Would Medicaid or Medicare pay us for taking care of my mother? - AgingCare.com

Would Medicaid or Medicare pay us for taking care of my mother?

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My children and I moved into my mother's home due to her Alzheimer's.

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Also I'd like to add that for Medicaid, they need to be eligible BOTH financially and medically in order to qualify. So many of the posts on this site are about dealing with $ as the costs of care and the costs to caregivers over time can be quite staggering BUT it's important to also remember that they have to medically qualify in order for Medicaid to pay.

Just needing assistance, being forgetful, being incontinent, not able to drive, etc may not be enough "at need" to be eligible to participate in a Medicare or Medicaid program. You may need to get mom's health history / chart to show "need". Just being old and having dementia isn't enough necessarily. You will need to speak with your mom's MD to see what's what and make sure you have mom sign off on all HIPPA forms to allow for this and you need a MPOA as well.

I moved my mom from IL to NH and bypassed the whole AL stage.It took about 5 mo of visits to her gerontologist to get her health history to show need. The visit mom had a bad H&H lab work and 10% weight loss and a couple of other things, her MD wrote the orders for skilled nursing care needed so she could move into a NH (a skilled nursing facility). If your mom needs caregiving, you need to be able to show documentation as to this need if she need medicaid or Medicare to pay for services. This is why its often easier to get them into a NH when they come from a hospitalization as they come in with a fat medical file and go to the NH for rehab and then just stay as they can easily show "need". If your mom has been living on her own and hasn't had much of a health history or hospitalizations, it's not gonna show she needs care. So give that some thought in addition to everything else……and try not to get too too overwhelmed in all this.
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Sheneedshelp - This is question numero uno on this site. I'd suggest you make a pot of coffee or pour yourself your favorite adult beverage and read the many, many posts on this site from others who have asked your ? before.

Basically caregiving in the US is done by family and done for free. That is the long answer short.

Medicaid are state run programs, so what type of waivers are happening will vary totally by state. Most states do NOT have a in-home caregiver program which pay family to caregiver. CA, however, does and it's IHHS run co. by co. with caregiving right above minimum wage for a set # of hours per week after caregiver has training. All reportable income. Seems to be $ 11 hr /18 hr week. The current trend for Medicaid for the states is for a larger community based program - like PACE - for the elder to participate in and keeps them in their home. There is a PACE center by us (the Benson Center) and they pick up the elder 3 - 4 days a week and they essentially spend the day at the Benson and then go home. So family has to be there to do all the non-center caregiving duties. Medicaid pays the PACE a fee per participant, family does not get paid. From a cost-benefit and cost-efficiency viewpoint, the PACE/Community site is a better use of funding that paying 1-on-1 to family for caregiving. Again most care is done by family as a sense of familial duty and for free

Mom gets Medicare and only if mom is at the point of qualifying for hospice will medicare pay for caregivers through hospice. Hospice means she is terminal with probably 6 mos left to live. And hospice is usually 2 - 3 days a week visit by hospice caregivers to see her for a few hours. All other caregiving duties will need to be done by family. So if mom needs 24/7 oversight, family will need to do this. The oft-told story is that mom's level of care gets to the point where family cannot do 24/7, so mom moves from her home to a NH and applies for Medicaid.

What is imho very important to remember is that IF mom goes into a NH and onto Medicaid, mom is required to do a co-pay to the NH of all her monthly income less a small personal needs allowance (varies by state from $ 35 - 105). This is also called the SOC - share of cost. So IF mom's monthly SS check or retirement check or other income sources are being used to keep the household afloat, that $$ will not be there once she goes onto Medicaid. The house - which mom's owns- will be an exempt asset for mom's lifetime. But all costs of the house will have to be paid for family. If you are a documentable caregiver for mom for 2 years prior to her admission into a NH, you can apply for a caregiver exemption from estate recovery (MERP) for mom's house. Now each state does MERP uniquely so just how the caregiver exemption is done varies. Some states require a letter from her MD or social worker that XYZ was needed for mom and that you provided for that from XYZ date to XYZ date; with the letter signed off by the doc or SW with their licensing and registration with the state. Whether this is hard or easy will vary. If your state does the verification after death and mom lives for another 4, 5, 6 years it could be very difficult to get such a letter from mom's old MD from years & years ago. There are other exemptions, exclusions to estate recovery on the house but it's totally up to heirs to get the documentation in or to go thorough the probate process to deal with mom's estate. Meranwhile you are paying all costs on the house……

Please, please, please make sure that mom pays for her care and her needs from her income and assets. If mom pays you to caregiver, you need to have a caregiver agreement drawn up, all legal and you pay taxes on the income paid. Otherwise mom will face a penalty and ineligibility period by Medicaid and this will happen when mom is in a facility and you will have to private pay for her care for mom to stay at the NH.

I'm going to guess that the "move" was incident based and not really planned or throughout through??? Like mom fell. Really read the old posts and take notes and then take a hard critical look at mom's finances and then see an elder law atty to see what if anything can be done creatively with mom's $ at this point in time.
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