Bella7 Asked January 2018
AL rent increased to $660...Dad gets $650 from SS. Now what?
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He has Medicare and Medicaid. I called the Social Security office today to ask for an increase and was denied. The new administrator at the AL is new and so far has been of no help. The lady said either family has to pay the rest or find a new home somewhere else, like my home! Um, no to my home!
Now what? I need to know what kind of questions to ask and to whom...any kind of advice that's out there please direct me!
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Apparently this facility took Medicaid in payment in the past. Apparently they still accept Medicaid payments.
Medicaid has a schedule of what they pay for what level of service. It is pretty much never the full asking price of the facility. That is why not all facilities accept Medicaid -- if they do, they also have to accept what Medicaid is willing to pay. Let's say this ALF charges $3,800 per month for the level of care your father is getting. Medicaid says, yes, we'll pay for this eligible person, but our schedule caps out at $3,000 for this level of care. [I'm making these numbers up.] This person must pay you $650/month, and we will pay $2,350. The facility cannot make someone else pay the $800 they come up short (compared to self-pay). They either accept the Medicaid number or they can't receive any Medicaid (for any residents).
The facility could raise the fee to $4,000. Private pay residents will have to pay the increase, but Medicaid will still be paying $2350, and Dad will still be paying $650, per law and legal contract. These amounts would change if 1) Dad's SS goes up or 2) Medicaid adjusts their fee schedule.
BTW, did Dad's SS amount go up a little for 2018?
Keep in mind that when Dad gets the proceeds from the sale of his house, he will not be eligible for Medicaid until that money is gone. For that period he will be paying the private-pay rate, which is higher than Medicaid has been paying. And it is higher than it would otherwise have to be, because the private pay fees are in effect subsidizing the Medicaid rates.
With funds so tight, I hate to suggest this, but it could save you money and hassle in the long run. Consult an attorney who specializes in Elder Law. The house sale should be handled correctly and also in the best interests of your Dad.
Try calling your Area Agency on Aging to see if there may be some legal assistance available.
By the way, did I mention that the way we pay for medical care in this country sucks?
LTC is a huge part of Medicaid, somewhere like 35-60% of costs. Feds require skilled nursing care to be a benefit. What I think will happen is that the medical “at need” aspect of Medicaid will be drastically narrowed.... that to enter SNF you will need 2 step MD certification (like what Hospice does, so there’s a system already used like this) to show medical “need” and they must be coming from a multi day hospitalization (so first 20/21 days paid by MediCARE, so less paid by state & they have a medical chart that is easily accessed) and medical recertification every 90 days and a part of the existing every 90 day care plan meeting required by MediCARE. No more moving into a NH from living at home, IL or AL. It’ll reduce NH admits 30-40% I’d bet. Just too bad for families if elder has to move in with them cause their still good on ADLs....
You know all of us who post on this site are experts on Aging & LTC.
Share your knowledge.
Folks just have no idea what AL, NH costs or how tight Medicaid eligibility is.
Or that MediCARE does not pay for LTC.
Or that Medicaid requires a share of cost of their income.
Work in detail info you know & experiences you’ve had into every day conversations. I’ve stopped being surprised that folks have no idea that NH cost 7K to 15K a month but it’s still good to enlighten folks with that dire info!
By the way we are purchasing his property at fair market value at the amount of $100,000 which will go straight back into Medicaid. We have done everything by the books! I'm NOT Complaining about the 10 bucks, what do people do when they don't have family to help them out continuously?!?
What if he didn't have us who would come up with the 10 bucks?! because he has nothing!
They're telling my dad he'll only get 30 bucks a month to spend
"only gap in funds" I WISH!
The deal is, I turn over all of my SS money except the personal allowance, and Medicaid pays the rest up to their limit, and the facility simply has to accept that.
So ... if Dad got a small increase this year in his SS, then the AL is justified in expecting him to turn that increase over to them. That's the deal. They are still losing money compared to their private-pay rates.
Do get some legal assistance with the property purchase. This stuff gets complicated.
Has lived at AL a total of about 16 months...(moved back home for 3 months last Spring) then back to AL.
Not once has he received any allowance. It's been a constant battle with the "officials" in charge of the finances there at AL. No one can give an answer why...it's always "we'll check on that " or "we need to contact such and such "etc. etc...
Anything my dad needs he gets from my husband and I, we pay his pharmacy bill that Medicare or Medicaid doesn't cover, we buy his toilet paper, clothes, rolaids, milk/food for his fridge, you name it! It's endless!!
Am I complaining? Yes! Because this father of mine was not there for me growing up when I needed things. Not material things, just the basic stuff it takes to raise a kid! My mom did it all. Dad had a girlfriend and took care of her two kids, he never came around or tried to call me or visit me or ask me how I was doing.
Skipped out on child support too and was forced to pay or face jail time. When I was born he told my mom that I was now her entertainment!
In my opinion this man I call dad is very lucky to have me for a daughter but most of all he's lucky that I married a man that has made me to do the right thing and that was to step up and take care of my damn father.
So yeah we will keep paying his way...who cares about the 10 bucks
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