Accessing Medicaid a.k.a. “Choices” to Pay for Long-Term Care
What is Medicaid?
Medicaid is a program that provides health benefits to more than 60 million people in the United States. Medicaid is funded with federal and state funds.
What is TennCare?
In Tennessee, our Medicaid program is named “TennCare”. TennCare encompasses all of the Medicaid based services in our state, including long-term care. Our focus is on TennCare as a resource to pay for long-term care. We will use the terms Medicaid, TennCare and CHOICES interchangeably.
What is CHOICES?
CHOICES began with The Long Term Care Community Choices Act of 2008. Those individuals that meet the financial and medical qualifications may choose to receive long-term care services at home, in a nursing home or in an assisted living facility that accepts CHOICES. There are three Groups in CHOICES.
What is CHOICES Group 1?
CHOICES Group 1 is nursing home Medicaid. Medicaid nursing home benefits are an entitlement when our client meets the medical and financial criteria. Once qualified, Medicaid pays for the client’s care. As a general rule, our client must pay his income to the nursing home each month. Referred to as “patient liability” the amount is calculated by subtracting the costs of health insurance, spousal support, and a personal needs allowance of $50 each month.
What is CHOICES Group 2?
When our client qualifies medically and financially for Group 1 care, he may choose to receive CHOICES benefits at home or in assisted living. If he receives services at home, TennCare will pay up the maximum amount that would be spent on nursing home care.
If our client chooses assisted living, TennCare will pay toward the cost of assisted living care to an assisted living facility that accepts CHOICES. TennCare also caps the amount the assisted living may charge to those enrolled in Group 2. Unfortunately, there are only a few facilities participating in CHOICES Group 2. When receiving services at home or in assisted living, our client may be able to retain some or all of his income.
What is CHOICES Group 3?
When a person qualifies medically and financially, CHOICES Group 3 provides assistance at home for those who do not meet the medical criteria for nursing home placement, but need a more moderate package of services to delay or prevent nursing home placement. To qualify for and remain in CHOICES Group 3 requires that you must be “at risk” of needing nursing home care unless you receive more care at home, AND be receiving SSI (Supplemental Security Income) payments from the Social Security Administration.
Do I have to spend all of my money on nursing home care before I can receive Medicaid?
No, you do not have to “just spend down” in order to qualify for Medicaid benefits. In fact, it is a really bad idea to do so. Depending on where you are on the elder care continuum, and whether you are married or single, we have many excellent legal strategies to help you access Medicaid benefits and preserve assets to supplement your care and to leave for future generations.
How do you DEVELOP A PLAN TO PAY FOR LONG-TERM CARE?
Our comprehensive Life Care Plan service is designed to help individuals to navigate the long-term care maze, including developing a plan to pay for care. We use a holistic approach in working with persons diagnosed with disabling medical conditions associated with physical illnesses and/or advancing dementia. Their current or anticipated future conditions result in their need for a safe environment, skilled nursing care and significant help with activities of daily living.
We start by considering the elder care continuum. This discussion examines the client’s present and future functioning and corresponding levels of care, from independent living to nursing home care. Cost of care and public benefit programs associated with each level of care are outlined.
We look at a number of issues. How far along is our client in the disease process? What activities of daily living can he perform alone? What instrumental activities of daily living can he perform? What other health problems is he having? How are the caregivers holding up?
Based on that information, we work with the medical providers to determine the level of care our client needs to maintain the highest quality of life and quality of care.
Then, we consider the client’s resources to pay for care. These may include income, savings, and long-term care insurance, as well as available public benefits such as Medicaid, Veteran’s and/or EEOICPA benefits. Family resources—such as spouses and/or children who are providing care are also taken into account. Based upon the level of care needed by the client, we look at options to pay for that care using private resources and public benefits.
My father is in the nursing home and on Medicaid, but he still owns his home. Is it too late to protect the home?
As long as your father is living, it is not too late to preserve equity in the home for our client and his family. See Saving Momma’s Home in our Resource section.
Our first priority is for our disabled client to receive the care he needs at the right time and in the right place. Next we look at preserving income and assets for the well spouse, and to the extent possible for the couple’s children. It is never too late to make a plan, and there are many creative ways to accomplish the goals of client and family.