For those of you who haven't had to deal with Medicaid yet, here is a preview.
I just got DH's yearly renewal paperwork to fill out. Let me quote part of it: "Attach proof of the amount of each resource received as of the first moment of the first day of the most recent month." Certainly. I'll just pull that out of the air for them in my spare time. (And how do you "receive" a resource? A resource is an asset, something you already have. They list income in a separate section.)
They listed every resource we have--twice, once in DH's name, and one in mine. (I wish we had twice the resources, but we don't.) And they also listed a bank account I closed a couple of years ago. I don't think I even have paperwork on that account now, after such a long period of time. But just saying the account is closed isn't good enough--I have to prove that the account was closed. Usually if you close a bank account, they want a statement from the bank as to when it was closed, and they want proof of what you did with the money.
Medicaid is a nightmare. One year I had to go to a hearing on an appeal when they denied DH's benefits. They said I refused to comply with their request for documentation. When I called them about it, they looked in the file and found the necessary documentation right there. Then they said that it wasn't the right paperwork. When I told them it was exactly what they asked for, they said I would have to prove I submitted the information (I guess the information being in the file wasn't enough proof), and then prove that it was the right information. I filed an appeal immediately. Then they told me that if I would drop the appeal, they could resolve the case right away. Fortunately, I didn't fall for that. I had already had enough dealings with them. They actually went to the hearing with the documentation I had sent. You know--the documentation that they said I refused to provide. The judge asked them why they were there, since they had the information they had requested. That was my question, too, but I was trying not to cause a scene in front of the judge. I was so scared and intimated by the whole situation. Thankfully, DH's Council on Aging case manager went to the hearing with me. It was nice to have a witness to everything, because the situation was so bizarre that I thought my mind was playing tricks on me.
Every time I get an envelope in the mail from Medicaid, my stomach starts knotting up. I know that some of you have your own stories about Medicaid. But if you haven't dealt with them yet, please take them very, very seriously. And if you ever send them any kind of paperwork, keep copies and send it by certified mail or by fax so you have a receipt. You can't be too careful. Gee, I sound kind of paranoid. Guess I am--with good cause.
I suspect they get reports from the same credit bureaus the banks use, and it is normal for them to have mistakes, especially listing accounts that have been closed. Makes me think that it is a good idea to get your credit reports before applying for Medicaid so you can ensure they are accurate. And then they got the report for you and your husband separately which resulted in they counting assets twice. This is the fault of the civil servants, they should have figured that out early on.
Faxing is no guarantee either. Wasn't Medicaid, but one time I had to send in paperwork so I faxed it. I had the receipt showing it went through but they could not find it. Told me the receipt was not proof they received it. So I no longer fax. Just like with email, it can get lost in transition space!
Jan, Boy did your post ever bring back memories of Medicaid. I too would almost have panic attacks going to the mailbox. I began to wonder if I was going off the deep end. I ended up paying a lawyer because the hassles that you describe were getting to me. I hated spending the money on a lawyer but I felt like my sanity was worth more. One story and this is the truth. Every year they "reevaluate" your benefits. I got this packet in the mail. I sent back everything they asked for. One day my lawyer called and said his benefits were being denied because I did not send in the correct information. I called my worker. She told me what to send. She gave me the fax number to fax it to. I did that and was denied because I did not send in the correct paperwork. Called my worker again. I tell her I swear I faxed it to the number you gave me. She tells me and I quote, "oh if you use that number we never get it." Had to send it certified mail. Unbelievable. If you can afford an attorney pay the money.
And remember as you are going through all this to be nice to them no matter what. Any snittiness or "attitude" and your LO's file is likely to go straight to the bottom of the pile. You must be lovely. Then make a small effigy of your caseworker and stick pins in it.
We absolutely, positively had ZERO assets when applying for Medicaid for Sid, so there was never a question of being approved. No problem with paperwork because there was nothing to report. HOWEVER, a big part of why I almost had a nervous breakdown and was unable to eat for 2 years was the stress and humiliation they put me through. Remember these words- Medicaid is NOT your friend. They are not there to help you. They are there to deny you. I don't know where the humiliating you comes from. They continuously told me that they were going to leave me with so little money that I would have to make a choice between placing Sid and being homeless. I swear to you, they said that was the hard choice many families had to make. They berated me, insulted the way I lived ( too upscale for them), and just about broke me into little pieces. Eventually, after 2 years of this, I contacted a compassionate agent from family services who assured me that I would be allowed to continue living in my Independent Villa, and he helped me through the process.
My best advice - Don't go it alone. Find someone who knows the system inside out to help you.
Wow..........I'm reading all this and thinking "How did I escape all this?" Maybe we weren't on Medicaid but whatever it was, I never had any of these problems and everything was free and easy.
Are Medicaid applications handled by the states or the federal govt? The states set eligibility requirements within federal guidelines. A quick look on the Internet shows applications accepted on state run servers. If the states handle it this could explain why applicants have very different experiences in applying for Medicaid.
Medicaid applications are handled at the county level. That is why even in the same state, people can have very different experiences county-to-county in terms of how the regulations are interpreted. Also, the county Medicaid case managers (at least in my NY experience) are so over-burdened that the job is essentially un-doable. Case managers in one of my NY counties had 700 files apiece. Medicaid is a godsend for those at a certain income level who need health care services, but it is no walk in the park. Unless your assets/income are so low that you're an open-and-shut approval, I'd recommend that you have some kind of advocate (Medicaid attorney, maybe) before you go down to DSS.
Off the subject of Medicaid, I'm interested that George found everything free and easy. I never had any trouble with Larry's insurances, either. He had the retired NYPD insurance, which was an HMO, and then he had his Medicare. The two together pretty much covered everything except for some co-pays which I don't remember as being a big deal. When he went on Hospice at home, and Medicare picked up 100%, that was just a gift sent from God. As much as I hate American health care, I have to say that that 100% Medicare coverage for the last four months saved me from the catastrophic financial losses that I was afraid of.
While my husband was in a facility and actually dying Medicare stopped paying claiming he was the working elders and had coverage elsewhere. WHAT!! Since I had never heard of Medicare POA of course I didn't have one. They won't speak to you without one.
I had an elder care attorney who has a Medicaid specialist on staff. The process was very easy for me. They handled everything. Even when I spoke with folks on the phone...they were very pleasant and helpful. I had SO dreaded the experience from reading here. But, I must admit, it was a very easy process. I guess I was one of the lucky ones in that regard. My advice is, get very knowledgeable people on your team to walk you through the process.
Oh....grooaan !!! I'm thinking of starting this process as soon as I get the present things taken care of. Sounds like a nightmare. I will bookmark this one for sure. In home care, for his hygiene issues, has begun...kind of irritating at the beginning as someone forgot to schedule anyone to come out! Hopefully, that is resolved. Daycare will start as soon as I set up the day I want (having a hard time even trying to decide that little issue!). My tummy is in knots all the time...
Oh Mim, Don't let this discourage you. Elizabeth says that Medicaid applications are often handled locally, so the people where you live may not be as bad as what others report. Do you have a local Council on Aging or Senior Center? They often have people who know the ropes. AIso, I would encourage you to find a local dementia support group where you might meet other people who are applying for similar benefits. Although some support groups seem to focus on psychological support, the support groups I found most useful were the ones where members gave practical information about how to navigate the bureaucracy.
I'm glad you started the process for in-home services and day care. I hope they give you some relief - constant care of someone can be so exhausting.
Hi Mim. A quick look at the Mahoning county website had all the information you would need to get started on getting Mahoning county Medicaid. The offices are down at Oakhill. It looks like it's quicker and easier than in NY--hope that's true!
If you're scheduling Daycare once a week, think about sending him on Tues., Weds., or Thurs. They are less likely to be short-staffed due to long holiday weekends.
I've had an elder lawyer since 2012. It was well worth the money. DH qualified for Medicaid in Nov. but had to pay privately for many months because of a gift. Thought DH would be ok t home for the lookback period but Alz had a different plan! Medicaid qualification was fairly easy in my state but process is still in the works. I had already paid for Nov so still waiting for a reimbursement.
DH is still at home but I have gone to look at a couple memory care that take Medicaid. Both of them will not take a person if they are already on Medicaid. My eldercare attorney had already told me that most homes want a person to be able to self pay for 2 years. One of the homes told me 4-6 months at a minimum of self-pay and the other preferred 2 years. Have any of you ran into this problem that it is difficult to get into a home if already on Medicaid?
We are trying to keep DH at home. I don't want to put DH in a home yet. So, I think he will have spent down too much to get into a memory care and be able to be self pay as long as they want. Our state has a waiver that supports this. Once he spends down to $10,000 or $12,000 someone at the Council of Aging said to come in and she could help with the application.
What has been other people's experience with getting into a care facility once the person is on Medicaid?
I know that nursing homes in Massachusetts that don't have trouble filling their beds (i.e. "good ones") will always take private pay over those on medicaid. They get more $$ in the pocket that way. It usually only takes a couple of years, or less, being in a nursing home before the private payers are eligible for medicaid. Its that costly.
Sounds like Oregon is weird - which is nothing new. Portland especially likes to be known as weird. I grew up south of Portland and did not feel weird- was just a country hick!
My mom and dad both were in nursing homes - they were divorced at the time. Neither had problems but then neither had any money to speak of. My mom had no assets - just her SS. My dad's wife had some assets from her first marriage but evidently they did not count, they just put a lien on the house they shared.
There is the option if she needs medical to hospitalize him (I assume he is on Medicare since he is on disability) and then refuse to take him back home. I am sure the fact you work plays a part in this whole Medicaid nightmare too.
Yes, it is easier to get a person placed from the hospital than from home. For one thing, hospitalization is expensive, and of course the money people don't want long stays just for custodial care...it costs them money. So they'll push for nursing home placement if the family can't take the person back home. The family may be told that the patient will be placed in the first available nursing home bed within 50 miles...but at least they get placed, the family is off the hook, and the family can start working to transfer the patient to a NH that is closer to home or that they like better. Sometimes it is a game of "chicken", as I think we've documented on this forum in the past--the hospital insisting the family take the patient back home, the family insisting that they can't do it...no matter how much the hospital bullies the family and tries to twist their arm into taking the patient back home, the hospital is mandated (at least in the U.S.) to provide a safe discharge plan. They can't just dump the patient out on the sidewalk, no matter how much they would like to. Sometimes if the patient's family doctor can find a reason (wink, nod) to get the patient admitted to the hospital, the patient can get placed. This is all nerve-wracking for families, of course, who are not familiar with the good old Placement Games That People Play. The short story is, just keep saying "no" if the hospital is pressuring for a discharge home, and you just cannot do it. There's no sense in the family members dropping down dead trying to take care of the patient at home when it's clearly too much for them. Hospitals don't care about that, though.
Oregon does have a waiver program for at-home care. So I think that is the route we will have to take first once DH spends down. I spoke to our Council on Aging and they said for me to come in when DH spends down to around $I0,000.
DH is on Medicare but he is also on my employer's insurance. My employer's insurance is his primary and my insurance is very good. Right now, I don't know why DH would have to go into the hospital. He is in very good health (he is 62). I was advised by one Memory Care Administrator that when DH can no longer get out of bed, have his doctor put him on Hospice.
It will be around 3 years before I can retire. DH's brother died at around 65 from AD. I think only one other relative lived that long. So I am expecting DH will go downhill a lot in the next year or two.
So far, we have been able to manage. But I like to plan out options ahead. I appreciate everyone's advice. As we all know, things can change unexpectedly.
So Medicaid would pay for in-home care in Oregon? That is essentially what my job was in New York--a public health nurse working for a county's Office for the Aging, making home assessments and authorizing Medicaid-billed home care and then running the cases. NY Medicaid used to be very generous in terms of home care hours...I believe it has tightened up somewhat with Medicaid managed care. I retired from the county job in 2008, but then went on working for a private home care agency.
I believe some states are less generous with Medicaid-billed home care hours. (i.e. "aide time")
Medicare doesn't pay for home care except for a few narrow circumstances following a hospitalization, and most HMOs and BlueCross/BlueShield type insurances don't either. (As I'm sure you know.) But Medicare-billed Hospice can be a godsend when the time comes. One thing I found was that not all Hospices have the same admission criteria. We were denied by one (He wasn't bad enough? Give me a break.), but someone advised me to try for admission to a different Hospice, and that one admitted him and followed him until he died. We kept him at home, which had always been our plan, if possible, and Medicare-billed Hospice in the home paid 100%. It was a godsend, needless to say, although here in Ohio (where we moved in 2012 to be closer to family), they could only give him one hour of aide time, five days per week. So I did a lot of the work myself with my son-in-law helping in the evenings, and some private pay aide time from a different agency to let me get out of the house for shopping and errands.