Would Medicaid cover assisted living through a Medicaid waiver?

Thanks for your insight into the BCBS issue, we'll verify that.

TM - I'm kinda surprised that BCBS is paying as his Medicaid should be his secondary payer to his Medicare.

There could be issues with BCBS payments down the road. Like 6 mos to a year to 18 mos later. What seems to happen is that once the Blues find out they are medicaid eligible, the blues will cancel or suspend coverage. They will clawback payments made to vendors paid. As the Medicaid Pending & application process can take several months, the blues could be paying for all sorts of costs from PT, OT, ambulance service, etc during the lengthy application process. Medicaud -once aporoved - pays retroactively. So Blues can clawback any payments made by them within the retroactive period. Vendors will need to rebill to Medicaid to get paid at Medicaid rates. If they don't participate in Medicaid, they will bill the elder and their DPOA.

It can get pretty sticky to deal with.

That's where he's been living for 15 years. That's his home.

TMCare, moving him to a friend's house is not the answer. No single person can provide that level of care. Very foolish to even consider it.

While FIL is pending Medicaid his pension and SS payments pay for the NH and once approved Medicaid will pay their portion retroactively? When he's discharged to home where do his pension and SS payments go? Does Medicaid and Medicare and his supplemental Blue Cross pay for most things? He also has a QIT (Miller Trust) for a bit of excess income.

You might ask them about Florida's new program called Florida
Statewide Medicaid Managed Care Long-Term Care Program (SMMC LTC). The county social services or any Assisted Living facility should be able to answer some questions about it. From what I read online, it appears that Florida now offers financial help for those who qualify for Assisted Living and in home care, depending on what is needed. That makes sense with what you have already been told.

It sounds similar to NC's Special Assistance program that covers cost for Assisted Living for those who need it per doctor's orders.

Talk to the Assisted Living place about how charges would work for one person on Medicaid and one self-pay.

His friend would not have to sell her house, but should think carefully about how she will maintain it, pay insurance, taxes, etc. Would she rent it out?

Yes, FIL would have to reapply for Medicaid in a different state. Once he has gathered all the information for the original application, another application should be easy.

Also, if FIL were to move out of state to live with family would he need to apply for Medicaid again in that state?

FIL does not own the home, he had been paying rent to his friend.

Thank you all. We just heard that FILs Medicaid should be approved this week and after an assessment of needs etc. he is being discharged to home. His friend said that if she (who owns her home) has too much difficulty caring for him social services said that they both could move to Assisted Living. How would this work? He'd be on Medicaid which would cover his needed care and she'd pay room and board? Would she have to sell her house?

Once your FIL is approved for Medicaid, what services he can receive and where depends on his needs. The state will want to provide the most cost-effective care. Therefore they prefer to cover assisted living rather than a nursing home. But FIL will have to be able to meet the admission criteria and also find a facility that accepts Medicaid. Providing help for FIL to live at home is a good option for the state program, but again that depends on FIL's needs. The waiver program will not provide 24-hour at-home care, because at that point it is more costly than a care center, but if he can get by with part-time help at home they provide assistance to keep him there.

I agree with Babalou that your focus now needs to be on getting all the paperwork done and submitted so FIL will be eligible for Medicaid (that is, Florida's program that administers Medicaid.)

Yes, the eligibility will "follow" him. He will not need to reapply -- but there is an annual renewal form whether he stays in one place or moves. If he suddenly inherits a large sum of money then he may not be eligible, but it would not be dependent on where he is getting care.

Most Assisted Living places do not accept Medicaid. If he has not improved in 100 days, I would not count on him going anywhere. Work with the nursing home to make sure they have all the records they need. Find out who is handling the application and stay in weekly contact with them.

I don't know the answer and it is likely to be complex, as there is a difference between " community medicaid" (home/al) and 'facility medicaid" which is what covers you in a nh.

Why does it matter right now? It sounds like at this moment, he needs to be in the facility where he is, and they are willing to keep him there as a " medicaid pending " patient. Put your energies into getting the application done correctly so that he gets approved with no snags or delays.