What if neither you nor your parents can afford to pay for the care they need and quitting your job to take care of them isn't an option?
I get this question a lot and it often goes something like this:
"My mom has some income from Social Security and less than $10,000 in savings. I've got a full-time job I need to keep. Mom was doing fine until recently, but now she's in and out of the hospital and having trouble taking care of herself. My sister and I are worried and wondering what we do next."
In a situation like this, there is a public program that may be available to pay for services your parent needs. It's called Medicaid and is run by states. This is not to be confused with your parent's health insurance, Medicare, which covers none of this.
Medicaid is important because it's the safety net when everything falls apart and you're out of options. You may have heard of it as a provider of health insurance under Obamacare. But, it's also a program that has paid -- traditionally -- for nursing home care when families run out of money and options.
The good news is that nearly every state Medicaid program offers alternatives to nursing home care. Most have created home and community-based services programs to help frail older adults (and younger adults with disabilities) stay at home and out of an institution.
But, the bad news is that the complexity of these programs can be challenging. States usually tightly control eligibility, benefits and access. And, very important -- no two states are alike.
Even though it's complex, you can still learn the basics. Here are answers to the four most frequently asked questions about Medicaid-covered home care.
What Does Medicaid Cover for Home Care?
Generally, states offer a broad array of services as part of their Medicaid home and community-based services programs. These can include transportation, respite care, adult day care, home modifications, some portion of assisted living in certain states, and of course, personal care at home with basic care needs.
But, part of what makes Medicaid so complicated is that it is NOT a national program with the same services for every American. The feds set some ground rules but the states have A LOT of latitude to design home care programs to suit their particular goals.
How Can I Get Information About My State's Programs and Services?
One good place to start is the aging and disability resource center (ADRC) in your parent's area. Google this term along with the name of your state (e.g., "Minnesota Aging and Disability Resource Center").
ADRCs operate as a single point of entry for families and individuals looking for Medicaid-covered support. They usually provide information about the programs and services that are available in your parent's community.
The ADRC will take charge of evaluating your parent's level of need and determining the package of services that would be considered "medically necessary" in order to meet that need. The ADRC staff does this by conducting a care assessment and then creating a care plan.
How Can I Figure Out if My Parent is Eligible?
Unlike Medicare, a program for which nearly everyone is eligible when they turn 65, Medicaid is just for people who have very low income and assets. And, almost all the home care programs also require that your parent is in need of a really high level of assistance with basic life tasks or that they have severe cognitive impairment -- generally at a level that would otherwise qualify your parent for a nursing home.
Unless your mom is already receiving supplemental security income (SSI -- a program for low income people that provides income support in addition to Social Security) and therefore automatically qualifies for Medicaid, she'll need to meet income eligibility requirements through one of basically two other pathways -- depending on what the state rules are.
One of these ways is to have regular medical expenses that are so high that they consume the lion's share of monthly income, effectively reducing it to very low levels. Many states operate under this pathway, called "medically needy" but the amount of money usually left over after your medical expenses is often so low that it's hard to pay for other living expenses in a home setting.
Fortunately, many states allow for another pathway through which individuals with incomes as high as about $2,200 per month can qualify (if they meet all the other requirements).
In addition to everything, your mom's savings must also be very low -- about $2,000. If her savings are too high for eligibility -- even if her need and income already qualify her -- she'll have to spend most of her savings first, before Medicaid will pay. So for example, if your mom has $10,000 in savings, she'd need to spend about $8,000 first on her care before Medicaid would pay (and she still needs to have relatively little income as well).
What Are the Special Programs I Should Know About?
If your mom meets all of the eligibility requirements I described above, you'll want to know if any of these programs are available in your parent's area.
One is called the Program for All-Inclusive Care for the Elderly (PACE). PACE is like a very personalized and coordinated one-stop shop for all medical and long-term care that frail older adults may need. There isn't a PACE program in every town or even in every state -- although there should be -- but check here, and if there is one nearby, I strongly encourage you to consider it!!
Another of these programs is often referred to as "cash and counseling," and it's offered in many, many states but often goes under other names. Basically, it's an option where the state will actually pay family members to provide care and/or will provide a cash allowance together with some counseling. This gives you and your parent more control and choice over the people you hire and types of services you get. The ADRC should be able to tell you whether this is an option.
The key in everything to do with taking care of aging parents is to be patient with yourself and know there are no easy answers and no clear path. You just have to keep putting one foot in front of the other and know that somehow it will all work out.