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How to Navigate Health Programs

Read a transcript of an online chat with Judy Peres, a long-term and palliative care expert

Medicaid does not cover all categories of all persons who have low incomes, but it does cover people age 65 and older and younger persons who have disabilities severe enough to qualify them for disability payments through the Supplemental Security Income program.

Medicaid eligibility rules are very complex and vary by state. In general, however, older people living in the community, like your mom, are eligible for Supplemental Security Income — or, in some states, those who have income less than the federal poverty level and who have financial assets of less than $2,000 for individuals and $3,000 for married couples are eligible for Medicaid. Supplemental Security Income provides cash benefits of up to about three-quarters of the federal poverty level to low-income people. Individuals are not eligible for Medicaid if they have home equity exceeding $500,000 ($750,000 at state option). Thirty-four states and the District of Columbia also have "medically needy" Medicaid eligibility rules, which allow people with higher incomes who have substantial medical expenses to "spend down" to Medicaid income requirements.

Comment From Jeff: I've heard conflicting things about respite care. I currently take care of my mother on a full-time basis. I was told she is eligible for 2 weeks respite care through Medicare. She is also a WWII veteran. Thanks for your response.

Judy Peres: Jeff, I am glad you are asking about respite care. Caregivers need time off from their caregiving responsibilities to relieve stress and prevent burnout. Brief reprieves from a caregiving situation are healthy not just for you but also your loved one. You have correctly identified the challenge in receiving respite care that is reimbursed. Medicare does not pay for respite care for the caregiver unless the patient is in hospice. Medicare respite care is inpatient care given to a hospice patient so that the usual caregiver can rest. You can stay in a Medicare-approved facility, such as a hospice facility, hospital or nursing home, up to 5 days each time you get respite care.

However, other help may be available. I suggest that you contact your local Area Agency on Aging for possible respite care sources in your area. You can also contact Senior Services and Social Services. Senior volunteer services and private nonprofit agencies are the common providers of home-based respite care programs. The U.S. Department of Health and Human Services Eldercare Locator Services helps place caregivers with agencies and services in their area. Their telephone number is 800-677-1116.

Comment From Susan Keller: Does the Affordable Care Act include coverage for palliative care for people dealing with life-limiting serious illness?

Judy Peres: Medicare is the dominant payer for care in the last phases of life. Medicare payment policies, however, are focused on acute care treatment in hospitals and skilled nursing services, which are not always aligned with patient goals of advanced illness management. Except under the Medicare Hospice Benefit and PACE program, original Medicare's financial incentives promote hospitalization and the use of skilled nursing facility settings. Because of the acute care focus, many components of quality palliative end-of-life care for advanced illness are not reimbursed. For example, interdisciplinary care, on-call services, home health aides for personal care, patient/family education for self-care, support and training of family caregivers, spiritual care, bereavement counseling and continuity of care across time, place and providers. The good news is that all of the above are covered by the Medicare Hospice Benefit.

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