Imagine your parent or spouse has had a fall or a stroke and is hospitalized. Usually, the following days and weeks are spent getting him or her stable, talking to family and doctors, and wrapping your mind around the incident that happened. It can be a shocking and overwhelming time. Often, these events are the beginning of a major life shift where the family has to come to terms with a loved one’s changing needs and abilities. Where will he live? Who will take care of him? Do we have the right documents in place or do we need to go to court for assistance? And who’s going to pay for everything?
From the hospital, the patient will frequently be discharged for rehabilitation in a skilled nursing facility. The goal of rehabilitation is to improve the patient’s abilities, and he or she will stay for only a limited period. Insurance and Medicare will cover some (sometimes all) of the cost for a stint in rehabilitation. This is the point when the patient’s unpaid family caregivers are scrambling to figure out what comes next. The writing may be on the wall: It may be clear that your loved one can’t go home without significant help and may need to move into assisted living or nursing care. And this is also the time to explore Medicaid eligibility, if you haven’t already.
Introduction to Medicaid
Private pay for facility care or at-home care is quite costly. Adult day care averages around $20,000 a year, and a private room in a nursing home can be over $100,000 a year. Aside from the private-pay option, veterans’ benefits or long-term care insurance kicking in, this is where Medicaid health coverage begins for many people in America.
If you’re not familiar with how Medicaid works and haven’t applied for it before, it can add to your caregiving stress to try to figure it out without assistance. Be wary of taking nonprofessionals’ advice as truth. Get the facts for yourself.
Medicaid is a federal and state program that helps with health care costs if there is a medical need for care and the person is financially qualified. Every state has different Medicaid laws. If you review your state’s income and asset eligibility requirements and know without a doubt that your loved one doesn’t have income or assets approaching or above those limits, you may be comfortable applying without assistance through a Medicaid office. In those cases, nursing homes or social workers may work with you to fulfill the applications.
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However, if there’s any question about whether the patient has resources or income that would prevent them from receiving Medicaid, a qualified professional can save time, money, stress and a disqualification from Medicaid. The professional could be an elder law attorney (this is true even if the patient is younger than 65, if disabled), Medicaid planning professional, or Area Agency on Aging or geriatric care manager. They should be able to advise you on the different planning techniques that could be used, including how to legally lower your assets in advance of applying for Medicaid and how to avoid financial moves that could disqualify your loved one.
The benefits of professional advice
Don’t underestimate the value of bringing in professionals to assist. As a caregiver, I tried to handle everything by myself. Although at the time it felt like there was no time to pump the brakes and explore our options, looking back I know that a few hours of working with a professional would have spared hours of hair-pulling research and thousands of out-of-pocket dollars.
I remember a period that was possibly the most stressful of my entire caregiving life: My mom had just been discharged from the nursing home where she had spent a few months. (We paid out of pocket for those months.) She was at the point where she could walk with a walker — a huge improvement from barely being able to stand. The first night she was home, I heard her crying out from the bathroom. Her legs had given out on her. She could not support herself and thought she was having a heart attack. The paramedics took her to the hospital, where doctors determined she was not having a heart attack and discharged her. She did not get discharged to rehabilitation; she went to a hospice house. After hospice stabilized her, the hospice team first suggested sending her to another long-term care facility. My mind raced from Mom can walk and she’s going home! to She’s dying on the bathroom floor to Don’t tell me we’re going back to rehab to Don’t tell me she’s dying to We can’t afford another nursing home. It was paralyzing and a stress I wouldn’t wish on my worst enemy. Ultimately, Mom was allowed to stay at the hospice house, but I know now that she would have had more options if I had committed to exploring them.
It’s never too late to review
Even if your loved one is already in a nursing home, it may not be too late to do some planning for additional financial support for their health care. A Medicaid recipient may be dually eligible for Medicare or receive veterans' benefits. A Medicaid applicant can be married and their spouse may have assets up to a much greater limit than a single Medicaid applicant. Explore all options, because the application process can take some time. There are a variety of programs and services, and Medicaid is by no means a one-size-fits-all program. Understand that there may be limited services, wait lists and enrollment caps that would be barriers to getting services right away.
When a major medical incident occurs, even though your world may feel turned upside down, reach out for guidance on your loved one’s Medicaid and insurance options as soon as possible. Medicaid benefits may even apply retroactively for the patient; in my state of Florida, a Medicaid applicant who has unpaid medical bills three months prior to their application may receive coverage for those. There’s no open enrollment period for Medicaid (meaning that there isn’t one certain window of time each year when applicants can be processed), so you or your care partner can apply anytime.
And if there is consideration of moving your loved one from their state of residence to yours, know that Medicaid does not transfer state-to-state and that you will need to apply in the new state of residence. So, incorporate this into your moving plan.
Even if you and your loved ones have the luxury of good health and fair winds today, remember that someone turning 65 today has a 70 percent chance of needing long-term care. While it may be uncomfortable discussing money matters with our parents or children, plotting the course for the financial resources you may need in the future will certainly make a time of crisis that much easier to bear.