How to pay for caregiving at home

ADspouse

Hello.  This is my first post on this site.  I am running out of money to care for my husband who is at home with me.  Long story short:  We live in MD and are married.  The state of MD Medicaid rules require me to deplete my retirement before my husband can be eligible for Medicaid.  I am only 52, so I cannot tap into my retirement without paying a huge penalty. Is anyone in the same boat?  Any advice?  Thank you.

Ed1937

Where did you get that information? I think it is not correct. You really need to contact a CELA (certified elder law attorney), and if that's not possible, an attorney who handles Medicaid as a large part of his/her practice. Don't rely on what you hear from a friend or other family member. You need a lawyer.

Welcome to the forum.  Sorry you have a need to be here.You have found a good one here, where you will get help and understanding.

M1

AD, I second what Ed says.  If you look at nelf.org you'll find a list of certified elder law attorneys by location.

Rescue mom

Another voice saying you need a lawyer who specializes in Medicaid for senior long term care. The rules for this kind of elder care Medicaid are different than Medicaid that does general health care for lower-income families. And much, if not most, of what you “hear” from others is out of date or misunderstood. I’m no expert either, but I really question that you’d have to give up your personal retirement.

Medicaid rules are usually complex and hard to understand, at best, but CELAs know the “tricks of the grade” to make it work better and faster.

I know IRL so many spouses who finally got an attorney who got Medicaid for their PWDs. Everybody, all of them, were amazed at how much easier it was with attorney—including those who thought they didn’t qualify, but did, with expert help.

Jo C.

Hello AD, I can only imagine how horribly stressful this must be for you.  Do you recall where you got that information regarding having to spend your own retirement accounts?  It does not ring true in a factual manner.  This is absolutely a situation where you will be best served by seeing a Certified Elder Law Attorney (CELA).  Medicaid not only has state regulations,  but the state must also abide by federal laws re Medicaid.

This speciality of elder law is necessary as there are so many bits and pieces of elder law that general practice attorneys most often do not have and that can cause a negative outcome.    I have found it comforting and startling by how much an Elder Law attorney can do to position a person for their well being and avoid financial disasters.  The CELA will also provide you with accurate information for the year 2022 as laws tend to change.

I know it is pricey to see such an attorney, but they can be well worth it to position oneself to protect the future.  (Sometimes, the first appointment will be at no charge, if you screen Elder Law Attorneys, you can ask about that.)

If you see a CELA, do let us know what you found out, we will be thinking of you and we care.

J.

wspceo1

I have just started with a CELA elder law attorney firm and any money that is in your ira's and retirement accounts cannot be considered to pay for your LO's long term care.  A few weeks ago, I picked up a very small book on Amazon that explains in clear and easy to understand language and when one must do to protect your assets, income and figure out care for your LO.  Its called "Planning to Keep it, an explanation of elder law planning".    It is using New York Law as basis for Medicaid but the concepts are Universal.  I found it a quick read and is helping me with what I know, what I don't know and where to get help.

Mint

AD

Agree see a CELA.  People mean well but I have learned the hard way talk to an expert.

JoseyWales

Welcome ADspouse - sorry you have to be here. I'm 54 and have been on this journey with my DH with dementia (age 58) for probably 12 years.

Echoing what everyone has said about a CELA attorney. Not just any attorney can do this, find one that specializes in elder care law. It doesn't matter that you're not retirement age, that's who specializes in Medicaid. And don't think you have to wait  until you need Medicaid help. Go NOW, there's a 5 year look-back for Medicaid that you need to be aware of and lots that can be done ahead of time.

My husband JUST qualified last week - it's a process. And the rules vary by state, so anything I could tell you here may not work in your state. My DH has been placed in memory care, so Medicaid will pay for his home. For me, I was able to keep all of my retirement accounts, my house and 1 vehicle. 

I will say that I haven't heard of anyone here who has been able to get Medicare or Medicaid to pay for help at home. Medicaid will only pay for placement in a facility. I know in my state, home care is not covered at all. I paid for almost 2 years of care at home out of pocket. 

Ed1937

Jo C. wrote:   I have found it comforting and startling by how much an Elder Law attorney can do to position a person for their well being and avoid financial disasters.  

This was well said. You will be surprised what they can do for you. And if you think you cannot afford a CELA, the question you should be asking is "Can I afford NOT to see a CELA?". The first visit has a good chance of being free of charge. You can verify that when making an appointment. So there is no real reason to put it off. Putting it off can be disastrous for your financial future.

After the first visit, you will know what they can do for you, and what the cost will be for their services. They will cover any questions about Medicaid, and explain how you can qualify. But you need to do this NOW!

 

 

Crushed

I agree that you need an elder care lawyer

you should also contact the Maryland access point  
 
 

https://aging.maryland.gov/Pages/maryland-access-point.aspx

you seem to need home and community services for a person who is otherwise nursing home eligible

Also   You can avoid an early withdrawal penalty if you use the funds to pay unreimbursed medical expenses that are more than 7.5% of your adjusted gross income (AGI).

  

Iris L.

JoseyWales wrote:

I will say that I haven't heard of anyone here who has been able to get Medicare or Medicaid to pay for help at home. Medicaid will only pay for placement in a facility. I know in my state, home care is not covered at all. 

Ask the lawyer if PACE (program of all inclusive care for the elderly) is available in your state.  It does provide for in-home care. 

Iris

ImMaggieMae

Is in home care, the type you pay out of pocket for through an agency tax deductible? What about Depends and other incontinence products?

Crushed

ImMaggieMae wrote:

Is in home care, the type you pay out of pocket for through an agency tax deductible? What about Depends and other incontinence products?

Virtually everything vaguely medical is deductible as long as it exceeds 7.5% of  your income

  

toolbeltexpert

Here is what is available  where I live. There is an estate recovery clause for this program. I am going to see a clea about my best strategy here. I hear alot post on another thread about cost.

The mcf I am looking at if I had to place is just about 4000. Personal pay only no swap to Medicaid.

I copied these from the tn.gov 

Here is a link to the services 

https://www.tn.gov/tenncare/long-term-services-supports/choices/what-home-care-services-are-covered-in-choices.html

Here is a link to the text that I copied

https://www.tn.gov/tenncare/long-term-services-supports/choices.html

CHOICES

Tennessee's CHOICES program includes nursing facility services and home and community-based services (HCBS) for adults 21 years of age and older with a physical disability and seniors (age 65 and older).

TennCare CHOICES in Long-Term Services and Supports (or CHOICES for short) is for adults (age 21 and older) with a physical disability and seniors (age 65 and older). CHOICES offers services to help a person live in their own home or in the community. These services are called Home and Community Based Services or HCBS. These services can be provided in the home, on the job, or in the community to assist with daily living activities and allow people to work and be actively involved in their local community. CHOICES also provides care in a nursing home if this is needed. Area Agency on Aging and Disability (AAAD) TN Map

For CHOICES COUNSELING assistance, contact your local Area Agency on Aging and Disability (AAAD) at

ImMaggieMae

Crushed wrote:

ImMaggieMae wrote:

Is in home care, the type you pay out of pocket for through an agency tax deductible? What about Depends and other incontinence products?

Virtually everything vaguely medical is deductible as long as it exceeds 7.5% of  your income 

Crushed, would that include placement in MC which can run over $80,000 per year?

  

OrganizerBecky

Each state is different regarding a spouse's retirement plans. I found this chart: 

medicaidplanningassistance.org/medicaid-eligibility-401k-IRA/  (I couldn't copy and paste the url, so had to retype it out - hope it's correct). 

In Maryland, the spouse's retirement plan is countable. In my state (Kansas), it is not, for example. 

Lynne D

You might check with your local Area Agency on Aging to see if they have a program that can offer you some in-home help now (mine gives us 3 hours if respite care per week).

Also, make surE you understand your state’s Medicaid Estate Recovery rules. Some (like CA) are very lenient (especially is you use that CLEA and establish a trust) and others basically require you to be impoverished, lien your house, and recover the funds from the house down you pass.