Trying to get home care for my mom, which means spending down. When that happens, I'm wondering about QUALITY of that care from state-run agencies?? I think our state (TN) uses Dept. Human Services agencies and contractors. Is my assumption correct? Whoever sets this up has had trouble keeping staff, and there are lots of "no-shows." One contractor could not find a caregiver, and we never heard from them again. A little later, another contractor sent someone, but we were notified they too eventually left their agency. I am not even sure of the status of whether or not anyone is trying to find someone. My thoughts are, my mom has to spend down, we could do that with some independent care agencies (they too have staffing challenges, these days, but there seems to be some accountability thru management.
BUT
that being said, Medicaid is a huge program…. Like everything from those big “Happy Teeth” vans for kids, to loaning out breast pumps, to paying for LTC in a nursing home. Each program has specifics as to income and assets for eligibility for an individual.
Heres what I’d suggest that you clearly find out about… your post reads that your mom is looking to be eligible for Medicaid IHHs program. In-home health services. (I’m assuming that she is a widow living in her home which she owns.) That is a way different program than LTC in a NH. Now for NH eligibility, rules are pretty clear cut for income & assets, income will have a max set by your state - abt $2,100-$2,300 - almost all their income is required to be paid to the NH ea mo as a copay AND assets are fixed at 2K max, These are kinda what it is universally w exceptions of extremely high cost of living areas like NYC or couple of states that do capitation approach. So if mom has a savings account with 50K mom has to do a spend down first of 48K to be ok for LTC NH Medicaid.
BUT
if it’s community based Medicaid program, those r not quite so draconian for income & assets. They r still living in the community, have a home or an apt / have a car so they have expenses related to all that. They r NOT required to spend down to the 2K in assets that LTC Medicaid requires. For community based Medicaid programs, it’s more about showing to be “at need” medically for care, getting assessed for # of hours of care and then doing a small copay of some of their monthly income towards the IHHS. Their assets come into play only if it’s a significant (maybe over 100K) amount of $ or their home is significant (+550k / 850k on upper E coast) value.
Please try to clearly find out what the maximum is for income and assets for whatever SPECIFIC program your mom is trying to get into. You don’t want her to spend down assets on things that she really doesn’t need to. Comprende?
Now on the finding a great IHHS company. To me a lot of this will depend on your mom’s assessment. Someone who is at 18 hrs a wk of care likely is categorized as any worker can provide, but one who is at 28-32 hrs of week is going to need more specialized caregiver. If mom is up there in hours needed, like shes 28+ hrs, I’d actually be way more concerned that she is not at all suited for IHHS, she’s more at the point of need 24/7 oversight which usually means NH or MC level of care. If this at all could be your mom - unless you & other family are going to be there to caregive all the non IHHS time OR you/ family/ mom are going to private pay for all non IHHS time - your more realistically looking at LTC placement for mom. What does her assessment show?
Personally, if she’s on the high side of needs assessment on IHHS right now, I’d fold it on doing inhome care and start to look for a NH or MC for her and use her savings to spend down to private pay for care in a facility that also has Medicaid beds. And sell her home unless the heirs have a pretty good possibility of exemptions/ exclusions to Medicaid estate recovery aka MERP.
Any Medicaid program participation if over 55 will involve MERP in some way. Keep this in mind if mom has a home or land.