My aunt has been disabled most of her adult life. She is 62 years old. She makes $1600 a month; 1100 goes to rent and she lives on the rest. She pays about $15 a month for health insurance. She does not have a lot of medical bills because she’s in some program that pays what insurance doesn’t. She has rented her entire life and has no assets.
Because she is disabled, her income threshold for Medicaid is lower than for an adult. She would qualify if she wasn’t disabled but because she is, she has $450 over the income limit.
I understand there’s a spend down but she doesn’t make enough money to be able to spend $450 a month on medical expenses and still buy groceries, let alone pay her utilities.
What options are there for people that are just barely over the limit? Her family members cannot afford to put her in assisted living, but her caregiver recently passed away and she desperately needs to be in assisted-living.
Rather than the drastic option of Miller Trust or QIT (Qualified Income Trust) there may be an easier way in this case.
Check with an elder law attorney for options.
Otherwise look to advice from Igloo who is pretty smart regarding this stuff.
A ? for you?, as she is 62, is she on Medicare? Like on SSDI long enough that she is on early Medicare eligibility plus Medicaid as her 2 health insurances? If so, this is great as it makes it easier for facilities to do medical billing for those under age 65. She’d be on 3 programs!
Background: Initially LTC Medicaid designed for those assessed “at need” medically for skilled nursing care in a Nursing Home. Vast majority over age 65 on BOTH Medicare & Medicaid for their health Insurance (& why I asked on the above). However, what has evolved is for LTC Medicaid program to pay for care in places other than a NH. Done via “waiver programs”. But as each State administers it’s Medicaid system uniquely within Federal oversight, a State may or MAY NOT choose to do these type of waivers. So imho as a first step in this, you need to help her find out IF her State does LTC waivers…. ask someone at the program paying for the old caregiver and also contact ALs to see if they participate and have an opening. If so, find one she will move to under terms of being a “Medicaid (waiver) Pending” resident. If she does this, she will have a requirement to do a Share of Cost of almost all her mo income less her State Personal Needs Allowance. If she has debts, or she has a funeral policy she is still paying on, she will default. AL who participate in waivers will be an all-inclusive type, so meals, utilities, laundry and some transportation included. In theory, doesn’t have to have extra $ as living costs paid by the waiver. All she will have is whatever her State has set as it’s Personal Needs Allowance. Plus a maximum 2K of nonexempt assets in a bank account for most States*.
heres how it could work: my cousin in TX has Muscular Dystrophy. He’s youngish, 45 but absolutely requires assistance every day but not really skilled nursing level. Worked till his MD made that impossible. Is legally disabled. On SSDI of $1600 mo. and MediCARE as health insurance as he has gone past the 2 yr probation period for SSDI coverage plus on Medicaid for his supplemental health insurance. He is a “dual”. His aging parents can no longer caregive so he moves into an AL on a LTC Medicaid waiver & as he is a “dual” he will go onto whatever TX MCO / managed care organization his facility or his city/ county is matched with. TX has a personal allowance of $75 a month so he has to pay the AL $1525 each month. Keeps only $75. His TX AL is aligned with Superior Health MCO, so he now goes with their doctors and clinics; Superior has a nurse practitioner who visits his AL regular. Should his medical needs increase, he will be referred to a SNF and move to the regular LTC Medicaid program.
* but for my cousin, as his disability stemmed from birth, he opened an ABLE bank account 5 years ago and we have placed 50K into it. $ in his ABLE account is not counted under LTC Medicaid rules. He does not have to spend it down to the 2K maximum that TX LTC Medicaid has in place for any & all other nonexempt assets. He can have both his ABLE bank account $ and up to 2K in another account. If he had not had an ABLE account and it was 50K in a regular savings account, he would have had to spend down 48K of it to be eligible for LTC Medicaid waiver.
Rules on these programs not straightforward. Complicated & confusing Personally I think an actively involved in their life POA can do an individuals LTC application. But for couple or outlier applications, like yours, having an atty do it is best.
Who is the POA for aunt?
If Aunt is mentally competent on her own, and has been this long on Disability, then I would be she has better access to this system than most of us in terms of getting questions answered?
Has Aunt discussed this with her Disability Aid workers?
What research on all this has Aunt and family done?
I am going to direct you to "the horse's mouth" for best answers about these questions.....that would be calling the program itself directly and asking for a counselor to answer and guide.
If the Aunt and her family go to online search engines (Google, Bing, et al) and types in "who helps those on disability aid with questions) you are going to comes to a massive line of both agencies and Disability itself.
You might also consider calling Local Council or Agency on Aging for pointers of where to start with these complicated Questions.
It is rare for disability to cover ALF but it may often cover group home situations. All of this will go according to state programs state by state.
Igloo here on AgingCare is often great at the complicated answers to some of these questions. She isn't always here, so I hope she's wandering the web this a.m.
Good luck.
Wishing you luck in researching the right direction to go here, but I honestly haven't a clue.