medical waiver for memory care

dorasalas

Hello everyone,

Just joined today, I've been caring for my mom who has Alzheimer's for 6 years now, she lives with us, but she is progressing rather quickly now and I just can't do it any more. I've been trying to get her into a memory care facility but most are private pay. I was told to get a medical waiver but there is a 2 year wait list. I was also told if I got a Physicians order to admit her into a nursing home they might take her and have Medical pay, but I have no idea how to start this. I can't afford to place her somewhere, pricing starts at 4,000 and go up to 10,000 a month. If anyone has been through this and has some advice I would really appreciate it. Thanks.

M1

Welcome to the forum dora. There's a free Alzheimer's Association hotline 1800-272-3900, they may have some suggestions for you and be able to put you in touch with some local resources. Your local Council on aging might also be able to help. . You can also talk to a certified elder law attorney, they have the expertise about how to qualify her for mediCal and what the steps would be.

Sandias

Hi dorasalas - many nursing homes that accept Medical (or Medicaid) prefer at least several months of private pay, then the social worker there can help you apply for Medical. Go tour a few places, talk to family members of the patients to get a more accurate assessment of the quality of care. Don't depend on the facade, or the colorful brochures. Once you narrow down to a few that you like, ask to talk to the social workers there about how to admit your mother, and how long the wait is.

A consult with a good elder law attorney is also a great idea, especially if your mother has assets.

Inglesita

Hi Dorasalas, I feel your pain. Finding Medicaid-funded facilities is a nightmare. Each state "manages" their own Medicaid program. I'm in Texas. What about you? I'm a single mom and work full-time. My mom has lived with me and my son for 10 years. She had to retire about 4 years ago because she could no longer use the computer or drive to her office that was just 5 minutes from our home. Now her dementia has progressed so that she can no longer toilet/wash hands herself, run any appliances, operate the tv or telephone, feed herself. She wanders and does not know where she lives and has forgotten her two sons. I have been looking for a Medicaid-funded memory care unit for well over a year. It is a full-time job with roadblocks and dead-ends at every turn. Attorneys have taken my money and provided zero assistance. I am so despondent, frustrated, angry, sad, severely depressed. Hope you find the help you need soon!

Ci2Ci

I am an unfortunate quasi-expert on this for Florida -- having to learn it the hard/painful way. If you are in Florida, private message with questions.

"Memory Care" can be Assisted Living (AL) facility or Skilled Nursing Facility (SNF). In Florida, the Medicaid Waiver program is for home care; and the wait list is years. MedicAID-LTC rarely pays for Assisted Living facility room & board; MedicARE pays zero longterm r&b. There are some AL facilities that have some MedicAID-LTC beds available, but they will be difficult to find and MedicAID-LTC will only subsidize the cost, not pay 100% as they would for a SNF. Depends on the state.

In Florida, I didn't have difficulty finding SNF that accepted MedicAID-LTC, but they might have a limited number of beds set aside for MedicAID-LTC recipients. The harder issue is finding Memory Care units (usually refers to it being a locked unit).

When researching facilities, the thing to ask is: do they accept MedicAID-pending applicants. Some will accept a resident right way, determining them to be a likely candidate for MedicAID-LTC (longterm care). But, they take a risk in accepting them without there being any private-pay funds at all.

If your loved has a bit too much assets to be financially eligible for MedicAID-LTC, you might be able to spend that down by prepaying the first months of their stay in SNF, to qualify them. Then, apply immediately. It can take months for MedicAID to complete the application process. If approved, they might make the eligibility date retroactive to the month in which you applied. In that case, you'd get a full/partial refund of your private-pay funds, after approved. (Then, you'd have to spend it down again to keep them financially eligible. Very strict rules about how you can spend it down.)

In addition to being financially eligible for MedicAID-LTC, the applicant must be determined "medically needy" for longterm care. Dementia can certainly qualify as such; but, it can be very difficult to get that determination if they are living at home -- outside a nursing home. If they determined the LO to be not medically needy for SNF care, you'd be stuck applying for that waiver. Very tricky. If the LO is every sent to hospital for any reason, this is the time to consider the transfer directly to SNF from there.

If your loved one is currently financially (or nearly) and medically eligible for Medicaid, you want to start the application process immediately once they are admitted to a skilled nursing facility. Even if you place your loved one in a facility starting as private pay, apply ASAP.