Medicaide not covering some prescription costs due to missing info.. ARGH!!!!!

I just found several bills for 3 months worth of Mom's prescriptions at the nursing home - this is for her portion of prescription costs after payment by her supplemental insurance.   I was told that these would be covered by Medicaide but OHH NOOOOOOO!!!  No one told me she MUST be enrolled in Medicare Part D to get this co-pay covered!!!

Generally, if a person is on Medicaide, their Medicare premium is paid the the state (Medicaide) and their premium for Medicare part D is greatly reduced to $1-$5 per month.  Long story short, the Social Security Administration  which administers Medicare has no communication from Mom's state Dept of Health that she's been approved and receiving medicaide, there fore, she can get Medicare Part D to cover this co-pay but until the SS office gets word from the state - her monthly premiums and deductible are MORE than the co-pays!!  I learned all this after four calls this morning.  I was especially preturbed that I spoke with a woman at the Medicare-Medicaide service call center - I assume she's paid by the federal government or employed by a contractor of the federal government - who took down all kinds of information then suggested a specific PRIVATE company that would best meet mom's needs for the least amount of money.   This choice is based on her prescriptions - it seems that private companies are diving up the pie.

I HATE this confusing BS and it really makes me want to advocate for ONE SOCIALIZED system - as it stands now her expenses are covered by two government programs, one private program and I need to get her enrolled with a 2nd private company to pay what the other 3 (2 public/government and 1 private) will not.   It means 4 sets of paper work, 4 sets of billings, 4 mailings, 4 account numbers - IT'S INSANE!!! It's no wonder that Medicare fraud is so easy!   I don't want to reduce American jobs but I wonder just how many people are employed to manage this mess? How many people are employed by doctors offices and nursing homes to wade through this mess?  If it were in ONE program, might it cost less money to administer?    I get especially frustrated when I consider the number of people to manage this bureaucracy and the waste versus the needs of patients and the push to drive down the cost of their care.  If it were all under one umbrella plan, perhaps it could cost less and my Mom wouldn't suffer the indignity of the cheap solution!!

Medicare versus Medicaide

In the past week I've had three calls from friends about the difference between Medicare and Medicaide.  Basically, one is a federal insurance program for the elderly and the other is a state program that helps indigent  - or poor - residents.

Disclaimer before you read further:   This information is based on my experience and knowledge of Medicaide in two separate states.  Each state is different; to find out the specifics of your state, do your research.  I suggest that you search "(name of your state) AND  medicaide" or contact the your state agency for health and welfare.   The Area Agency on Aging within your local area is also a good resource to help you begin to understand Medicare and Mediciade in your state.


The basics:   Medicare and Medicaid are BOTH paid for by tax dollars - and you didn't think the USA has socialized medicine....
Medicare is government supported health insurance for the elderly, it DOES NOT PAY for nursing home or long term care.   Citizens 65 years and older pay premiums directly from their social security. You may select any doctor who accepts this as payment.
Medicaide is government paid nursing home (long term) care.  It may also help pay for Medicare premiums and for prescriptions.  Most of the funds for medicaid come from the federal government but the programs are administered by each state.   Each state still has to contribute something toward Medicaide.





Medicare is a federal insurance program available to US citizens over 65.   To pay for this plan, the federal government takes premiums directly from social security payments.   Most of us will be covered by Medicare at some point.   Even if you have health coverage as a retiree, those programs usually defer to Medicare once you turn 65 and you're likely to need more medical attention, prescriptions or procedures.   In some cases, the primary insurance you had through a pension plan or employer becomes your supplemental plan, meaning that it pays some of what Medicare does no. Medicare does NOT pay for long term care in assisted living or nursing homes.  They will not pay for on-going home health care or aides for elderly either.   They will pay for up to 120 days in a nursing home provided the patient shows improvement and any therapies administered help the patient improve to return home or return to assisted living.   As a citizen, you automatically qualify for Medicare and, near your 65th birthday,  you will receive a letter advising you of your status.   As of this writing, June 23, 2010, there are many doctors across the country who refuse to accept Medicare payments so use caution when selecting a doctor.

Medicaide is a state program (it may be called something else in your state) generally administered by the State Department of Health and Welfare.  Medicaide is not limited to the elderly and may also cover children of poor families, people with physical or mental disabilities or the most poor citizens.   It generally does not include dental or vision but in some states eye exams and dentures are covered one time during a set period, like onc every 5 years.  Medicaide DOES pay for long term care in assisted living or nursing homes and there are certain criteria to meet before an elderly person may receive Medicaide.    Generally these are:

• Spend down to $2000 or $2500 in assets. This means that the elder MUST use all possible assets before they may receive medicaide.  They must consume all cash, CDs, stocks, bonds and savings. Note that if at anytime, an elders assets grow to MORE than $2000 or $2500, they may be disqualified from Medicaide until that money is spent.  If you know this will happen, you can plan for it and buy something that they need like depends, lap robes, eye glasses, dentures (medicaide will pay for eye glasses & dentures but only once every few years). Here's a link to an article about the Medicaide spend down on Agingcare.com.
• Look back periods:  These can get you in to a lot of trouble.  Each state has a defined period where they look back at expenditures to determine whether someone qualifies.   This is to prevent transfer of ownership of valueables, gifting of cash, stocks, bonds, etc or deeding of any property before an application for assistance.    The object is to ensure that assets are used to provide for someone, that they consume their resources before receiving public resources for their support.   Some states have a look back period as long as 7 years!!  so be sure to thoroughly understand this before accepting anything from your elders.
• Homes may be exempt: The elder may own a home and the state will not force the sale of it if a spouse, dependent child or other relative lives there.   The state may also permit the home to sit - without being sold - if the elder plans to return home.  
•  Financial recovery:  most states seek some kind of financial recovery from an elders estate.  First they will put a lien on a home or proprety so that when the elder passes, the state will expect to recoup funds spent on care.  If the home/property is occupied by a surviving spouse the state may not use liens.   The state may also try to recover funds by forcing the sale of cars or other valuable possessions such as art or antiques.   
• Pensions and social security must be spent toward care:  Any monthly income received by an elder must be spent on their care, this is often called a co-pay or care contribution.  In my mom's case, her social security and pension are deposited directly to her checking accounts and I write a check for her contribution each month.   The state pays the rest directly to the  nursing home,  I don't have anything to do with that.    
• Monthly personal allowance:  Most states permit each elder to keep between $30-50 a month for their personal use.   This isn't a lot at all so I supplement when necessary.   I do not give the money directly to her but do pay for her hair cuts, permanents and regular hair appointments.   

Some other things to consider about Medicare and Medicaide: 

• Medicare is your PRIMARY insurance after 65 but Medicaide helps: You'll still have to pay a monthly premium if you go on Medicaide but Medicaide will pay the premium for you.  So for doctor bills, procedures, tests, etc.   Medicare pays first, your supplemental plan (if you have one) pays second and Medicaide pays third.   Without a supplemental plan, Medicaide probably covers it all or the doctor may write off some of the charges.
• Medicaide can start and stop payment so WATCH THEIR BANK ACCOUNTS!!:  If an elder is hospitalized, their care may be paid my Medicare for that period and for a time (sometimes as long as 120 days, 3 months)  AFTER they return to a nursing home.   BE CAREFUL and watch their funds during this period.  If their monthly income is NOT used for a nursing home while Medicare is paying, it can build up over the $2000 or $2500 in maximum assets.  This nearly happened to my Mom so I bought some personal items for her to ensure that she did not accumulate more than $2500.   I also started a burial fund - allowed by her states' Medicaide program) and plan to contribute to it if/when she begins to accumulate more than $2000.   On a personal note:  I don't feel like I'm ripping off the state or being dishonest in this case,  she would have been only $250-300 over the $2500 but that relatively small amount would cause all kinds of headaches and I'd have to redo her medicaide application all over.  

What's what is the difference between medicare and medicaid medicaide? what is the medicaide medicaid spend down spenddown? can mom dad give me money and still get medicaide medicaid?  Will medicare pay for nursing home.

Financial assistance for caregivers hard to come by...

Caring for elderly parents often means financial hardships and sacrifices for the elders and their families.  In my own sphere of the world I've spent more money than I can count on travel to help my parents. My husband put a new roof on his mother's home and bought appliances as her old ones gave out.   Friends have taken their parents into their homes, paid supplemental insurance premiums and prescriptions.  Now some purchase clothing, shoes, personal care items and goodies once their parents go on medicaide.  Medicaide permits the elder to keep between $30-50 per month for personal expenses but often it's not enough even for a little splurge.

I  read articles and questions/answers on Agingcare.com and just noticed that they have a special section specifically for care givers and finances.  See it here:  Aging Care, financial articles. Remember that financial resources for care givers are FEW, someone might find some assistance so I feel it's important to share.

Can I get paid for taking care of mom dad? Can i get paid for staying home with husband wife? Can daughter get paid for taking care of grandma grandpa grandmother grandfather? Will medicaide medicaid pay me to stay home with mother? will medicare pay me to stay at home with parent spouse? 

Medicaide should help but for a few months will put Mom's accounts in the hole!!

Mom just began getting Medicaide to supplement her rent for a nursing home and for a few months she won't have enough to cover all of her expenses.  I'll have to chip in about $100 a month.   Mom must pay nearly all of her income (social security and pension) to the nursing home.  She gets $30 for her personal needs and $200 for her supplemental insurance premium.   The deficit happens because Medicaide considers ALL of her social security - the grose amount BEFORE deduction of premiums for Medicare part B.   Medicaide is supposed to pay the premiums now but it takes a while for the Federal government to get the message and stop the withdrawals.   So for a few months Mom is required to pay out what she doesn't get.    I spoke with Medicaide and they said she will get reimbursed for the Medicare part B premiums but it could take 3-5 months until it's all said and done.   So, I'll make regular deposits in Mom's account and continue to make calls if it doesn't happen by July.  
Medicaide wants more than Mom dad gets Medicare premiums are still withdrawn medicare premiums put mom dad in the hole medicare premiums cause over drafts over drawn

Use caution when moving your parent to a new state

Moving your parent to an ALF or nursing home near you seems ideal but it could cause financial duress and mean your parent doesn't qualify for financial assistance.  Some states will not approve financial assistance (medicaide) until a person has established residency.  In my Mom's state, that's 30 days and proof that she intends to stay.  In another state it's six months!  At $3-5000 a month, that's a substantial amount to pay until they qualify.

The best practice - do research LONG before your parent or elder might move closer to you.   Contact your state medicaide office to understand VERY clearly the residency requirements, asset limits and application process.


How can I move my parent to a new state? moving my parent near me, state aid and moving my parent, 

Moving a parent to your state could cost A LOT!!

Before moving your elderly parent to your state be very careful about finances.   If your parent requires financial assistance from the state for medical expenses or long term care, you might NOT be able to move them.   Assistance programs like this are intended for STATE RESIDENTS, not transplants from other locations.    Your parent might have to establish residency in the state BEFORE they are eligible to get any assistance.   Each state has different residency requirements so check those out thoroughly before moving your elder.

The best advice I can offer is to move your parent close to you BEFORE they might need the assistance - long before.  If you don't do this, you might have to pay their expenses or have them live in your home until they establish residency and qualify for assistance.   

Pop wants to get hitched? Shacking up is easier!

I spoke with a flabbergasted friend last week and I've debated whether or not to blog about it.   My need to point out the variety of scenarios and possibilities for our elders and offer some practical advice won out.... so here it is:

My friends widowed father, age 82, wants to marry a woman he met through his church.   I encouraged her to support him. Provided his finances are in order; his needs will be met without monetary penalty  and with an iron clad Power of Attorney for medical care.   It's a good situation for both of them, they are of similar ethnic heritage so they like the same foods, have the same memories of growing up in the US with immigrant parents - it's all similar history.    They want to move in to an apartment in an assisted living center in the town where each raised their kids, went to church, have doctors and mutual friends.   Another important factor - both are comfortable financially and don't have any dependents that need to inherit their money. They've also downsized and both have few "heirlooms" to argue over.   It's just a great situation and each will be happy.  I've heard other, far less happy scenarios (and, you know you're going to hear about it now...)

My sister in law suffered a great deal of hurt after her grand father remarried and died soon after.  
"Grandpa" was actually the second husband of Grandma; he'd been married before but had no children.  He married Grandma when the daughter was a young woman.  He was a good husband and when a step-grand daughter came along, he wished to be called "Grandpa".    Grandma and Grandpa each brought their own houses, furniture, funds and mementoes into the marriage.  Among the four of them, they had an understanding that all of the things each (Grandma and Grandpa) brought to the marriage would go to their respective family should anything happen.  Some years later Grandma passed away suddenly.  Grandpa was lonely afterward and step-daughter didn't want to take anything from the home for fear of upsetting him.  Just three months passed and one day Daughter got a call from Grandpa's neighbor - he was married!   Daughter went to investigate and learned that it was true, Grandpa married a woman he met at his "club" and she had already moved into the house.   Daughter wanted to gather some of her mothers things only to see that many had been tossed out and the new wife refused to let her take antique furniture, photos of her family - nothing.   This began a very contentious and mean spirited exchange of visits, calls and even a couple of calls to police!  In the end, the Daughter and Grand Daughter got nothing and it was crushing for them.   They wanted the mementos from their mom, grand father and great grand parents that were with the step-grandpa.  After the shock of loosing Grandma, they left things to help him feel a sense of continuity and family and now his lonely heart was more important.  He died a few months later - no will, nothing written down and the "new" wife got it all - Grandma's house, Grandma's furniture, dishes, even the doilies.   Legally, there was nothing the Daughter or Grand Daughter could do. Grandma died with no will so everything went to Grandpa. When Grandpa died with no will it all went to his spouse. 

Now if Grand Pa had just shacked up with the new woman, they would have legal recourse.  ...  That is what I would propose to an elder if they wished to share their life with some one rather than be all alone.   There are all kinds of things to consider when elders marry:

• In most states a spouse can be forced to provide some kind of support for necessities - no matter how long the marriage.  
• The legal act of marriage can also tie up funds if a spouse incurs debt after saying "i do".  Debt, funds and property acquired before the marriage are not likely to be considered community property but it all depends on the state. 
• Should one spouse need state assistance, the state can put a lien on a home even though s/he only spent a short time there and didn't contribute to the upkeep - it all depends on state law.
• Widows pensions might also stop if a woman is remarried, to retain income, stay single!
• The contents of a house are generally considered the property of the home owner unless it's a high dollar item like artwork, jewelry.  
• Elders should give away heirlooms SOON or specifically call out distribution in a will.  Even if the remaining spouse remarries, the original heirs will have a legal standing to obtain things if it's written down.
  

I've also seen wonderful examples where families are co-operative, where grandma or grandpa WANTS to downsize and passes along heirlooms to be enjoyed while they are alive.   It seems that the painful examples are those we remember most.   I am by no means an attorney or legal expert but I do know that isolation ane loneliness are strong motivators.  If you love your elder, help them to feel less lonely, encourage them to be honest. If they want to share their lives, help them do it in a way that feels best for them and maintains relationships with their kids and grand kids.  Also try to form a friendship with the new "significant other"; they probably need some love and support too.  

Medicaide letter confuses but ALF clears it all up...

We received a letter from Medicaide that said Mom's aid level was about $390 a month.  It's good news that they processed it so quickly but I still have questions.   The letter arrived at my mothers house where my brother lives so he read it to me.   He's not very patient so I didn't ask him to read it over and must trust him when he says "it's a short letter and there's no other discussion or facts." 

Luckily, the director of Mom's ALF called this morning to tell me about the information they received from Medicaide.  She was very clear about the details, and long story short: Adding Mom's income and Medicaide, she will be $1125 short each month for her rent.  Since we paid her rent for January, that total amount is considered a credit with the ALF.  We'll divide that balance by two and use it to pay for January and February.  Come March, Mom will have to share a room.   Her room is already very small so they will try to move her to a larger room.  I expressed concern about mean or aggressive roommates and she assured me they will work with us to find someone who mom will enjoy.  I am also concerned that the room will be too crowded.  Nearly all of the residents have walkers, so with two beds, two walkers or wheel chairs and a couple of rockers or recliners and the room will be chock full!   I HATE that she has to share a room but she complains about lack of company so perhaps it will be good for her.

Now more work for me - getting things set up on direct deposit for pension checks, payment of rent and payment of pharmacy bills.   Ugh! 

Additional information requested by Medicaide

Two weeks ago I submitted a Medicaide application for Mom to her state Department of Health and Welfare.   Last week, Wednesday to be exact, I got a call from a lady reviewing her information.   She needs MORE information from me.  I expected this request but didn't know exactly what she'd need.   Long story short, she needs information that specifically identifies Mom's expenses for medical insurance and prescriptions.   This is necessary so the state can very specifically determine how much of Mom's money will go to her basic needs, her assisted living facility, her medical insurance and her prescriptions.  Then the state will determine exactly how much they will contribute toward her room and board at the ALF.    This leaves me really stressed about two things:

First:  We need to get a signature on a form, called an "Intent to Return Home".  My brother and I are really worried over getting her signature on this form.  We fear that she'll believe it means that she can go home then we'll have to tell her all over again, why she can't.

Second:  I worry that the state will pay so very little that the ALF will require her to share a room.  I worry that she'll get a disruptive and mean roommate.   I've heard awful stories from friends and acquaintances about room mates stealing money, clothing, pooping in beds, locking themselves in share bathrooms and the like.  Yikes!!!  All I can do is pray for the best and try to make plans to reduce her stress if she gets a room mate.

Why is this "Intent to Return Home" form necessary?  Because, without it, the state might force the immediate sale of her home to pay for her care.  If my brother didn't need a place to live, if the market were better and we'd get more money for it, we'd gladly do support her.  But!  the reality is that my brother, with his own health issues and need for low-cost housing, needs to live at her home.   She would also be heartbroken to know that her home is sold; she would loose all hope.   We are letting her live in a state of denial.  It keeps her happy and supports her sense of well being.  The state WILL recoup the money they spend on Mom by forcing us to sell it upon her death.   The state will place liens on it each year for the amount paid on Mom's behalf and collect when it sells.  I have no problem with this arrangement; it means we will probably get nothing from her estate but that's okay.  She should pay her way and this way she will.  This gives us a means to ensure my brother has a home andshe feels good that "home" is there just in case she may return and the state gets it's money. 

The "Medicaide Lady" also asked for a print out of her pharmacy expenses for the past quarter, October 1 through December 31; a copy of her Medicare Card and copy of her last pension check stub.   This seems like a pain because I provided her with a list of these expenses and an average of her prescription costs based on what the pharmacy has been charging to my credit card. But, she needs evidence and she's in charge so we comply.  I understand why and it's really in Mom's best interest, she wants to ensure there are no extra prescription fees, no extra premiums for Medicare Part D and the like.  So - I have a couple of things with me and my brother will gather some of the documentation and we'll send it in.   The next hurdle will be a visit from a nurse to gauge Mom's need for assisted living and nursing care.  

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The medicaide application is IN! Now we wait....

I submitted an application for Medicaide (State assistance) on Mom's behalf  today.   This means we've exhausted her existing cash resources and we are asking the state to contribute to her rent/care at the assisted living center.    Before compiling all the relevant paperwork I tried for four months to get some information from the State of Idaho about a couple of things but I got know where.   We have an odd situation concerning Mom's property - which I'll save for another post - so I wanted to understand what the state would do.  Starting 4 months ago, I began emailing, calling and contacting friends who work for the Idaho Dept of Health and Welfare.  I got little information other than a standard reply, "we must consult our manuals and get back to you".  Well, I heard nothing until I bugged just the right person and got a number for a "customer service center".  They  readily found someone who could actually answer my questions.  I called them three times to see if I'd get a consistent answer.  I did so figured it was safe to submit the application.

I'm not trying to "game" the system but I needed to understand how the State would approach some jointly held property and just what evidence the state wants to see regarding taxes and assessed values.   I felt pretty good after submitting an 1 inch thick packet of material, that is until I spoke with the Director at her ALF.  My mood quickly soured.  She told me some not-so-good stories about applications getting lost, delayed more than 60 days and in general, made me concerned.  I kept copies of everything so I can resubmit the materials if necessary but I'm just worried about paying for her care until Medicaide kicks in.  We worked out a plan to use Mom's Social Security and pension plus some funds from me for the time being but I can't contribute much for long.   So - I'm left waiting again.  At least I have a short-term plan until we know more.

I must admit to having qualms about being so open that Mom's applied for state assistance.  On one hand, she's proud and I'm proud; I hate to admit that she's broke.  On the other hand, she's never taken a dime from anyone else and my parents worked hard to provide for themselves, their parents, their kids and other extended family.   Often they went without and lived simply.  They never let anyone go without food, shelter and the basics even when it meant they didn't save a thing.  In her old age, she's paying for that "take care of your own" attitude.   What's worse, to let many go without years earlier or have one person accept some help now?

This is by no means a free ride.  The state will ensure that she contributes all she can (social security and pension) and will permit her to keep $90 a month for her personal needs.  She's spent just about that much on hair appointments and minor things each month.  It's not a lot so I'll have to supplement for things like clothes, shoes, treats or soda pop.  I'm happy to do that for her; it's relatively little money and if it makes her happy then it's worth it.    Her sacrifice years ago meant that I and our family had what we needed so now we can give up some to ensure she's comfortable.