With Medicaid, does Spousal Impoverishment apply with Home Health Care, or only with Managed Long Term Care? - AgingCare.com

With Medicaid, does Spousal Impoverishment apply with Home Health Care, or only with Managed Long Term Care?

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Hi, My wife is 51 years old, and has been diagnosed with ALS. We live in New York State. It will be a stretch, but if we were to qualify for Medicaid, I have a question about Spousal impoverishment I wonder if someone could help me with.

From what I have been reading it sounds like Spousal Impoverishment only kicks in when my wife is enrolled in managed long term care. I would love for her to never need MLTC, and get care for her exclusively in the home. Does anyone know if she gets home care rather than MLTC, does my income allowance still go up to $2,890? And regardless, what can that $2,980 be comprised of, just income I generate, or other?

Any insight would be appreciated. Thanks!



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jonico, you've gotten wonderful advice from community members who know what they are talking about.

You are a wonderful guy. I hope that you and your wife will have a lot of precious time. even though this will be a hard journey to travel.

Each state has different Medicaid laws. To be completely certain about what you plan, I'd check with a Medicaid attorney. You may want to ask you State Attorney General's office for a referral. I wouldn't think you'd need more than one appointment to get this settled.

Best wishes for you and your wife. Please keep in touch,
Carol
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Hello, I also live in NY. All Medicaid patients in NY go on managed care. No way around that. The care manager will determine if she gets home care or if she needs skilled nursing. Believe me, they want her home as long as possible. Your income allowance varies with your expenses for food, clothing, shelter and medical care.
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Jonico - if your bride has been diagnosed with ALS, she will qualify for early Medicare. Medicare not Medicaid. If her current insurance runs a dent into your finances having her be able to go onto Medicare & off yiur current private health insurance could be quite an advantage & provide extra funds towards a caregiver ALS is within special status for Medicare. She does NOT have to wait till 65 to get on Medicare. She will need to apply for SSDI to start all this. But she should not have to wait for the SSDI determination to be done to get her Medicare card as ALS is a special category for Medicare once SSDI is filed. I'd suggest you contact the Lou gehrig foundation to get a volunteer counselor for NYS to guide you in this.

The whole early Medicare benefit is kinda unknown. So expect that you may know more than folks you talk with. That's why speaking with family's within the Lou Gering association can really help as they've navigated all this. I don't know if this is how it's done in NYS but for my area the Foundation has transition teams for families newly diagnosed with ALS that help the spouse or kids get a plan of care going often with foundation volunteers. They can be a real godsend.

ALS & end stage renal are special category for early Medicare.

Once she gets SSDI approved, she should then also get eligible for Medicaid. Hopefully between her early Medicare and then Medicaid, her health care costs should be covered.
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I forgot to add.......For ALS the usual 2 year waiting period for early Medicare is totally waived. She applies for SSDI and once she gets a filing # for SSDI (maybe 3 months), she should get the early Medicare card & coverage.
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Thanks Pam and Igloo. Both of your posts were helpful. Igloo, you are right on, regarding Medicare. My wife has been on Medicare and SSDI since January 1st, and the process was in fact quick and pretty easy, thankfully.

My greatest concern is with the home health care costs with Medicare. I am toying with the idea of scaling back my work dramatically to not earn so much that she could qualify for Medicare. With the Spousal Impoverishment provision it seems at least possible it could work for us.

Ideally I would like to be her primary caretaker and and essentially commit to it full time, with help from home health care providers. This would mean I could hardly work anyway. The alternative seems to be to keep working (distracted to say the least), and allow others to care for her as the ALS progresses. If we do that, we could easily eat up all our assets paying for home health care.

I'm thinking about cashing in everything we need to do, selling our house, and using the cashed in assets to step up to a nicer home that would hopefully be a special place for my wife going forward.

Does anyone have experience with a Medicaid Lawyer to give me an idea of what it would cost to get a thorough analysis done? Any thoughts on what I am considering doing? I am willing to become "poor" to spend as much time as I need to with my wife, as long as I can. I figure if we can live very modestly in a nicer home, it would be a good thing. I also figure I wouldn't be abusing the system since I would be doing most of the care taking and hopefully keeping her from ever going to a managed care facility.

Thanks for thoughts...
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Jonico,

God bless you. You've done a lot of homework already. You should be proud of that. I agree with two major things here. 1) Every state IS different. 2) Absolutely retain an elder care attorney to help you through this. I did for both my Mom and Dad. Dad was put on Medicaid first and Mom was the "community spouse". Our lawyer knew what to do so Mom could keep living in the condo by receiving the SS check. He passed a year ago, now Mom is on Medicaid and in a LTC facility after having a few major strokes. I couldn't have managed the system or the timing of these filings without the lawyer's help. Best of luck to you and your wife.

-SS
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Go to an attorney and put your assets jn an irrevocable trust. In 5 years you cannot lose your house or anything and ekll quslify fir medicaid at home or out services. Dont go broke over this, you are way way too young!
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I am also in NY and was able to get my mom to qualify for community medicaid. Meet with a social worker if possible, but definitely interview a few elder law attorneys. There are financial issues to overcome and ways around them. A good attorney will know exactly what your options are and the consequences of each option.
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