Can my grandpa get In-Home Supportive Services (IHSS) if he has a share of cost with Medi-Cal? Also, can someone please explain share of cost?

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After speaking with Area Agency on Aging, a Medicare specialist, and a Medi-Cal worker I am still confused on this issue or maybe I just keep asking the same question hoping for a different answer. I'm not sure yet. Hopefully someone can clear this up for me once and for all.


Here's some background on my grandparents. They live in their own home but both need assistance. My brother has been my grandfather's caregiver for the last 8 years. My grandpa is 88 and has a lot of physical issues but mentally he is still sharp. He is partially blind, can no longer walk or get himself out of bed. He needs assistance with everything. My grandma has dementia and is a diabetic but can still get around on her own for the most part. My aunt takes care of her and stays with them at night.


After 8 years my brother is burned out. I contacted Area Agency on Aging to see if my grandpa would qualify for IHSS to help relieve the burden. I was told that it was a waste of time for them to apply because their share of cost is too high. Their share of cost (SOC) is $1067 so it is high but they also have a lot of monthly medical expenses. What I was told was they would have to spend $1067/month on a caregiver before IHSS would start helping. The person I spoke with said that my grandpa would never reach that threshold. According to her we could hire someone to care for my grandpa and it would cost at or near their SOC. My grandparents are already struggling with their monthly expenses I can't imagine how they would cover their existing medical costs and $1067 for a caregiver too.


When I spoke to the Medi-Cal worker I was told if they have a share of cost at all then IHSS would never approve them because IHSS doesn't take people with a SOC, no matter the amount. I was also told the only things that count toward their SOC are recurring monthly expenses. They do not count other medical bills unless it's a recurring expense. For example, I asked specifically about things like hospital bills since my grandparents are currently making payments to a local hospital for a recent stay that cost them about $600 and I was told that wouldn't count toward their SOC for that month because it was a one time bill.


So here's where my confusion is. I thought any medical expense could count towards their monthly share of cost but what I'm being told is only recurring medical expenses count. My Aunt says what they spend for medical expenses varies every month. This month it'll be much more since my grandpa would like to get a prosthetic eye. She says it'll be about $3,000 just for that expense and they plan to use a credit card to cover it. It's my Aunt's understanding that the SOC would only come into play if one of my grandparents end up in a nursing home. Can someone clear the whole share of cost thing up for me?


I'm also being told that you can't qualify for assistance through IHSS if you have a share of cost but the Area Agency on Aging website states you can get IHSS with a share of cost if you meet all the guidelines for SSI except income. So which is it? If I insisted on pursuing IHSS and my grandpa was approved do they now have two separate share of cost of $1067 to Medi-Cal and IHSS? Because $2134 is almost all the income both of them bring in and they still have living expenses.


The Medicare Specialist said she couldn't help me unless we could reduce their share of cost. Since they are on a Medicare Advantage Plan they can't buy supplemental insurance and they are past the point that anyone would underwrite them anyway even if they tried to get additional insurance since my grandpa has end stage renal failure so no way to reduce share of cost. She advised me to take my grandfather off of dialysis so he could go on Hospice. She felt with his health issues it was probably time to let him go. At this point I kind of broke down. Okay I was a total sobbing mess. Thank goodness it was a phone conversation and not a public place.


I've come to the conclusion that IHSS is probably a dead end. We are currently exploring nursing homes but the last time he was in one he went downhill fast that's why my brother stepped in. Plus I've been informed that it could take awhile to get him into a place since there is a shortage of Medi-Cal beds available in their area.


I was hoping to keep my grandparents together and in their own home. I thought IHSS was the answer. That's probably why I'm holding onto this idea so hard. I wish I could jump in and take over for my brother myself but I'm taking care of my mom who has some serious health issues of her own. I'm probably making this way more complicated than it needs to be. I'm just grasping at straws. I need some guidance and clarification.

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The social workers try to discourage you. You have the right to ask them to come out to do an assessment. Once they determine the hours your grandparents would be eligible for you just need to do the math and determine if you should proceed. In other word at the going rate of $11.18 per hour (LA county) as long as your grandparents receive at least 100 hours per month it makes sense to do. 90% of government workers don’t even know how their programs work. Just keep pushing to have them assessed
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The medical bills need to be submitted to the Medicaid agency so it can determine if the SOC has been met during the appropriate time period, which may be called a base period. Without the bills being sent in the state won't know when it's obligation kicks in. Are they being sent in?
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Hi BarbBrooklyn, My aunt took over their finances ages ago and she was the one who told me what their co-pay was going to be with their insurance for the eye prosthetic. I would have thought Medi-cal would pick up anything over their soc so I'm not sure why it's costing so much. I don't know if this affects anything but she has never had any interaction with Medi-Cal beyond their annual redetermination. So is it possible some things are not getting reported or applied correctly? I know some of my grandpa's doctors do not take Medicare or Medi-cal but they take his insurance. I just discovered this when I started looking into things. I'm assuming that the hospital bill and other expenses that month must have been below their soc if Medi-cal didn't pick it up. Thank you for the heads up on the caregiver contract. I know it was something my parents insisted on when my brother first started caring for my grandpa but I'm not sure it was completed and signed or not. I will ask about this because I think if they don't have one it might cause some issues with Medi-cal.

Hi DonnaF, Thank you for your kind words. I hadn't thought about a care manager. That and an elder law attorney sounds like what I need. Since I started looking into this a few weeks ago I feel like my brain has turned to mush. It's so overwhelming.
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Hi slogurl, I absolutely feel your pain. I am in New York and every state has it's own rules. My best advice is an elder attorney but also a good care manager. It's the care manager that knows how to get through and around the system. There is always so much involved that it becomes extremely confusing for the average person such as you and I. I am eternally grateful for the care manager that I worked with. I don't believe I would have succeeded in getting mom on Medicaid and 24/7 home health aides if it wasn't for her.
Don't ever give up. Just keep asking questions and look for new roads to go down. I don't know about California but here in New York, I believe they make it complicated so that people give up and that saves the state a whole bunch of money! Take care of yourself.
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Isn't the prosthetic eye covered by insurance?

If your grandparents have Medicare and Medi-cal, why did they owe the hospital?
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Hoping that they've got a caregiving contract with brother.
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Hi vegaslady. Thank you for your response. I understand what you are saying. I didn't mean to imply that my grandparents were throwing money away on my brother instead of using those funds to pay for their own care. I feel like I need to clear this up.

My brother is my grandpa's full-time caregiver not some mooch. The little money my brother receives is compensation for his services. My brother has attempted to hold down another job while taking care of my grandfather so he could cover his expenses on his own but the demands of being a full time caregiver make it nearly impossible. My grandfather has many medical issues. He is partially blind, can't walk, can't sit up without assistance. He cannot perform basic functions on his own. Having someone around full-time to assist my grandpa is vital to his care. I think my grandpa's doctors would agree that a caregiver would be necessary in his case to meet his medical needs. If my grandparents had hired a private caregiver to perform all the functions my brother currently performs, it would cost them much much more than the $500/mo they give my brother now so that he doesn't have to stress about rushing to a second job.

I'm not sure what public benefits would be available to my brother in this situation without some sort of work requirement but it is something I will most certainly look into. In my previous post I was simply trying to say that between the money they pay my brother for being my grandpa's caregiver and the money they spend on other medical expenses they are spending at least $1067 a month right now. If we hired an IHSS caregiver and my brother was allowed to move on it means the money is there to cover their SOC and financially it could work without my grandparents experiencing any major shift in their monthly out of pocket expenses. Theoretically.
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It makes sense to determine financial eligibility before the government spends money doing a needs assessment. They would be expected to use their funds for their own care a n d not be giving it away to an adult child. If he needs help he should go apply for public benefits for himself. Their SOC or spend down is what they have available after the minimal amounts allowed for their basic living needs. The rest is "available" for them to spend on medical needs.
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Thank you Barbbooklyn for the link. I thought they should have conducted some sort of assessment before telling me IHSS couldn't help. She really had no idea how much care my grandpa would need yet. If my grandparents spent all their share of cost of $1067 on a caregiver at the going IHSS rate for their area it would be about 3 hrs/day. I feel like he would need at least twice that many hours but i honestly dont know for sure myself. Maybe I gave up too quickly. I had not considered sitting down with an elder law attorney. I will definitely look into that now.

The scenario you described with your MIL makes sense to me, Momshelp. I'd thought if we paid all the share of cost towards the caregiver first that Medi-Cal would pick up the rest of my grandparents medical expenses. If that were the case, I think with a few changes, my grandparents could make it work financially. Between their current medical expenses and the money they give my brother to cover his rent, gas, and food ($500/mo) it's about at their share of cost or over already. The way it was explained to me though it didn't seem like it worked that way. It sounded like what they pay to the IHSS caregiver does not count towards their Medi-Cal share of cost but that can't be right. I'm sorry to hear about your mom. That's a lot of money to come up with every month especially when there are other expenses to consider and resources are limited.
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I'm in California & my MIL passed away 7 years ago. I say that because regulations change. Anyway her share of cost was 670.00 monthly. We used that to pay a caregiver first so that all her meds,doctor co-pays & out patient procedures were paid by the state. At that time recurring didn't matter. Now I just tried applying for my mother & her share of cost was calculated at about 1400. Case worker also told me that money would pay a lot of hours directly if I just bypassed IHSS. 1400 a month straight out of her income is way to high for it to help me.
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