Families facing placement of a loved one into long-term care can face challenges on multiple fronts. Principally, the issue of level of care must be addressed. Does the loved one require skilled nursing in a nursing facility? Could the loved one thrive in assisted living facility? Or could the family member possibly remain in-home home health care and/or receive home community-based services, and perhaps attend adult day care. The proper level of care can be determined through an assessment of the loved one’s ability to perform certain activities of daily living.
If it is determined that skilled nursing in a nursing facility is required, the next issue to be addressed is payment for that care. Neither Medicare nor health insurance cover long term care costs. Additionally, skilled nursing in a nursing facility presents the challenge of being the highest cost of care. In addition to finding a quality nursing home, determining how to pay for care, potentially for years, can be daunting. Does the family member require Medicaid long-term care assistance immediately? Does the loved one have some level of private pay that the resident must spend down, but an amount that might be expected to be exhausted at some point during their nursing home stay? If so, will the resident be required to move, perhaps even to a different nursing home? (The answer to this last question is a definite “NO” by the way?
At QMC, our professionals specialize in assisting families through this exact process. And not to worry; there are positive, workable answers to all of these questions, and there is a place for your loved one to receive quality nursing home care in a quality nursing ability, regardless of the resident’s ability to pay out of pocket for the entire stay.
But it does take planning and the proper guide. At QMC, we are that guide. The first step in the process is to determine exactly how much in the way of private pay the resident has, including any long term care insurance benefits that may be available. As part of this process, it must be determined which of the loved one’s assets are required to be spent down prior to qualification for Medicaid benefits, and which are not required to be spent before qualification for Medicaid coverage.
A special category: with proper planning married couples are allowed to keep additional funds, fyi, enabling earlier financial eligibility. A spousal share can be allotted to the spouse still living in the community if such planning is completed at the beginning of the care facility stay. Additionally, the community spouse can receive a portion of the nursing home spouse’s monthly income to live on, lowering the income limit for monthly payment to the care facility. This will also foreclose any possibility of estate recovery, as all of the preserved assets have been designated as a spousal share and not assets held by the nursing home resident.
Once this process is complete, QMC will then assist the family with determining which nursing homes are appropriate given that level of private pay. At this time, we will also work with the nursing home to set the stage for transition to Medicaid coverage at the appropriate time (when the private pay has been exhausted and the available funds have dipped below Medicaid asset limits.
Once placement into an appropriate facility has been made and the time for Medicaid eligibility has arrived, QMC continues to guide you through the process of navigating the Medicaid program. QMC works with the facility to make a transition at the nursing facility to provide for Medicaid payment for the loved one’s care. Additionally, QMC works with the family to meet all of the Medicaid eligibility requirements, collects all necessary documentation (health insurance data, identification, powers of attorney, bank statements, statements for annuities, social security statements, etc.) and makes the Medicaid application to the Department of Health and Human Services or Social Services (DHS).
QMC handles all of the details regarding the Medicaid application, Medicaid eligibility, etc. The family does not need to make contact with the Department of Social Services; QMC handles all of the processing of the Medicaid application with the State.