Medicaid Qualifications

[LouG906]

What is the name of your state? Florida
I am in the midst of filing an application for the State Home & Community Based Services , Channeling Project (which she is qualified), and for Medicaid for my 94 year mother. She presently resides in an Assisted Living Residence and is not in need of a nursing home at this time.

My question is, can she qualify for medicare? My mother has a burial plot and paid funeral expenses. She also has a medicare supplement (renewal -partial payment of $885 is due in two weeks). She also has a bank account which has under $1400 and will have less after the supplement is paid. Her income is a monthly Socia Security check of $902 monthy. Her monthly expenses for the Assisted Living Home, medication, personal items, etc. exceed her monthly income. Will she qualify for Medicaid? If not what do I need to do to have her qualify.

 

[LouG906]

What is the name of your state? Florida

I am in the midst of filing an application for the State Home & Community Based Services , Channeling Project and for Medicaid for my 94 year mother. She presently resides in an Assisted Living Residence and is not in need of a nursing home at this time.

My question is, can she qualify for medicare? My mother has a burial plot which is paid for as well as paid funeral expenses. She also has a medicare supplement (renewal -partial payment of $885 is due in two weeks). She also has a bank account which has under $1400 and will have less about $515 after the medicare supplement is paid. Her income consists of a monthly Social Security check in the amount of $902 after taxes and medicare payments are taken out. Her monthly expenses for the Assisted Living Home, medication, personal items, etc. exceed her monthly income. Will she qualify for Medicaid? If not what do I need to do to have her qualify.

 

[BlondiePB]

What is the name of your state? Florida

I am in the midst of filing an application for the State Home & Community Based Services , Channeling Project and for Medicaid for my 94 year mother. She presently resides in an Assisted Living Residence and is not in need of a nursing home at this time.

My question is, can she qualify for medicare? My mother has a burial plot which is paid for as well as paid funeral expenses. She also has a medicare supplement (renewal -partial payment of $885 is due in two weeks). She also has a bank account which has under $1400 and will have less about $515 after the medicare supplement is paid. Her income consists of a monthly Social Security check in the amount of $902 after taxes and medicare payments are taken out. Her monthly expenses for the Assisted Living Home, medication, personal items, etc. exceed her monthly income. Will she qualify for Medicaid? If not what do I need to do to have her qualify.

When was the last time your mother owned any real estate (i.e. a home) and a motor vehicle? Why isn't your mother signed up on a Medicare HMO plan where there is no additional premium?

 

[LouG906]

When was the last time your mother owned any real estate (i.e. a home) and a motor vehicle? Why isn't your mother signed up on a Medicare HMO plan where there is no additional premium?

The day before I was signing her up for a Medicare HMO she broke her hip and was unable to do so.

 

[LouG906]

When was the last time your mother owned any real estate (i.e. a home) and a motor vehicle? Why isn't your mother signed up on a Medicare HMO plan where there is no additional premium?

She also never owned any real estate or a motor vehicle

 

[BlondiePB]

She also never owned any real estate or a motor vehicle

Send the application. Your mother should qualify. Try the Medicare HMO again. Assisted Living Facilities (ALF) do not take residents that require skilled nursing care; therefore, mom must have recovered from the broken hip.

If her primary care physician (PCP) is the ALF's resident physician and is a good physician, call the PCP's office and ask what Medicare HMO plans he/she takes. That will save transporting mom to the PCP's office.

 

[candg918]

BlondiePB,

I have been following this thread and am confused.

Will some ALF facilities accept Medicaid? I thought only skilled nursing facilities qualify. Does it depend on the state of residence?

Thanks

 

[BlondiePB]

BlondiePB,

I have been following this thread and am confused.

Will some ALF facilities accept Medicaid? I thought only skilled nursing facilities qualify. Does it depend on the state of residence?

Thanks

I'm going to assume that you are referring to an ALF paying for room & board, right? If so, where in this thread does Lou state that Medicaid is for room & board?

(Hint -- Lou's mom is already residing in the ALF)

 

[candg918]

Why would an elderly person on Medicare and a supplement need Medicaid for anything other than room and board? Is there another big expense - other than prescriptions - that I am missing that is not Medicare/supplement covered?

Every ALF facility that I talked to here requires evidence of assets sufficient to cover their costs. They would not permit a resident to remain (in any but the life care community) if their assets ran out. They do charge a base for room and board and add for the assistance with activities of daily living. Is this what is covered by Medicaid? Is the ALF rolling everything into a single number their way of keeping out Medicaid residents?

The nursing homes take private pay and some take Medicaid and Medicare rehab. Some even sort them into different wings of the facility. I assume those not taking Medicare rehab have either not completed the certification process or have been kicked out of the program for some reason. Some of the nursing home residents in places I visited appeared very self sufficient and looked like they could handle an ALF; I had assumed that they were in skilled nursing because they were Medicaid pay.

Thanks.

PS. I am easily confused. Thanks for your patience in explaining these issues to us!

 

[BlondiePB]

Why would an elderly person on Medicare and a supplement need Medicaid for anything other than room and board? Is there another big expense - other than prescriptions - that I am missing that is not Medicare/supplement covered?

Every ALF facility that I talked to here requires evidence of assets sufficient to cover their costs. They would not permit a resident to remain (in any but the life care community) if their assets ran out. They do charge a base for room and board and add for the assistance with activities of daily living. Is this what is covered by Medicaid? Is the ALF rolling everything into a single number their way of keeping out Medicaid residents?

The nursing homes take private pay and some take Medicaid and Medicare rehab. Some even sort them into different wings of the facility. I assume those not taking Medicare rehab have either not completed the certification process or have been kicked out of the program for some reason. Some of the nursing home residents in places I visited appeared very self sufficient and looked like they could handle an ALF; I had assumed that they were in skilled nursing because they were Medicaid pay.

Thanks.

PS. I am easily confused. Thanks for your patience in explaining these issues to us!

The current negative difference between Lou's mother's income and the cost of the ALF, will have to be explained.

The first sentence of this thread is: "I am in the midst of filing an application for the State Home & Community Based Services , Channeling Project (which she is qualified), and for Medicaid for my 94 year mother. "

Lou has found resources for his mother.

An elder that has Medicare, a Medicare HMO, or Medicare with a supplemental insurance can still qualify for the Medically Needy (Medicaid) program. This is a cost-shared program and pays for the Medicare Part B deductible, prescriptions, and any other medical expenses AFTER a specific amount of out-of-pocket medical costs are reached in a month.

I just received the Medicare 2006 and have not had an opportunity to read and learn about Medicare Part D and whether or not medically needy Medicaid pays for the new Part D.

 

[candg918]

Thank you for the explanation!

It is then true that Medicaid will not pay for an ALF facility room and board component. My experience with the Medicare supplement policies has been such that everything I associated with "medical care" except prescriptions has been covered. I had never even considered the items you mentioned. It also brings up the point that even if someone is lucky enough to have long term care insurance, there are other expenses associated with Medicare that need to be in the budget and which should influence the choice of health care providers/HMO.

Thanks again for your patience in explaining the coordination of Medicare and Medicaid!

 

[LouG906]

I hope this explains to those I confused.

The Assisted Living for the Elderly Medicaid Waiver is a state and federally funded program which targets frail elders, at risk of nursing home placement.

This program provides extra support and supervision through the provision of home and community based services to eligible recipients living in Assisted Living Facilities. which are licenssed for extended congregate care or limited nursing services and are medicaid waiver providers.

The program provides assisted living services and case management services to eligible recipients to enable them to live in the home like setting of an ALF as long as possible. The purpose of this program is to delay or prevent more restrictive nursing home placement by maintaing the health of recipients and to minimize the effects of illness and disability.

The Assisted Living Facility is reimbursed at a daily rate of up to $28 for services (depending upon clients income) for each day the eligible client resides in a facility. They also over up to $125 per month for incontinence supplies.

One of the requirements for this program is to apply for Medicaid. The other is that the recipient must meet at least one of the following functional criteria:

- Require assistance with four or more activities of daily living or three plus supervision or administration of medication.

- Have a diagnosis of Alzheimers's disease or another type of dementia and require assistence with two or more activities of daily living.

- Have a diagnosed degenerative or chronic medical condition requiring nursing services.

*Activities of Daily Living:

Bathing, Dressing, Eating, Toileting, Transferring, Walking/Mobility

Sorry I confused you and hope this explains what I was asking.

SO...My concern is .............will she be qualified for Medicaid and if so will she qualify for the maximum funding available of $28 @day.

 

[BlondiePB]

I hope this explains to those I confused.

The Assisted Living for the Elderly Medicaid Waiver is a state and federally funded program which targets frail elders, at risk of nursing home placement.

This program provides extra support and supervision through the provision of home and community based services to eligible recipients living in Assisted Living Facilities. which are licenssed for extended congregate care or limited nursing services and are medicaid waiver providers.

The program provides assisted living services and case management services to eligible recipients to enable them to live in the home like setting of an ALF as long as possible. The purpose of this program is to delay or prevent more restrictive nursing home placement by maintaing the health of recipients and to minimize the effects of illness and disability.

The Assisted Living Facility is reimbursed at a daily rate of up to $28 for services (depending upon clients income) for each day the eligible client resides in a facility. They also over up to $125 per month for incontinence supplies.

One of the requirements for this program is to apply for Medicaid. The other is that the recipient must meet at least one of the following functional criteria:

- Require assistance with four or more activities of daily living or three plus supervision or administration of medication.

- Have a diagnosis of Alzheimers's disease or another type of dementia and require assistence with two or more activities of daily living.

- Have a diagnosed degenerative or chronic medical condition requiring nursing services.

*Activities of Daily Living:

Bathing, Dressing, Eating, Toileting, Transferring, Walking/Mobility

Sorry I confused you and hope this explains what I was asking.

SO...My concern is .............will she be qualified for Medicaid and if so will she qualify for the maximum funding available of $28 @day.

Send the application in. Your mother should qualify. You will receive a notice from DCF in the mail. I understand EEC, ADL, and all the other acronyms.

(note to candg918 - You will be confused.by this. It's the waiver.)