What Do We Do If Senior Needs Memory Care But Not Nursing Home?
Medicaid transfer rules
Question:
My former spouse (I am his power of attorney and health care proxy) currently resides at a rest home and is in need of a higher level care, preferably an affordable memory care unit. I was delighted to find one that is perfect! Unfortunately he no longer qualifies for the PACE Program as his Social Security is now $3,300, above the limit of $2,900. Over his eight years at the rest home he spent down his savings and went on MassHealth and then switched to Commonwealth Care about two years ago. Are you aware of any long-term care settings for folks with dementia that are between assisted living and nursing home? He is not ready for a nursing home. His sense of humor, participation in activities, curiosity are all, thankfully, very much intact.
Response:
You are facing one of the many gaps in our so-called “system” of elder care. While Medicaid (MassHealth in Massachusetts) pays for nursing home care, its coverage of other kinds of care, including home health and assisted living is both more limited and the eligibility rules are more complicated. They also vary considerably from state to state (and are at risk with the Medicaid cuts currently making their way through Congress as I write this since while nursing home coverage is mandatory, these other types of coverage are discretionary). They are likely targets if Medicaid agencies have to reduce their spending to make up for reduced contributions from the federal government.
All that said, PACE is a wonderful program that combines Medicaid and Medicare dollars to provide comprehensive care for seniors. It stands for Program for All-Inclusive Care for the Elderly. PACE programs are operated by non-profit providers who do whatever is needed to provide necessary care, but they have a lot of control over that care. So, for instance, they would cover the memory care unit you identified only if it were part of the care network.
At least in Massachusetts, your ex-husband should still be able to qualify for PACE if he’s over-income if he meets a deductible, but that would require having sufficient funds available to pay out-of-pocket for the deductible period. That might be a problem since he’s spent down his savings, but since this might be just $400 a month, perhaps you or other family members could find the funds to pay it.
Unfortunately, the process might be more difficult than the funds. It’s not that you simply pay $400 a month to a care provider. Instead, it’s a six-month spend down where you or others would have to pay $2,400 towards your ex-husband’s care proving this by producing invoices and proof of payment. But it could be worth it if all the stars align — the facility you identified participating in the PACE program.
Otherwise, unfortunately, your ex-husband may have to move to a nursing home before he’s ready if that’s the only place that Medicaid would cover where he would be safe. That would, of course, be counterproductive for everyone given the high cost of nursing home care. There’s also the possibility that he would not qualify for Medicaid coverage because he would be deemed to not need to be in a nursing home. Talk about being between a rock and a hard place.
Related Articles
Don’t know how your trust works?
Whether you’re creating a plan, managing a trust, or are a beneficiary of a trust, this book is your easy-to-read roadmap.
