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My grandfather is in a rehab facility following a hospital stay but is going to be released in a few weeks. He had a caretaker coming in three times a week and when she walked in, she found him on the ground and no one knows how long he was lying there following a stroke. He lives in WA and I am on the other side of the country. He needs at least daily visits but we think for his own safety that he should be in an assisted living facility. The problem is that he has already drained his assets but he makes too much from his social security income to qualify for Medicaid. Even the increase in caretaking costs to have someone come in daily would be more than we can afford as a family. None of us have much disposable income and we can't put a dent in the cost of daily caretaking, let alone the cost of the assisted living facility or a nursing home. We are concerned about his safety but also, no one is in a position where we can take him in. I'm out of my element and really need help navigating these waters. What happens if he needs care but can't afford it? Is there a way to forfeit his income so he can qualify for Medicaid? What options does he have?

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Here is a website for the state of Washington Aging and Long Term Support Administration.
They have a finder tool that will help you access resources and find out what's available in Grandpa's area in Washington for either in-home care or long term care. It includes a link to Area Agencies on Aging in various counties.

dshs.wa.gov/altsa/resources
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Talk to an elder care attorney about a Millers trust.
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Individual states determines the upper income limit for Medicaid. Miller Trusts are not available in all states. See and elder law attorney to help you thru the Medicaid application process.
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A great site is called social security works. Com. This site truly is amazing. Very helpful no matter what state you live in. Good luck. yuki
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rocketjcat's response is correct. I don't know if an actual Qualified Income Trust (aka Miller Trust) needs to be set up if his only income is SS, but effectively all of his income will go to the Nursing Home and Medicaid will pick up the balance of the cost. Once he qualifies for Medicaid, it may be as simple as assigning the SS payment directly to the NH.
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I live in Washington State and work for an Area Agency on Aging, so I know quite a bit about the Medicaid world. I would also recommend working with an elder law attorney in Washington who knows our state's Medicaid rules. Look for ones who provide Medicaid planning.

There's a great website called Washington Law Help (.org), with a lot of great info that might be good to read before contacting an attorney. I'd recommend reading a document called "Questions and Answers on the COPES Program." On the homepage go to the section on Seniors, then click on In-Home Care/COPES.

In Washington State, COPES stands for Community Options Program Entry System. It covers in-home care, as well as care in an assisted living facility or adult family home (a privately owned home licensed w/ the state that provides care for up to 6 residents). (Note these are different than skilled nursing facilities/aka nursing homes, which have different rules and are under a different Medicaid program in WA.)

The Q&A on COPES will explain how someone can qualify, how much income the individual keeps as a "Personal Needs Allowance," and how much they pay toward the cost of their care. Unfortunately, yes, if living in a residential community the facility will take the majority of the person's income and they get to keep a small amount for personal expenses. The state will pay a certain "daily rate" to the facility based on an assessment done by a DSHS social worker. So people with higher care needs get a higher daily rate than people with lower needs- the facility must then balance how much $ they'll get with how much work/staff time the person will take. When someone lives in a facility with the help of Medicaid the majority of expenses are covered--room & board, meals, utilities, most medical expenses (the state subsidizes Medicare), incontinence supplies, as well as Durable Medical Equipment. Their personal needs allowance can be used for things like clothing, personal items, fun outings, etc.

The big issue you will find, however, is finding a facility that will take him on Medicaid right away. Please note, I do not say any of this to discourage you, but to just let you know what you may come up against. Many assisted living facilities and adult family homes in Washington do not accept Medicaid at all, because the reimbursement is so low. The assisted living facilities that do, at least in Western Washington, usually require at least a 2-3 year private pay period before allowing a Medicaid "conversion" after the person has "spent down" their financial resources. They also have only so many Medicaid "beds," so if one becomes available, it is usually filled by someone who's already been living there & paying privately. Sometimes if they don't have anybody ready to convert and one of their spots is available, they may take a new move-in on Medicaid, especially if the person has a high participation/income (because they'll be getting a large amount from the individual on top of what the state's daily rate is for that person). So the best thing to do is ask, because you never know and you might have good luck!

Do you think he could return home with in-home care? He'd be able to keep more of his income, but he would likely pay a high participation if he has a high income (see the Q&A on COPES). Because he'd still be in his own home, he'd still have to cover all his own living expenses and utilities, bills, etc. The COPES program does not provide 24-hour care in the home. So if he is truly needing 24-hour care, he might be better off in a facility.

I hope this information helps! You can also call the Area Agency on Aging that is local to where he lives, as they might be able to offer advice and provide referrals for local facilities, in-home care options, elder law attorneys in the area, etc.
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Agree with above posts. Go to an elder law attorney who can help you the most. Now, I said elder law attorney not your family attorney. The elder law attorney will explain everything for you to do and why and when. The best to you..
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Agree with all of the above re: seeing an elder care attorney.

The key person here to be in touch with is the social worker at his current facility. THEY need to assess what the proper level of care is upon discharge and can probably hook you up with good local resources.

Talk to the SW and find out if they see him staying with them as a Long Term Care patient and if they will accept him "medicaid pending".
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Hoping someone with more Medicaid knowledge will chime in, but I didn’t know there was an upper limit on SS to qualify. My moms monthly income from SS and her pension is 3500. Now she pays most of her that to the NH and Medicaid pays the 6500 balance. So in effect she is “forfeiting her income” through the Medicaid process. If there’s a house or spouse involved it becomes more complicated, but your question was just about SS income.
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Every state is different. Office on Aging in your county should be able to help you. Some ALF take Medicaid, but you have to ask. Also at least in NY you can apply for Medicaid and either pay the excess income to DSS to qualify or have a Medicaid spend down. My mother's income is $75/mo to high and they allow her cost of Depends and vitamins and medication copays to be spent toward the spend down. They said we could just pay excess to ALF but then I'd still need to pay for those things. The other thing to look into for cost of homecare is a pooled trust. In that case the "excess" is his monthly expenses paid out, like rent or mortgage and taxes and insurance. Really you need to talk to the people (Office of Aging or Eldercare Attorney) from his state to find out what is best for him.
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