I have a confession. I've been avoiding writing about Medicaid. It's so complicated it scares me. But, Medicaid can be really important to daughterhood because someday you might have to decide if it's right for your parent. So you have to get smart about it.
Here's why Medicaid is important: It's the safety net for when everything falls apart. When your frail mother has been caring for your Dad at home alone for five years and she can't do it any longer. When 24-hour-a-day home care is too expensive and it still wouldn't be enough to keep your dad safe. And, then when his nursing home care quickly depletes their savings.
Maybe you've only heard about Medicaid as a program that provides health insurance under Obamacare. Well, for much longer than we've had Obamacare, Medicaid has been paying for nursing home care and, sometimes, home care for people who are very frail or disabled and whose income and assets have either been depleted by the costs of care or who never had much money to begin with.
The challenge here is navigating this very complicated program to get the help you need. Among the many complexities you'll face as a daughter, few are more daunting and flat out scary than pursuing Medicaid eligibility....
But, as many of you know, I believe that you always just gotta start -- you just have to get in the boat and start rowing, and the very first thing you need to do is avoid the big misconceptions that trip up so many people.
Here they are:
Misconception #1: Medicaid is a lot like Medicare
Not true. MediCAID is nothing like MediCARE. And, it is not a substitute for Medicare. Medicare is the program that pays for health care -- like doctors and hospitals -- for everyone over age 65 and certain people with disabilities who are under age 65.Read 4 Tips to Make You Smarter About Your Parents' Medicare
But, Medicare does not pay for long-term care -- meaning care your parent needs on a sustained and ongoing basis in a nursing home, an assisted living facility or ongoing home care. To get those services, you'll either pay for them yourself or, if you are eligible for Medicaid, it will pay for some or all of them.
In fact, if you are an older adult, and you become eligible for Medicaid, you keep Medicare. This means that you'll receive coverage from BOTH programs.
That's right. You can be covered by Medicare and Medicaid at the same time, for different things.
Misconception #2: Medicaid is available to everyone
Unlike Medicare, which nearly all of us will qualify for just by virtue of turning 65, Medicaid is VERY protective of who gets benefits. It's a safety net program that is designed to swoop in when things are pretty tough.
So, it requires applicants to go through a challenging, complex, and often lengthy eligibility determination process.
In order to get your parent's long-term care paid for by Medicaid, you have to meet these basic requirements.
You Have to Have a HIGH Need for Care. Medicaid rules require you to need a lot of help doing one, two or more of the most basic activities of daily life; like bathing, eating. Or you have a severe cognitive issue like dementia. So, you'll have to go through a process in which Medicaid assesses your level of need.
Your Income Has to be Too LOW to Pay for Care. Medicaid is saving its money for people who most need the program. So, you have to either have a low-income to start OR, so much income already going to medical care or long-term care, that you don't have enough to cover the full costs of your care.
You Have to Have LOW Savings. Medicaid requires that you to have very little savings in the bank -- about $2,000. When it comes to income and assets, there are a lot of rules for lots of different circumstances. For example, your parent can't have just given you all their savings in order to qualify for Medicaid -- at least not recently. Medicaid will actually go look at all your parent's bank statements over the last five years and examine every little transfer they made. Also, if the Medicaid applicant is married, the frail person who has a spouse does not have to deplete his or her income and savings as much as someone who is widowed, divorced or never married. The idea is that the non-frail spouse should not become destitute as a result of this process.
Misconception #3: Medicaid Will Take Your Parents' Home
It IS true that Medicaid is not set up to spend millions of taxpayer dollars on someone's care just to have that person's family inherit a mansion when the person dies. On the other hand, Medicaid rules do try to preserve the family home for your frail dad while he's living or for your non-frail parent, or for your sister who has been living there taking care of your parent for years and years.
This is complicated and it's also scary. It feels like very big stakes -- especially when it comes to your parents' lifetime savings and/or their home. Your parents' financial security and yours could be very connected.
This is where many experts and books will tell you to get a lawyer to advise you as you are going through this process. And, I tend to agree. You can start by checking out the website of the National Academy of Elder Law Attorneys (NAELA).
But, the problem is that not everyone can afford a lawyer. If that's the case, I recommend starting by consulting the free state health insurance assistance office in your parent's state. These trained volunteers can either help you directly or help you drill down to other resources.
Misconception #4: Medicaid is a national program that's the same for everyone
Part of what makes Medicaid really complicated is that it is NOT a national program with the same rules and requirements for every American. This is another way it is different from Medicare, which is a federally run program that applies the same rules and benefits to everyone.
Medicaid is actually run by states, although the federal government shares the costs. The feds set a lot of rules FOR STATES and then states get to make many rules for themselves.
The reason any of this matters for you is that, if you are caregiving for a parent in a different state, you will need to understand the rules in his or her state. And, if you are considering moving your parent, you'll -- very unfortunately -- have to compare the rules across the states.
Misconception #5: Medicaid only covers nursing homes
Medicaid has traditionally paid mostly for nursing home care. But, no one really wants to be in a nursing home. So some states operate home and community-based services (HCBS) programs. This is a very big topic for which I will write an entirely separate blog very soon.
But, in the meantime, to find one, I recommend that you start by asking about "HCBS programs" through the local area agency on aging (AAA). And you can find the AAA through this federal locator - click here. But beware! Unlike nursing home care, state Medicaid programs do not HAVE to offer HCBS so the availability programs will vary depending on where you live -- see misconception number 3.
What's Most Important
When is Medicaid right for your parent? It depends on so many individual and family circumstances. And, it depends on your state. There are no hard and fast rules. But, if you've been walking down this caregiving road for a long time and you are looking at nursing home care, Medicaid may be necessary to pay for the care. OR, if your parent's money is running out because of expensive care --- even if he or she isn't in a nursing home --- then it could be helpful, especially if there's a good community program in your parent's local area.
More than anything, I want you to know that, whatever your situation, you are probably already really tired. And, figuring this program out for your family is not easy. Just remember that it's a crazy complicated hard situation. Not that you are failing. You are good and normal and doing everything you can. That's all you can do.