Follow
Share

After months of meeting with an elder lawyer, collecting all the documents needed, my mother's application for Medicaid was finally submitted last week. Now the lawyer tells me I must arrange for an evaluation (2 in fact) to prove that she does need 24/7 care. I didn't know about this. And apparently the evaluations take 3 hours! What on earth do they do - does anybody know? This process is never-ending. Fingers tightly crossed that she ends up getting Medicaid after all this.

This question has been closed for answers. Ask a New Question.
Find Care & Housing
Igloo, I think it was due to a lawsuit several years ago. Not sure about the number of Medicaid NH beds. My mom is in a nh in Connecticut, near one of my brothers, and I've never really investigated nhs here in the city.
Helpful Answer (0)
Report

I was overjoyed to find out that NYC Medicaid covers 24/7 home care, though I'm holding my breath until the actual application goes through, hopefully soon. We are paying out of pocket until then. I'm not sure if there's coverage because of a nursing home shortage or what.
Helpful Answer (1)
Report

Barb - copy that! so I'm guessing there basically are so few medicaid beds in NYC so in-home has to happen. A unique situation. All boroughs?
Helpful Answer (1)
Report

This is only NYC we're talking about, not the whole State of NY.
Helpful Answer (0)
Report

When my mom went into a NH in TX back in 2011, daily medicaid R&B was about $145 a day, 53k a year. To me it was really amazing just how much basic & skilled services could be provided & provided across the board equally for all residents for such a low amount. The private pay residents - other than having a solo room - had the same meals, social services, nursing care, whatever. I flat couldn't figure out the math, I mean jeezlouise hotel rooms run over $ 150 a nite & with drab free breakfast & no skilled nursing on call. So I asked. Apparently key is for NH to have about 25% of beds at all times with MediCARE rehab residents as payment triple or more. Guaranteed 21 days /100% and then possibly another couple of months at 80%. So Medicare is kinda underwriting a NH ability to have Medicaid R&B beds.

Barb - is some of the billing for 24/7 at home being heavily shifted to Medicare?

If Medicare gets changed to be more limited under this new administration, the NH aren't going to be able to stay open imo. The future is not gonna be pretty on Aging in America.
Helpful Answer (0)
Report

I agree Igloo. I don't see how in the world that kind of expenditure would be sustainable. It may be a great benefit, but, man. So, I suppose that the state of NY picks up that cost for around the clock in-home care. Do you think they think it's less than paying a Medicaid rate to a NH? In my state, NC, the Medicaid rate to a NH is considerably less than a private pay rate?  Of course, here, there is no provision for in-home around the clock nursing care.
Helpful Answer (0)
Report

Barb - omg NYS medicaid will pay for 24/7 in-the-home caregivers?!
Not payment to family living there as caregivers like what California's IHHS program does? But paying a caregiving agency for 24/7 care? Is there a cap on rate?

Wreck NYS state budget? If $ 25 hr a mo, then $ 18K mo / $ 216k yr w/out equipment, transporation, or speciality like PT, OT, ST..... Add those, HUGE cost.
Is it a very narrow limited program? Most states place a limit on at home to around 28 -32 hrs as over that it's not cost effective as they can get 24/7 in a facility with skilled nursing & on site staffed ancillary services for less. Even then states are looking to PACE type of larger community based long day elder programs to have them go into rather than 1-on-1in home or a NH for those ambulatory with family having to pick up all care outside of PACE time.

Do you know what NYS has as medicaids daily reinbursement Room & board rate for NH?

I just cannot see how the costs are sustainable for NYS or any state once the tsunami of baby boomers start hitting medicaid eligibility.
Helpful Answer (1)
Report

I seem to recall that there was a lawsuit a couple of years ago, but I can't find a citation.  Nevertheless, I have several friends who were able to obtain, through Medicaid, 24/7 personal care for their parents.

Just read on one home care agencies website that a person must be evaluated first by a nurse from some sort of independent agency to determine what care she needs, and then again by the home health care agency's own nurse.  With supporting documentation from a doctor.
Helpful Answer (0)
Report

BB, is that possibly because of the astronomical costs of NH's around you?

Xinabess the assessment needs to take some time, partly because just *everything* takes forever with older people :) and partly because there's a range of 'activities of daily living' that they'll want to look at. But it shouldn't be too much of a trial for your mother. Do be there to assist, but do try not to butt in, and certainly don't argue or contradict your mother directly - just calmly give the assessor the correct version.

E.g.
Assessor: "have you fallen in the last six months?"
Mother: "Oh no! I'm always careful to hold on, you see."
You to assessor: "You'll want to note: several times, including two serious falls one leading to a fractured wrist."

But your mother may pleasantly surprise you and be actively interested in the process. I remember at the end of my great aunt's, she was asked to write a sentence on the OT's form. She put: "I am beginning to be hungry."
Helpful Answer (0)
Report

Igloo, in NYC, you CAN get 24/7 inhome care through Medicaid.
Helpful Answer (0)
Report

Xina - so much of what's in articles on medicaid is on financially being "at need" for eligibility.... The 5 year look back.... Doing a spend-down, etc . All emphasis is about $$. Family is often blindsided that the elder has to show medical "need" as well.

If your moms discharge paperwork when she left the NH and what is in her current health chart, her doctors orders for care & medication management show "need", she should be ok.

What are you hoping that medicaid will provide? There will be a limited # of hours of care per week. Medicaid will not provide for 24/7 care at home
Helpful Answer (1)
Report

Sunnygirl, my mom is no longer in a NH (thank god) She's been home w 24/7 care for a few months now. I will definitely be there, as will one of her aides.
As always, I appreciate all the advice I get here!
Helpful Answer (0)
Report

Yes, the person cannot be relied upon to accurately report what they can and can't do. My cousin thought that she could manage her own meds, but, she could not recall anything about her meds and didn't even read notes to herself.

Also, in your profile, it appears that you mom was already in a NH. Is that right? The facility should be able to document what level of care that she needs. Be careful that the person who is preparing this form actually knows her needs.
Helpful Answer (0)
Report

By the way, Xina, make sure that you are there during the evaluation because elders don't always tell the truth during the evaluation. My MIL is in hospital right now with symptoms that have escalated to a point of near immobility that have been going on for SIX MONTHS and she denied to her own detriment. Remember, you will have to keep re-certifying for Medicaid every 1-3 years, depending on the level of care. Getting government benefits requires jumping through hoops, but not jumping means that you pay out of pocket. Stinks but...
Helpful Answer (0)
Report

Her primary MD should have any previous test records. Look there first, then ask for the records or updated testing. The actual testing is pretty benign, dealing with memory, problem solving and ADL's such as eating, bathing, dressing.
Helpful Answer (1)
Report

This question has been closed for answers. Ask a New Question.
Subscribe to
Our Newsletter