my mom and my MIL in 2 different states is that the NH gets the Medicaid reimbursement directly from the state (it is based on a state set day rate) and the NH Medicaid recipient does not get the Medicaid $ to manage. Some NH heavily press on you that the residents SS or other income go to them directly and the NH places their monthly personal needs allowance in a trust at the NH. (I somehow doubt they can force you to do this as it's your mom's SS and retirement). Other NH allow the family to write them a check for whatever their income less the personal needs allowance, so you have that $ to spend on them and if you want to do a personal needs trust account at the NH you determine that and the amount in it.
For my mom inTX, it's $ 60 a month personal needs allowance. I set up a separate personal needs trust account for her at the NH from a check written from her account and this can be used for her to go to the hairsalon at the NH or if they need to buy her something small (staff and residents do shopping trips) so that they have no need to have any $ in their room. You do need to be mindful and not let the allowance (both at the NH or in their bank account) build up as if it does it could exceed their Medicaid asset limit especially if they left some $ in their bank account as assets to begin with. Annually I get a notice from TX DHHS to review my mom's Medicaid status and have to submit the current and last 3 months prior bank statements as well as other financial related ?'s, so I make sure that she spends it so that it passes review.