When Mom, Dad need a nursing home, Medicaid can help


Welcome to Saturday. I hope you and yours are planning a lovely 4th of July and that, for one day, we’re all able to let go of our politics and just remember that freedom is NOT just another word for nothing left to lose.

I’m picking up where we left off last week, which was that we have to find a way to continue paying for Dad’s care in a nursing home, now that we can see that his liquid financial assets will be pretty much gone in a couple of months — and that “way” is called “Medicaid.”

In order to qualify for Med icaid in a nursing home, there are three “pieces” of eligibility: Dad has to actually need that level of care (we’ll assume that’s a “given”), he has to qualify in terms of his income and he has to qualify in terms of his assets. Let’s start with “income.”

The income figure for nursing home Medicaid eligibility isn’t a “hard” number; in order to qualify, your monthly income has to be less than the total of the nursing home’s Medicaid rate PLUS Dad’s regular monthly medical expenses. Example: The monthly Medicaid rate for “Strawberry Fields Nursing Home” is $6,800 per month, and Dad’s monthly medical = $275.00; thus, Dad’s income has to be less than $7,075 per month. Not a problem? I didn’t think so.

The assets piece (“resources”) is a bit more complicated, but not insurmountable; basically, a single person can’t have more than $2,000 in resources, which generally means bank accounts, property, stocks/bonds, etc. The house is often exempt, unless Dad has more than $536,000 worth of equity in it, a car usually is, as are personal belongings and what not. TIME OUT:

The “resources” piece if Dad is married vs. the “resources” piece if Dad is single are VERY different. I’m going to refer you right now to a wonderful, free website. Go to www.washingtonlawhelp.org and click on the “60+” icon, then click on “Long-term care assistance,” then click on “Questions and Answers on Medicaid for Nursing Home Residents.” What you’ll find is a great pamphlet on the subject by attorneys, but folks like you and I can actually understand it. Read it, please; now, read it again. I’m not going to attempt to recap everything that’s there, because that would waste your time and mine, so I’m going to jump ahead to a common scenario, but let me remind you of this: If you need any help with any of this, call any of the numbers at the end of this column, and decent people will help you, for free. Don’t hesitate: We don’t consider it an “interruption” — we consider it to be our job.

Here’s a common scenario for a lot of us: Dad was living alone in his house, on a low-to-moderate income, with a few bucks in the bank. When it all became too much you, Caregiver, helped him to get into a nursing home and started paying with the income and assets he had; at the same time, you (because you have a “Durable Power of Attorney”) put his house on the market for “fair market value.” His money ran out in a couple of months, so you shepherded him into Medicaid eligibility and Medicaid has been paying the nursing home bills — OK. Suddenly, the house sells. Now what?

First (this is always first …), don’t panic. What this means is that Dad is no longer Medicaid-eligible because he just came into a substantial “resource,” so Medicaid stops. What happens is that you continue to “private pay” the nursing home for Dad’s care, out of the proceeds from the sale, and when those proceeds start getting pretty low, reapply for Medicaid — No harm, no foul, but let me point something out:

These proceeds from the sale are, in fact, Dad’s money. So, if he needed dental work or clothes or a TV or a radio or or or, those are perfectly legitimate expenses, so don’t hesitate to spend it on his behalf. The only thing you (he) can’t do (well, shouldn’t do) is give the money away (to the granddaughter, or whomever), because THAT will disqualify him from Medicaid for “X” amount of time, but pretty much anything else on his behalf? You bet — Go for it.

Then, again, when the money starts to dwindle, reapply for Medicaid, complete the annual Re-eligibility paperwork, keep the DSHS Financial Worker informed of what’s going on (financially), and things will go pretty well.

I’m not going to pretend that this Medicaid stuff isn’t complicated. It is, but lots of us have done it, and there’s plenty of help out there for you — and for Dad. The worst mistake is to start doing things or making decisions without understanding their implications, because once money and/or assets are gone, they’re gone.

And if you decide to consult an attorney (which is never a bad idea), be sure that said attorney is familiar with Medicaid law (“Elder law”). I’ve seen some great attorneys give lousy Medicaid-related advice because it simply wasn’t their forte, so be sure that you’re not engaging a podiatrist to do neurosurgery.

The main point of all this was to be sure you know that there is help, and it can be done and you, Caregiver, are not alone.

You never were. Dad said to say, “Thank you.”

Mark Harvey is the director of Information and Assistance for Olympic Area Agency on Aging. He can be reached at harvemb@dshs.wa.gov or 532-0520 in Aberdeen, (360) 942-2177 in Raymond or (360) 642-3634. FACEBOOK: Olympic Area Agency on Aging-Information & Assistance.