Tag Archives: medicaid

The Final Installment

19 Nov

Today I am going to wrap up our discussion by speaking about two additional programs that are available to help low-income seniors: Assistive Care Services and VA Aid and Attendance.

Despite the number of low-income seniors needing long term care subsidies to remain at home, except for Mississippi, Florida has one of the lowest reimbursement rates for services. In order to entice private providers to accept clients into their assisted living facilities, the state decided to create the Assistive Care Service (ACS) funding program. This program is a matching fund. By taking some state funds and requesting the federal government to match it, the state was able to provide $9.28 per resident per day to help pay for services. Separate from the Medicaid program, Veterans are eligible to have services paid through the Aid and Attendance program. Unlike the Medicaid waiver program, this is an entitlement program, meaning if you are eligible, you receive it, no waiting lists. However, the time it takes for the VA to approve applications can be long, on average 6 months. Following are the requirements to apply for both the ACS and the VA Aid and Attendance programs.

ACS-Assistive Care Services (State Program)

Call DCF (Department of Children and Families)

1-866-762-2237

  • Must be 65 years or older, or 18 years of age and blind or disabled.
  • Must be a U.S. Citizen or qualified non-citizen.
  • Must be a resident of Florida.
  • Must have a social security number or have filed for one.
  • Physician must complete the 1823 for the client to be admitted to the ALF.
  • Client must be in an ALF.
  • Total asset limit is $2,000 for an individual or $3,000 for a couple.
  • The client will receive $9.28 per day to help offset the cost of living in an ALF. The program will not pay for any day the client is not at the ALF, i.e. days in the hospital or on vacation.
  • If applying for ACS, the client can NOT be on the Medicaid Diversion program.

VA Benefits – Veterans Aid and Attendance

Call the Department of Elderly and Veterans Services

Broward County: 954-357-6622

  • Must be eligible (served over a 90 day period, some of that time must be during wartime).
  • Any age may apply. The program takes 3 – 6 months to process; residents are responsible for the full rent until approved.
  • Program will pay retro-active from the date the application was submitted.
  • Must meet the medical criteria. Must meet the financial requirements.
  • Needs to be in an Assisted Living Facility to apply:
    • Veterans are eligible for up to, approximately, $1,703/month (2013 rate)
    • Widows are eligible for up to, approximately, $1,095/month (2013 rate)
    • Married couples are eligible for up to, approximately, $2,020/month (2013 rate)
  • Cannot exceed $80,000 in assets, not including a home.
  • Residents can apply for Medicaid Diversion and VA benefits. If qualifications for both programs are met, may receive both benefits.

I hope that I have helped to inform you of some of the programs and options that exist to help you care for your aging, low-income parents.

 

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Another program to help you in helping your Mother

12 Nov

As promised, today I will discuss another program that is available to very low income individuals. The Medicaid Diversion program is available to very low income individuals who are eligible for supplementation to their social security check and to those with a small pension. This is a match funding program, meaning the federal government contributes some funds as well as the state. You have to be eligible financially as well as physically. Here are some of the requirements that must be met in order to be eligible.

Diversion – Long Term Care

(State and Federal Program)

Department of Elder Affairs 1-800-963-5337

Florida: www.elderaffairs.state.fl.us 1-850-414-2000

  • Must be 65 years old.
  • Must have a diagnosis of dementia plus need at least 3 out of 5 ADL’s (activities of daily living);
  • or require assistance with 4 ADL’s plus medication management;
  • or require assistance with 5 or more ADL’s.
  • Activities of daily living include: bathing, dressing grooming, ambulation and toileting.
  • State CARES unit will come to assess the client to see if they meet the program’s criteria.
  • Can also need IADL’s (Instrumental ADL’s which are: housekeeping, shopping, cooking, transportation.
  • A physician must complete a 3008 form for the State.
  • A physician must complete an 1823 form for admission to an ALF.
  • Must have income less than $2,130 for an individual, $4,260 for a couple. (These are 2013 limits)
  • Total asset limit is $2,000 for an individual or $3,000 for a couple.
  • Facilities are paid per contract; families are responsible for monthly room and board rate to the facility. Facilities may charge COLA increase annually according to a lease agreement.
  • Incontinency is a covered benefit.
  • medications are covered through Medicare Part D or the individual’s personal insurance.
  • PT (Physical Therapy), OT (Occupational Therapy), ST (Speech Therapy), Labs, Physician Visits, Hospital Coverage, Dental, Hearing and Vision will be covered if not otherwise covered by Medicare or personal HMO Insurance. Diversion will also cover any and all non-covered services, co-pays and deductibles.
  • The contracted Diversion company becomes the secondary insurance to Medicare.
  • Transportation is not a covered benefit. Medicaid should cover under Logistic Care.
  • There is a hospital bed hold up to 21 days. if the client is out more than 21 days the facility will not be paid and the family will be responsible for the difference.
  • Clients do not have to be on SSI or OSS to qualify for this program.
  • Client may NOT receive HOSPICE benefits while on a Medicaid Diversion program.

Next time I will speak about ACS – Assistive Care Services and VA (Veteran’s Affairs) Benefits.

Stay Tuned!

 

 

Someone has to pay

7 Aug

As states begin to provide more home and assisted living services to seniors the number of nursing home beds begins to decline. A study done by Harvard Medical School found that a 10% increase in assisted living capacity led to a 1.4% decline in private pay nursing home occupancy. Most nursing home residents pay privately for nursing home care thus don’t affect the occupancy in Medicaid beds. In order to decrease the number of nursing home Medicaid beds, states must make an effort to increase funding for Medicaid clients living in nursing homes that want to receive services at home or in a Medicaid funded community care (assisted living) facility. To this day, the private assisted living industry takes Medicaid eligible residents only if they have an occupancy problem. They prefer not to deal with the complexities of billing the government and the excess of monitoring and reporting that goes with having a Medicaid resident. However, state Medicaid agencies are hard pressed to reduce the number of individuals in nursing homes paid by Medicaid if they are going to see reductions in their Medicaid long-term care budgets.

Although this move benefits clients who wish to remain at home, it drastically impacts the financial viability of nursing homes across the U.S. With less private paying clients nursing homes will start cutting back essential services to an ever growing number of very frail clients. What is more, some states like Pennsylvania are billing family members for the cost of nursing homes. The Pennsylvania law stipulates that family members of nursing home clients are ultimately responsible for the cost. Some families have been billed some $96,000 for the care provided to a family member residing in a nursing home.

At the end someone has to pay, either a family member or us, the taxpayers. What the story tells us is that long-term care in the U.S. is broken and needs to be reformed soon. One answer will be for states to continue to rebalance their long-term care program, provide more community care and make it easier for providers to want to work with the government.

Impact of Supreme Court Decision on seniors

30 Mar

In June the U.S. Supreme Court will determine the fate of the healthcare reform and with it, the fate of many seniors in this country.  There is consensus that healthcare reform cannot be viable if the public option is deemed unconstitutional.  This comes at a time when the economic and health security of seniors is at its worst.  Healthcare reform,although aimed at the 40 million uninsured individuals, provided great benefits to seniors who cannot afford long term care.  Included in the healthcare reform were incentives to state to provide affordable long term care to seniors who want to remain in their communities and avoid costly nursing home care.

Lets take a look at what is at stake.  Debt and deficit reduction proposals by policymakers include major changes to thre three major entitlement programs, Medicare, Medicaid and Social Security.  Some proposals include raising the age of retirement to 67 years, asking higher income Medicare beneficiaries to contribute more to the cost of Medicare and federal block grants to states so they can pay the federal share of their Medicaid program expenses.  One mistake made by policymakers is to look at each of these programs separately and failure to recognize how interrelated they are in their effect on the economic security and well being of seniors.  For example, stopping annual increases in social security payments will result in less funds available to seniors to pay for healthcare.

Most seniors live on low or modest incomes, 1 in 10 have income below the poverty level ($10,458) and the number of seniors living in poverty increased when you take into account out-of-pocket expenses from 9 to 15%.  Many seniors today do not have long term care insurance coverage which means that assisted living and community care services are unaffordable or that paying for them will require a larger outlay.  It is predicted that low incme seniors will exhaust all their assets by the time they reach older age.  It is estimated that 2/3 of those 65 years and older will need long term care services.  Meaning that they will be solely reliant on Medicare and Medicaid to survive.  And yet most states restrict long term care funding in community settings forcing these seniors to enter nursing home care prematurely at four times the cost.  Dont they see the writing on the wall, or is it that they constantly engage in wishful thinking?  Those who will fare the worst are minority groups.  Poverty rates among black and hispanic seniors are more than twice as high as those among their white counterparts.  To compound the problem they suffer from a multitude of healthcare problems, again higher than the white seniors.  One wonders what information our policymakers rely on to make untimely and disastrous cut cutting decisions.  Not our seniors.