Just this past week the clients I saw about applying for Medicaid to hit almost all the items on this list. Scroll down and see if any happened to you.
1. The nursing home tells the family: “We have no long term care beds. Your spouse/parent will have go to another nursing home.” (False)
This reason occurs when the person is discharged from the hospital for skilled care (rehab) in a nursing home. It is often a nice, expensive looking facility. After a few weeks the family is told the Medicare rehab is over and you will have to find another.
Why get advice? Because most nursing homes in Metro Detroit have long term Medicaid beds. There are two reasons why the corporate office tells its admission employees there are no Medicaid beds, when in fact the whole facility may be licensed for Medicaid. (It happened last week.)
Reason 1: Medicare pays hundreds of dollars a day more per day than the nursing home gets from long term care patient/residents. (That’s true of “private pay” as well.) So the nursing home strategy is to get people in only for the short term Medicare treatment. They have no intention of serving all residents for long term care.
Reason 2: When it comes to long term care, Medicaid pays “wholesale” not retail. That is Medicaid does not pay the $400 per day the nursing home will charge the resident. It pays perhaps two thirds that rate.
2. The nursing home does not tell spouses about their right to part of the savings and resident income.
Under Medicaid a spouse is allowed a share of the money (assets) and the income of the nursing home resident. Let’s use a hypothetical Smith family. They have $40,000 in savings. Mrs. Smith has social security and pension income of $2,700. His wife has Social Security income of $800.
Savings: In 2019 Medicaid allows a “community spouse” is allowed a minimum of $25,284 (and the resident/applicant is allowed $2,000). The Smiths’ have $40,000 in savings. Their “spend down” is $12,718. They could meet the entire amount by prepaying the resident’s funeral at the maximum allowed by Medicaid. $12,770 (2018). They may more realistically spend about $7,000 and use the other $5,718 on other needs or bills. (Caution, see next paragraph on Income.)
Income: The community spouse is not told about her/his right to income support. Medicaid allows the community spouse a minimum monthly of income of $2,057. The spouse is almost always allowed a few hundreds dollars more by “excess shelter expense.” This includes rent or home taxes, insurance and utility expenses. So let’s say a wife has social security income of $800 and her husband has an income of $2,700. If her calculated monthly income allowance, including excess shelter expense is $2,357 then she would get $1,537 of her husband’s income to get to $2,357. His monthly Medicaid co-pay would be the remainder minus $60 for his personal needs and enough to pay any monthly medical insurance premium. If his monthly insurance premium were $303 a month his co-pay would be $700. (Medicaid calls the co-pay the “patient pay amount.”)
3. The nursing does not tell the family about “retroactive” application.
Families are not told that instead of paying the nursing home they may “spend down” and apply the next month for Medicaid. Medicaid’s rule is if you complete the spend down by the end of the month you are eligible the whole month.
Example: Mr. Smith’s Medicare rehab ends on the 10th. The nursing home tells the spouse they want a check for $14,000 to pay to the end of the month and for the next month. What should Mrs. Smith do? Write no check and inform them she will apply for Medicaid to pay his bill. She would then proceed to do the spend down in number 2 above. After she got all the paper work together she could submit a Medicaid application the next month along with a “retroactive application” (a separate form) and have Medicaid pay the entire bill except his monthly co-pay. She would write a check to cover his co-pay. In 2 above it would be $700 and the next month it would be another $700.
4. The family is told they need to spend down by paying the nursing home. (False)
While it is true that a resident is responsible for getting his bill paid, that duty may be satisfied by applying to Medicaid for payment. As relayed above Medicaid requires “spend down” of assets until the resident is eligible. That spending can be anything for the resident or spouse. It need not be for the nursing home. It could be for prepaying the funeral. It could be to fix up the house so that it could sell for a better price. Almost all homes of elders could use a ‘refreshing.” It could be for the purchase of a new car.
5. The family is not told the resident may pay nothing to the nursing home if he will return to home within 6 months.
As relayed above the resident’s spending not only includes spend down of assets but also a monthly co-pay. That monthly co-pay can be waived if a doctor certifies the resident is likely to return to home within 6 months.
6. Bonus! This article is not legal advice. (Don’t rely on articles like this. Verify your situation. Get advice from an attorney!)
MORAL: Medicaid is such a complicated program that very few people know the allowances it makes for the applicant and family. Get advice, save your hard-earned money for those you love and get your benefit from all those taxes you paid for decades.
And, of course, give us a call if you want to be sure you are saving as much as you can, (Hint: 248-356-3500)
