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mscoulter Asked December 2015

Does anyone know of a list of items covered by Medicaid other than prescription drugs?

Medicaid starts January 1st and I want to prepare a list for mom's doctor. There may be items she needs that I haven't thought of.

mscoulter Dec 2015
My mom is blind, broke both hips and has arthritis, the worst of it in her knees. She can't see where she is going or what she is doing, so she can't be left alone and can hardly do anything for herself. Here in NY the aides get paid for overnight the same as they would for 13 hours. If they gave me 13 hours a day it would cover 24 hour care. I would still have to handle a lot of things such as grocery shopping, bills, medical appointments, running the house, and overseeing her care. But if she got the care she needs, I could move back into my own home with my husband, take care of him and the house, and my cat, and maybe even conduct some business. This is grossly unfair to me and to my husband who has been wonderful so far. Even though there is not a single task she can do on her own, somehow this nurse figures 9 hours a day will cut it, but it won't. She cannot go into a nursing home because she gets hospital delirium very easily.

jeannegibbs Dec 2015
Wow! Mom got approved for 9 hours a day? I'm impressed. Generally for 24/7 coverage it is less expensive to place the elder in a care center than provide 24 hour care at home. So almost no one gets 24 coverage at home, even if they need it. It is assumed that a spouse or relative can provide additional care. If not, then they try to find a cost-effective way to provide that level of care.

In my experience, even though part of their mission is to hold down costs for the county or other entity, case workers are sincerely interested in providing as much care as they can justify. But they can't authorize cleaning assistance if the recipient insists she can clean her own house. Hence the importance of having a knowledgeable person present at the interviews.

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mscoulter Dec 2015
Thank you jeannegibbs. Here in NY we have to choose a managed care provider, and they send a nurse to determine eligibility. The problem is that it is her job to reduce costs for the managed care company by denying services, so I don't expect to get a list from her. Even though my mom clearly needs round the clock attention, she is only authorizing 9 hours per day or personal care aide. I will be shopping around for another managed care company, but I have been told that getting her doctor to "prescribe" things is the way to get those things. I am new at this and have little idea of what is available that can be prescribed. That is why I am looking for a check list of possibilities.

jeannegibbs Dec 2015
I don't know how it works in NY, but in MN the person is assigned a case worker and that person is invaluable in determining needs, suggesting helpful items, and asking the doctor to order things if that is necessary. Be sure you are present when the case worker visits. Often the person on Medicaid for whatever reason wants to appear more able than he is. "Can you prepare your own lunch?" She answers "Of course!" and you say, "Yes, Mother, you do a good job of carrying the lunch tray I prepare for you to the table." The case worker cannot approve Meals on Wheels, for example, if there is no evidence it is needed. Our case worker told me I made her job so much easier because I always presented an accurate picture.

Medicaid covers major items like an adjustable bed (if the doctor thinks it is needed) or a bed railing. It covers incontinence supplies if/when that becomes necessary. In this state it covers Adult Day Health Programs (day care). It may provide some in-home care if the evaluation deems that necessary.

Work with the case worker! He or she is your new best friend!

pamstegma Dec 2015
Whatever she needs has to be by a written MD order, so ask the MD what he thinks she will need. An adjustable bed comes to mind as one of the big items.

mscoulter Dec 2015
I am in NY in case anyone knows of a list online. I have tried searching but just comes up with general medications. I have been told for example, that surgical gloves that the aides use is covered, and also diapers.

freqflyer Dec 2015
You would need to check with your State Medicaid office as each State has their own rules and programs.

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