Medicaid/Medi-Cal or No?

LB3

The last time I posted a few months ago, my mother had just been diagnosed with Alzheimer's (having just transitioned from MCI). Many people advised that I speak to an elder care attorney immediately to see if I could get my mom qualified for Medi-Cal (since we live in CA) which I genuinely appreciated. I have since educated myself by speaking with several consultants and lawyers, and I'm trying to compare the cost of restructuring her finances (which are considerable) to the cost benefits of qualifying her for Medi-Cal and it's hard to tell if it will be worth the expense. She is physically very healthy otherwise, and I hope she will be with us for a long time to come so I'm trying to prepare. Of course, what I really need is a crystal ball to predict the future since everyone mentioned that progression is unpredictable - I don't have a ball, but I do have this community! Would some of you who qualified your LO for Medicaid or Medi-Cal be willing to share with me the ballpark figures of their LO's long term care? Or potentially some scenarios that you didn't see coming where Medicaid/Cal saved your LO's finances? In my research, I read that the total cost of care could easily exceed 300K! I suppose between extended home care and a 2 plus year stay in a nursing home that cost 10K a month, that number might be real (and very, very scary). This disease is so awful. It breaks my heart to hear my mother repeat herself more as time passes and I'm scared of what's to come. It's hard to stay objective and make these financial decisions right now, but I know that I have to. Thank you SO much for your feedback. I felt so sad and lost when she was first diagnosed and the support I immediately received from this community was invaluable.

dayn2nite2

Medicaid/Cal is for after your assets have been used for care.

Why would you be "restructuring her finances" at this time?  Be careful because there is a look-back period and the moving around of money is viewed suspiciously.

The nursing home care at 10K/month may be a little low, especially for California.

Just make the best decisions you can and give her the care she needs with the assets she has, and then apply for Medi-Cal when she is nearer to running out of money.

If you do place her in a facility, make sure it's a NH that has Medicaid beds so she doesn't have to move to a new facility and Medicaid can just take over when her funds are exhausted.

star26

We did not consider medicaid because my Dad had too many assets. But I'll give you some of our figures to help you pencil it out. In our area, home care is $25-$30+ per hour (even for overnights and 24/7) and facility care is $10,000/mo. Adult Day Care was $75/day. You can save some money at "board and care" homes instead of a typical facility but you may or may not find one to your liking. We paid the $350/day facility rate for respite care: 10 day minimum. If you are going to care for her at home for at least a while, I would budget in at least 30 days of facility respite care per year should you need it. One advantage to knowing in advance if/when she is going to run out of her own funds and need MediCal is because some facilities will only take MediCal if the person has been private pay for a certain period, such as a year. So, you want to plan it right so your choice of facility is not limited. Likewise, you wouldn't want to place her in a facility that does not take MediCal at all and then have her run out of money a couple years down the road and have to move her. "The 36 hr Day" book may clue you in on caregiving needs and challenges that could lead you to needing to hire more help or place her in MC. I penciled out several scenarios (because you never really know how things will play out) so I knew that he would be okay financially no matter what for the foreseeable future, and I updated it every so often for my peace of mind.

LB3

Thank you so much for sharing! I just ordered "The 36 Hour Day." Brilliant. I'm definitely not touching any of her assets without the guidance of an elder care lawyer and/or Medi-cal consultant. My understanding is that her assets could be transferred to a "Medi-Cal Trust" so that she may qualify for Medi-Cal while protecting her assets. Having said that, moving all her assets may prove too expensive, so that's what I'm trying to gage. I'm wondering if she'll eventually need 100K, 200K, 300K in care over the next 2-10 years. I know it's impossible to know for sure, but that's why it's helpful to have your feedback on costs. Thanks again!

Jo C.

There are many different facets to this.  If one has Medi-Cal, one can only be placed in a Medi-Cal contracted facility and paying for care at home is pretty much non-existent in any solid way.

We decided to use our parents assets to keep them in their own home with a 24 hour caregiver as long as possible as they both refused to be placed outside of home.  They well knew where they were.  After all, it was their money; not mine and they had saved for a rainy day.

Later, my mother needed placement; she was no longer able to be cared for at home due to several reasons.   We were able to place her in a facility as private pay for about two years, and it was a wonderful facility.  Step-dad was still home with the 24 hour aide who was a treasure, and Dad was content and felt safe.

The time came when money was very low; at that point, I qualified my mother for Medi-Cal for her nursing home; they had a contact with Medi-Cal, so that became her payor.

My step-dad died at 96, just two months before he ran out of funds; BUT when he had to be placed for a short time in a NH at the very end of life, we had him qualified for Medi-Cal too.

It was all about the highest quality of care and their comfort as both though with dementia knew who they were and where they were until near their deaths.

As said, it was their money; not mine.

J.

King Boo

The sooner you act, if you are going to, the better.

300,000 is a low side estimate, I would say.  Private pay nursing homes were $120 K plus a while ago in my area, MC 70 K.  Research stages of what is anticipated for your mother, as well as consider her chronological age.  Planning for a 70 year old is different from an 84 year old.  Planning for EOD, LBD is different from ALZ.  

One can move assets and still entirely plan to use them for care before using Medicaid.  There are numerous circumstances that can come up in the  unknown future.   Being penniless to change facilities in case of need is generally not a good place to be, if you have the option.

Hypothetical example:  You planned and sheltered enough money for 6 months of nursing home care.   Mom develops behavior difficulties that necessitate her move from her current nursing home, where they are dementia experts but not prepared to deal with an increased behavioral needs resident.

Do you think you are going to have the facility of choice queing up behind others with Medicaid direct beds which are limited?   Or do you think you will have more success with showing them you can private pay for 6 months before converting to Medicaid?   I call this 'key' money.   It won't come into play at all facilities, but could help at a lot of them.  

Medicaid does also not cover everything your Mom could need.  Having at least a small reserve helps. Extra medical equipment, private pay an extra aide, etc.  Having a choice of medical provider can also be important.  Not everyoffice accepts Medical assistance.

How much were you quoted?  5-7000 is not even one month of care, and legal fees are legitimate expenses.   Of course, if there is not enough money to 'clear' these expenses to be set aside, or it is only a few thousand, then it is not worth the effort.  

Do nothing - the course is set.

Shelter something - you can still follow the same course-but have the option of reserve funds for her care.