No Medicaid assistance because $1,374 a month in SS is too much. Any advice? - AgingCare.com

No Medicaid assistance because $1,374 a month in SS is too much. Any advice?

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Haven't been on here for months. Wife and I had taken care of her mother for 8 years but could not do it any more, 3 hospitalizing falls in 3 months, and had us trapped in full time assistance. No appreciation from her or wife's brother, so we placed her in nice AL facility, $3400 a month. She had accumulated enough from living cost free with us to have enough to last about 6 months on private pay. Facility said no problem, they'd take her on Medicaid when she ran out. All seemed logical, only thing is she'd have to go into a shared room. State only pays them about $1280 a month but that was OK.

It's time to apply for the assistance. Turns out that she gets $1,374 a month from SS before Medicare payment. State says that their limit is $1,228 (North Carolina) and even if she got $1,229 from SS she would not get one nickel for AL. Yes, if she needs nursing care or memory care that limit goes up and they'd likely cover. But now, nothing, nada. So it's us use her SS and OUR money to make $3400 a month or I have no idea. I'm stunned. We do not want to deplete our resources at about $2500 a month. Does this make sense?

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ShadyAcres - you are a gem! Really all this a lot to ask of family much less the in-laws.Thank goodness you have the deeper pockets to coshare the additional costs with the other BIL. My hubby & I were 110% in agreement that neither of us would ever take either mom in early on in our relationship and thank goodness as seen too many "would be happy as we approach or are in retirement" couples who now are at the divorce / estrangement stage due to 1 of their parents moving in with them or 1 of them is now all focused on their parents need and forgets their spouse. Or as hubs says - total hallway sex (where you pass each other and say F*U). We & many of our friends kinda has a precursor to all this due to Hurricane Katrina and spent a lot of time figuring out where & how to live /work in a great deal of uncertainty for ourselves & our elderly parents. There is the rare sweet mom or dad who is a delight to have in the household but really family just cannot provide the level of care that they need as they age. Good luck on getting MIL qualified for NH, work with her doc on this so she can have the chart clearly showing need for skilled nursing care so she can get in.
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Had a nice conversation on phone (wow, free!) with local elder care law attorney. Basically confirmed that there are no solutions available other than cough up. Said that consensus is that within 3 years in this state there will be NO assistance for AL care. So I guess everyone's OK with an 89 yo person who worked til they were 80 having to figure out how to live with their walker and horrible back on $14,000 a year.

Talked with AL facility and their non-Medicaid shared rooms are nicer than Medicaid. The M ones basically have a partition, the non-M have two separate bedrooms and a shared bath, so that's fairly livable. Cost is $2500 a month, add in personal stuff, Medicare supplement, and after her SS it's about $1700 a month out of pocket. Split with brother in law that's a doable number for us. Frankly, given her declining energy levels it won't be long before a Dr. can certify her for nursing home for which she would meet the limits.

It'll be interesting seeing how she takes this. She insisted she didn't want to go on Medicaid, I guess for pride reasons. She will still not like moving into a smaller room, and can't wait to hear the complaints. I admire everyone who cares for elderly and know that it is a far greater burden for many than this has been for us. However, 8 years of her in our home, falling doing dumb things, failing to do anything for herself including prescribed therapy, being one self centered person who has never showed anything like sincere appreciation, well, I'm done being the gracious accommodating son in law. Will do anything and everything to help my wife in her efforts, but ever since she turned on us both and showed her true colors, I've had it.
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Really other than paying for the elder law attorney, I would not spend a penny of your own $ in all this.

So it is the problem that the state won't pay for any AL? at all, ever, only NH?
OR
is it that mom is $ 146.00 over state limit of $ 1,228.00 max monthly income?

If it's the latter, mom can probably do a Miller Trust (aka Qualified Income Trust) for overage, and she will then be within state limit. Attorney needs to do a Miller & they are totally legit for Medicaid.

But if it's that no matter what, Medicaid will not ever pay for AL, then you have to get mom qualified medically to show the need for skilled nursing care aka NH care so she can move into a NH. Now the easiest way would be IF the current AL's medical director will write up the orders for mom to show that "skilled nursing care" is needed. Will they do that?

For my mom I moved her from IL to NH and totally bypassed the AL stage. Her IL was at a "tiered facility" that went from IL to AL to NH and had a hospice wing - I thought it would be the perfect solution. So wrong. The medical director (who was not affiliated with the gerontology group my mom saw) would not accept mom in the NH - even though she had orders for skilled nursing needed from her doctor - the facilities medical director stance was she was OK for AL. The AL (like her IL) was only private pay, & imho you cannot overlook the whole profit motive on all this.

What I did was basically find another NH. Now the gerontology group mom was in also were medical directors of several NH. So I just got her into one of those. Now you may have to have her seen every 4 -6 weeks to build up her medical file to show the need for skilled nursing care. It took about 3 - 4 months and the visit where she had a 10% weight loss and & bad H&H lab report, he wrote the orders.
Also there are some easy changes that can be done, like change the Exelon pill to the Exelon patch which requires more "skill" to do; or compounding a medication which requires more "skill" to do.

Right now for your mom, I bet she will not qualify for NH as she's good for AL. So you need to do whatever to change that to needing skilled nursing care so she can get cleared for NH and onto Medicaid. Hopefully her current place will work with you but if not start calling around to get the names of MD who are medical directors of other NH and get your mom to become a patient of theirs. Good luck.
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My husband's SS was over a limit, too, so we had a monthly "spend down" (like a deductible) before Medicaid kicked in each month. That was in Minnesota, and that was for in-home care (things like day care, a PCA, medications, etc.) I don't know about your state and about ALF. Certainly what you are describing does not make sense, but that has never been the criteria for bureaucratic rules. :(

If I were you I would consult an attorney who specializes in Elder Law and knows all the ins and outs of Medicaid in your state. I certainly hope you will not have to deplete your own assets -- you are going to be old someday, and who knows what your care needs will be?
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