Community Medicaid

Drapper

I am currently going through process to get my husband approved for community Medicaid. My understanding from the company I have hired to advocate for me, is that an interview will be required by the state, with my husband and I to determine hours I will be allowed. Hours will be positioned more as respite for me. My husband is pretty physically active and can still shower , dress and eat himself. He is not incontinent. He has spatial issues, has a 5 second memory and cannot cook, find rooms etc. he is prone to anxiety and difficult behaviors if not happy with situation. Cannot be alone at all . He is 76

he is in denial of having any issues. I am greatly concerned about this interview process really upsetting him and causing a total meltdown and breaking down my relationship with him.

Has anyone been through this process? Any advise ? I am dreading this and almost wish I never started it. It was a considerable amount of money to hire law firm to handle this. And I can’t just walk away from it at this time. I know my needs will change down the road , and approval now will help later on.

M1

Drapper i think you are right to go ahead with it. I worked for our state program, the hours are typically determined by how much hands-on help he needs, so i suspect you may not receive many hours now, but you may need it to qualify him more for possible placement in the future. It of course is more cost effective for the state for him so stay in his own home than to provide nursing home care, but respite for you is not going to be their primary concern. Typically time is allotted for bathing, dressing, grooming (such as shaving, skin, hair care), toileting, walking or wheelchair use, meal prep and setup, housekeeping, laundry, shopping, and escort needs. Time is allowed for safety supervision if the primary caregiver works outside the home requiring visits of four hours or more (that is called attendant care, while visits of four hours or less are called personal care). In our state there is a statutory limit that someone can receive only 27 weekly hours of attendant care, any more than that is only approved if it is a cost effective alternative to nursing home placement. In home respite is provided typically as a certain number of hours that can be used per year (216 is the state maximum here).

Hopefully the interviewers will have encountered similar situations before. I would try to have a conversation with them in private if you can.

harshedbuzz

@Drapper

I've not been through this, but a couple things come to mind:

I know that every PWD's progression has a timeline that is unique to them, but I wonder if you are over-stating his abilities in his ADLs given you describe him getting lost in his own home. My mom long claimed dad was fully independent around ADLs because she didn't realize how much scaffolding she put into his day. Yes, he could shower and change his clothing but only after she verbally prompted him (he'd say nagged), adjusted the temperature and pressure to his liking, gathered his towel, bathrobe, shampoo, soap, whisked away his dirty clothes and laid out an appropriate outfit for the day. Mom once left him for a week to attend a funeral with a good friend checking in daily; dad didn't shower or change clothing the entire time. Left to his own devices, he couldn't initiate or complete it. Same with food. He could self-feed, but the meals had to be prepared for him; he'd run a sandwich shop in his youth but couldn't make a simple PB&J if mom gathered the ingredients for him.

Is your reconning that he needs 24/7 supervision supported by anyone in his medical team? If his neurologist or PCP has said this, I'd get it in writing for the interviewer.

Was it on the advice of your lawyer that you present these hours as respite for you? IME, governmental agencies aren't looking so much into supporting caregivers as much as controlling care costs by keeping him out of a Medicaid funded bed in a care facility as long as possible. The one person I know who went this route used her own health needs and running of the household to justify hours. She had high BP and was overweight-- part of her needs was to get to a gym and shop/prepare healthy meals per her doctor's orders. They were willing to support her health in the interest of delaying him going into a facility.

Would it be possible for them to fund a day program? These are generally less expensive because of the economy of scale, so you might get more hours and socialization for your DH. Sometimes these programs are more reliable because individual caregivers can be hard to find and retain. Sometimes a Medicaid recipient is promised x number of care hours but can't provide the actual person to provide those hours. I have a family member whose grandson is in a Pediatric Specialty Care Center (SNF for children) because he's medically fragile and there are no warm bodies picking up the hours he has been granted. FWIW, kids with disabilities in my state tend to fare a bit better than adults because the pediatric pay scale is a bit more generous than the one for adults.

It sounds like your DH has anosognosia. This is pretty common among PWD. While it looks like denial, PWD often are unable to recognize the degree to which they are impaired by it. While my dad would admit to "my memory isn't what it was", he was unaware of his losses around empathy, executive function, apathy, higher order thinking, spatial reasoning, time management, etc. Basically, a PWD who has anosognosia doesn't know what they don't know.

Related to this, they can be terrible reporters. Dad went through a phase where he stopped showering-- even with mom's assistance. Before dementia, dad was fastidious often showering first thing, after work, after a round of golf/before dinner with several wardrobe changes. In his mind, he absolutely believed he'd showered because, well, he always showered so of course he already had.

Good luck.

HB

Jeanne C.

The interview to qualify for Medicaid was pretty simple in our case. It was done over the phone by a nurse and involved a lot of questions about ADLS. Make sure you take into account everything you need to supervise that your husband still does semi-independently.

After approval, the social worker from the managed care organization administering the Medicaid insurance conducted the interview to determine hours. She literally typed the answers to ADL questions into a program that calculated the hour allotment. Again be very forthright about all that you are doing to help your husband. My husband did need to be present for the social worker interview and it was hard. He became very agitated and upset when I talked about the problems he has (anosognosia for the win) but I forced myself to keep going even though he was upset. He was very angry, but he forgot about it pretty quickly and we now have so many benefits to make this a little easier.

PS for us, Medicaid also covers a day program.

Drapper

Thank you all for your comments. They are very insightful and give me much to think about. He definitely has anosognosia ( I’ll have to lean how to pronounce !)

My point person at law firm who does application, advocates , and is there with me during interview process, told me she is requesting a phone interview versus in person. I am not looking for crazy hours , maybe 12 a week st this time, and am hoping to get day program covered. Although my husband is not currently in day program , and had tried it , and didn’t like it. ( although maybe he is ready now ).

I agree I may be over estimating his ADL,s. I do need to turn on shower, give him towels , shampoo and lay out all clothing. I also do need yo make all meals, clean up etc. he can’t even find the refrigerator. I need to think more about this. I don’t want someone to do these things for him. I want a companion.

he has a companion now for 2 days 4 hours through private care agency. I was hoping he would join Medicaid agency albeit, he may not want to. I do hear these agencies don’t have people, particularly since Covid.

i need to talk more with my contact, I have not been that engaged, and have been putting it off, as I am dreading the interview. my husband will yell and scream and get very upset at anything he perceives as an insult. He is on seroquel now, which helps. I may need to give him something else to calm him down for interview.

Your comments have helped me tremendously. Even regarding what my questions actually are. Thank you all.

I also understand there is sn annual recertification process. So this is not a one time thing. I expect my needs will change within a year. So this is a good reason to get in the system now.