I am overwhelmed with the financial planning for my dad's long term care.
We looked at assisted living facilities, and he was assessed and determined that he needs skilled nursing. Unless he improves, he will need skilled nursing. He recently asked me to look into a reverse mortgage to pay for his care while he stays in his home. The thing is, his level of care needed. He will need skilled nurses to visit 8 plus hours a day.
I spoke to an elder law attorney for some advice (free 15 minute consultation). She mentioned a STAR PLUS waiver. I read up on it, but I don't understand it. And how it relates to Medicaid.
Any advice is deeply appreciated. Thank you!
Star + Plus is a Medicaid waiver program that places elder enrolled in community based Medicaid into a MCO - managed care organization - for all care needs which Tx Medicaid pays for directly to the MCO. They can pay BOTH for clinic hospital stuff but also in home care if he’s assessed to need it and the MCO can do it. Depending on where you are in TX will determine just how many MCO options are out there. If dad is really rural, it can be a red flag as flat not many to choose from.
If his care is high, maybe over 32 hrs week, it might be that it’s beyond the max allowed by MCO to do in home care. In home care seems to run 18-24 hrs per week avg with all other care time either done by family or dad hires caregivers to be there when family cannot. Your going to find there’s a Tipping point on max # of hours. So if your dad is clearly over that, he’s going to be assessed for in facility care with 24/7 oversight.
Molina, United & Superior are biggest players in MCO for Texas. Superior imho is really good MCO as they have been in this for ages with Medicaid kid health programs; have well established relationships with hospitals, clinics, labs, which has transferred over to their elder health care network. I think all big TX cities have Superior.
the other red flag is on the RM. $ RM pays him is “income” for your dad. This is sticky as Medicaid is “at need” both medically and financially. You would clearly need to find out IF that RM $ paid to him would increase his income to the point that he would NOT be eligible for community based Medicaid. Also before he does a RM, look to see if the amount of $ actually paid (maybe 45% of appraised value) is actually enough $ to pay for inhome caregivers the 5 or more days he needs for 2+ years besides whatever you and family provide for free. AND if his old regular income (like his SS $) can cover all his home & living costs for 2-3 years apart from the RM$. If that RM flat isn’t enough $, I’d try to keep him from doing it. Just sell the place and he use the $ to private pay for care, unless you / family have your own reasons to have him continue to own it and you want to assume property costs without owning the house.
Please realize that MCO will require dad to only get care within the MCO network. It’s similar to Medicare Advantage plans in this aspect. But the MCO will be lots more calendar based for care, like he will be seen automatically every X # of days for his BP by a MCO tech rather than he calls and set an appointment with his MD internist.
The NH in TX are mostly all now on MCOs too for those with Medicaid beds. If he gets in a community based MCO, you might want to have him go into a Medicaid accepting NH affiliated with the same MCO. So ask if the MCO your looking at also does LTC facility as well.
good luck and take breaks when you feel overwhelmed!
https://hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus
I would call Office of the Aging in your County and make an appt to have this explained to you. Your Social Service office maybe able explain too.
My opinion, these programs may not supply the hours you need. You will still need to be the Caregiver. If an AL says he needs more care than they can give you may need to consider LTC with Medicaid helping to pay the bill.