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It’s me again. Someone told me they were asked for $54,000 up front until Medicaid kicked in. Is this possible??? We’re on community Medicaid they already know we don’t have assets of 54,000 hanging around.
You need to talk to the Administrator at the nursing part to get info straight. They may not take Medicaid until the person has paid privately for a length of time. My Moms AL wanted two yrs private pay before they would consider Medicaid. Then there had to be a spot open. If this is how they work, then you will need to look around. Make an appt with Medicaid to see what you need to do to set up Medicaid for husband. Take bank statements along and proof of any other assets, like bonds, shares, stocks, CDs, IRAs. SS info and pensions. This will give them an idea of how the assets can be split so you will get enough to live on. Oh, cash value insurance policies not provided by the employer. If you feel after talking to a caseworker its too overwhelming, then consult with a lawyer.
Is the facility one that has an inital buy-in and they also have a open to the community a day program that anyone can participate in? If so, that’s 2 totally different programs and tracks for how things are paid for.
I’d bet the day program is part of a community outreach that has state, city, county or religious organization funding that between all those covers operating costs for the day program. The residents of the facility likely have a part of the $ they pay within thier monthly bill that goes to the day program. If your hubs as a community participant pays a small fee or goes for free, it doesn’t really affect the bottom line of the day program. A lot of the services (flu shots, blood pressure checks) are billed to Medicare and the place likely get a management fee for hosting these. It’s a win win for all as less Medicare billed for a MD office solo visit for those in the community program; the facility herds their residents over for health screenings so less facility staff time for routine stuff.
Medicare likely has a shared billing to Medicaid for anyone in the day program that’s a “dual” (on Medicaid & Medicare). If this the system then it’s not the facility taking Medicaid but the day program taking Medicaid.
The distinction is important cause if he were here to become a permanent resident he would need to meet whatever requirements they have for entrance. If they don’t participate in LTC Medicaid, then its private pay. If this is the situation then your going to need to find a place that takes LTC Medicaid. His community Medicaid eligibility has different requirements than Ltc Medicaid does. A lot of places do not take LTC Medicaid; they only take Medicare for health services billed but are private pay for the room & board costs. Some places that have a AL & a NH only take Medicaid for the NH part and draw exclusively from a waiting list of current residents living in the private pay AL section to fill the limited # of medicaid beds in the Skilled nursing/ NH section.
If he's been going there for a while, you’ve gotten to know the staff. I’d suggest you talk with the SW ( social worker) as to what other options for places exist. Private pay places have residents run out of $ all the time and it’s the SW who often helps find a new place for them. The SW should have ideas for you. Good luck.
oh also LTC Medicaid is going to look at your & his assets totally differently than Han community Medicaid. He’s only allowed 2k in assets, he has to be impoverished. But you DO NOT yourself have to be impoverished. But you may have to move $ to establish yours vs. his. To me this is never a diy and your best having an elder law atty look at your situation before you ever file for Medicaid. You can have in most states 119k as your assets and your income is not a factor for him. If you need some of his income to make ends meet, the atty can shepherd your getting a Community Spouse Resource Allowance from his monthly income (instead of all of his income getting paid to the nH). CS stuff is not simple, really an atty is worthwhile.
As we’ve said in your other post regarding what Medicaid will and will not do, you should consult an Elder Law Attorney who specializes in dealing with the tangled webs of Medicaid and knows the laws of your state.
Even if Medicaid has all your facts and figures, I’m sure you’ll still have to fill out reams of paperwork for a transfer from long-term, in-home care to Nursing Home Care.
I never heard of a facility asking for what could amount to almost a year’s board and care up front. Who is the “someone” who told you that? My mother was admitted to the Nursing Home Medicaid Pending. She was self-pay until Medicaid kicked in.
If you don’t want to hire an attorney, call or visit your local Medicaid office. Take any paperwork you have regarding the Community Medicaid. Don’t leave until you are absolutely certain you understand what they’re telling you.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
I’d bet the day program is part of a community outreach that has state, city, county or religious organization funding that between all those covers operating costs for the day program. The residents of the facility likely have a part of the $ they pay within thier monthly bill that goes to the day program. If your hubs as a community participant pays a small fee or goes for free, it doesn’t really affect the bottom line of the day program. A lot of the services (flu shots, blood pressure checks) are billed to Medicare and the place likely get a management fee for hosting these. It’s a win win for all as less Medicare billed for a MD office solo visit for those in the community program; the facility herds their residents over for health screenings so less facility staff time for routine stuff.
Medicare likely has a shared billing to Medicaid for anyone in the day program that’s a “dual” (on Medicaid & Medicare). If this the system then it’s not the facility taking Medicaid but the day program taking Medicaid.
The distinction is important cause if he were here to become a permanent resident he would need to meet whatever requirements they have for entrance. If they don’t participate in LTC Medicaid, then its
private pay. If this is the situation then your going to need to find a place that takes LTC Medicaid. His community Medicaid eligibility has different requirements than Ltc Medicaid does. A lot of places do not take LTC Medicaid; they only take Medicare for health services billed but are private pay for the room & board costs. Some places that have a AL & a NH only take Medicaid for the NH part and draw exclusively from a waiting list of current residents living in the private pay AL section to fill the limited # of medicaid beds in the Skilled nursing/ NH section.
If he's been going there for a while, you’ve gotten to know the staff. I’d suggest you talk with the SW ( social worker) as to what other options for places exist. Private pay places have residents run out of $ all the time and it’s the SW who often helps find a new place for them. The SW should have ideas for you. Good luck.
oh also LTC Medicaid is going to look at your & his assets totally differently than Han community Medicaid. He’s only allowed 2k in assets, he has to be impoverished. But you DO NOT yourself have to be impoverished. But you may have to move $ to establish yours vs. his. To me this is never a diy and your best having an elder law atty look at your situation before you ever file for Medicaid. You can have in most states 119k as your assets and your income is not a factor for him. If you need some of his income to make ends meet, the atty can shepherd your getting a Community Spouse Resource Allowance from his monthly income (instead of all of his income getting paid to the nH).
CS stuff is not simple, really an atty is worthwhile.
Even if Medicaid has all your facts and figures, I’m sure you’ll still have to fill out reams of paperwork for a transfer from long-term, in-home care to Nursing Home Care.
I never heard of a facility asking for what could amount to almost a year’s board and care up front. Who is the “someone” who told you that? My mother was admitted to the Nursing Home Medicaid Pending. She was self-pay until Medicaid kicked in.
If you don’t want to hire an attorney, call or visit your local Medicaid office. Take any paperwork you have regarding the Community Medicaid. Don’t leave until you are absolutely certain you understand what they’re telling you.