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Old 10-01-2017, 01:33 PM   #21
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we checked with some of the nicer nursing homes in our area . while they have a limited number of medicaid beds once you are in privately and paying for 2 years ,done deal , they will take medicaid assignment and nothing changes .
In Illinois, many NH's that accept medicaid have only the minimum number of Medicaid beds necessary to qualify them for Medicare rehab patients. Many are private-pay exclusively. In the NH where my MIL is living, there are 18 Medicaid beds (out of about 120) in 9 rooms. The Medicaid rooms are a bit smaller than private pay double rooms and two rooms share a single bath (instead of one bath per double room.) Amenities, food, staff, etc., seem to be the same for Medicaid and private-pay.

When we extensively shopped for a place for MIL, we found all the "decent" NH's only accepted folks who started as private pay and that would be able to pay for a couple of years (among other financial circumstances such as SS, pensions, insurance, military benefits, their evaluation of your health and longevity, etc., etc.).

MIL's situation was that she had only SS and the value of her condo (which would cover almost two years). She was accepted with a guarantee that if she outlived her money, she would be allowed to stay on Medicaid. But, she was required to move into a Medicaid bed from the beginning. That is, for almost two years, she private-paid for Medicaid accommodations. The rule is that you must be in a Medicaid bed at the time you run out of funds in order to be allowed to stay on Medicaid.

There were no Medicaid beds available for folks with no/little money or resources at the beginning. All 18 Medicaid beds are always full with previously private-pay folks who outlived their funds. They don't even keep a waiting list for Medicaid new resident applicants. But there is a waiting list for private-pay applicants willing to start directly in a Medicaid bed since they know their finances are limited and they are likely to run out of money.

They made it clear that if we initially moved MIL into a regular private-pay double room and she ran out of money before passing, she'd have to move out. The Medicaid beds are always full and their policy is to not keep Medicaid folks in private-pay beds.

It seems that in Illinois, where state payments are low and slow (especially slow), NH's are working hard to be able to attract private-pay customers and keep Medicaid beds at either zero or the minimum required to qualify for Medicare rehab business (fed requirement).

I can't say this is how it works at all (or even most) Illinois NH's, but this is how it worked at the ones we checked out except for one that had a high percentage of Medicaid beds and that one was unsatisfactory and we never considered it.
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Old 10-01-2017, 01:39 PM   #22
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. The Medicaid rooms are a bit smaller than private pay double rooms and two rooms share a single bath (instead of one bath per double room.) Amenities, food, staff, etc., seem to be the same for Medicaid and private-pay.
Most of the times Ive had the great misfortune to visit these places, the patients used diapers, the bathrooms were for the visitors, the sick and dying never left the beds.
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Old 10-01-2017, 01:47 PM   #23
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The issue with Medicaid patients from a nursing home and nursing home patient pov is that the state doesn't pay enough to adequately staff the needs of patients. I would not ever make an estate plan that anticipates using medicaid.
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Old 10-01-2017, 02:37 PM   #24
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Most of the times Ive had the great misfortune to visit these places, the patients used diapers, the bathrooms were for the visitors, the sick and dying never left the beds.
Yeah, there is some truth to that. Lots of the patients are incontinent and the sickest are not mobile. In fact, I've yet to meet any patient there who could competently just get up and walk out. They're there for a reason.

MIL, despite having only one leg, wheels around the NH considerably, attends classes and activities, enjoys or bitches about the food depending on the day and generally is well aware of her surroundings. I'm glad we've been able to keep her in a quality situation, although it's been challenging due to her sad finances.

MIL's smaller Medicaid room and two-rooms-to-a-bath situation really hasn't been a problem. The overall place and staff are good and she's been very lucky with roommates.

We're thankful.
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Old 10-01-2017, 02:43 PM   #25
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The way you are going, your money should not run out. Later on get yourself a beautiful ranch, handicapped accessible, with a beautiful view, and lots of light from the room where you will have you bed. At least two extra bedrooms (live in help and visiting relatives). The trick is to have someone you can trust to handle your affairs when and if you can't.
Thank you for the confidence! It never feels like it is 'secure enough'.
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Old 10-01-2017, 02:49 PM   #26
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The issue with Medicaid patients from a nursing home and nursing home patient pov is that the state doesn't pay enough to adequately staff the needs of patients. I would not ever make an estate plan that anticipates using medicaid.
+1

It shows up particularly at NH's with sizable percentages of Medicaid patients. We researched and worked hard to get MIL into a predominantly private-pay place with an a priori agreement she could stay when she ran out of money. She is attended to by the same staff that attended to her as when she was private-pay.

I think the fact either DW or her brother visits almost 7 days a week might play into it too.

During our search, we visited a high-percentage-Medicaid NH and it just didn't cut it on a number of fronts. We wondered how they could attract any private-pay clients at all.
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Old 10-01-2017, 03:04 PM   #27
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The issue with Medicaid patients from a nursing home and nursing home patient pov is that the state doesn't pay enough to adequately staff the needs of patients. I would not ever make an estate plan that anticipates using medicaid.
+2

I think this is one of those issues that is talked about more than practiced, and then only by people with few financial assets.

Nursing homes that are not SNF are not desirable places to live, and residents live there when they have no option. Home care or ALF with a high level of assistance are preferred options, and if nursing care is required, a private pay NH is usually a more desirable choice, and has a higher aide to bed ratio.

There are exceptions, mostly in states like Mass, but otherwise, I think this issue of people shielding real wealth to go to Medicaid funded homes is not substantial.
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Old 10-01-2017, 05:42 PM   #28
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The problem, with Medicaid paying for nursing care, is that you likely get sub-standard or minimal care. That's why most here, when trying to qualify for ACA subsidies, want to avoid medicaid.

When you pay more, you get more. Even in a nursing home. With money brings choices - no matter what purchase you are considering.
This seems to vary state to state. From personal experience I've found that Mass seems to make no distinction between payers and Medicaid. My brother (self paying at $600 a day) shared a room with a Medicaid drug addict who was hit by a car. What was different was that the drug addict got more therapy.

His therapists urged me to try and get him on Medicaid. "We'd be able to give him so much more time; he shouldn't be paying!"

IIRC, 97% of NH patients in Mass are paid by Medicaid, hence, few, if any NH's make the distinction.

YMMV.
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Old 10-01-2017, 07:01 PM   #29
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This seems to vary state to state. From personal experience I've found that Mass seems to make no distinction between payers and Medicaid. My brother (self paying at $600 a day) shared a room with a Medicaid drug addict who was hit by a car. What was different was that the drug addict got more therapy.

His therapists urged me to try and get him on Medicaid. "We'd be able to give him so much more time; he shouldn't be paying!"

IIRC, 97% of NH patients in Mass are paid by Medicaid, hence, few, if any NH's make the distinction.

YMMV.
+1, When I went to the social services office at the hospital, to arrange for a private "nurse"(aide) for mom, the lady told another patients family, "get medicaid, its the gold standard. They pay for everything". Maybe they got a nurse for free, I had to settle for an aide that we pay for. BTW the term Gold Standard was her words not mine.
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Old 10-01-2017, 07:11 PM   #30
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Ozanam Hall, nice and clean. Run by the nuns.

If i ever get time to leave my house I'll give Fatoullah a call. A poster said he has over 5 million and another that has 20 million and they sleep well at night gaming ACA subsidies. And that maneuver "made them smart". Thats peanuts compared to what one can save by gaming medicaid. I want to thank them for pointing this out, Now maybe Ill game the medicaid game , I'd like to be smarter.
i am familiar with ozanam .in fact it would be a choice . i highly recommend fatoullah . he is tops in his game .
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Old 10-01-2017, 11:54 PM   #31
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I plan on being able to afford to age in place so I don't need to worry about trying to make myself medicaid-eligible as medicaid does not pay for aging in place
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Old 10-02-2017, 12:13 AM   #32
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I plan on being able to afford to age in place so I don't need to worry about trying to make myself medicaid-eligible as medicaid does not pay for aging in place
It does in New York
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Old 10-02-2017, 06:20 AM   #33
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The part I struggle with the most is when there's a spouse left with no funds available. Seems very hard on them to not only watch their spouse suffer through nursing home care and spending down of assets, now they have to face who knows how long with limited or no assets. I watched my grandmother tried to care for my grandfather at home so that their money would last. He ultimately ended up in the nursing home for 2 to 3 years. Luckily her stay in the nursing home was fairly short and remaining assets were adequate to cover her stay.

My boss tries to take the moral High Ground, his mother had plenty of assets but her husband died at a very young age so no trailing spouse to worry about. He likes to Crow about how proud he and his family are that she was able to pay for her own Healthcare. however this is the same guy who would twist and wiggle out of $10 on a contract. I think if the situation was different and one of his parents was still left after spend down of assets he would have a much different approach. It is ultimately a moral question.

Many moral questions of a similar nature. How about those that divorce continue living together so they can claim higher Social Security? Had a previous co-worker that strategically did just that.

Another (probably non- popular) issue is tithing. My personal feeling is morally everyone should tithe however it is a moral question I certainly don't think less of folks that don't.

As to the Medicaid question, perhaps if there is a trailing spouse assets can be protected for that spouse but not just to pass the kids? Might make the Social Security Gamers think twice about divorcing if their assets are at risk:-).
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Old 10-02-2017, 06:45 AM   #34
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The part I struggle with the most is when there's a spouse left with no funds available. Seems very hard on them to not only watch their spouse suffer through nursing home care and spending down of assets, now they have to face who knows how long with limited or no assets. I watched my grandmother tried to care for my grandfather at home so that their money would last. He ultimately ended up in the nursing home for 2 to 3 years. Luckily her stay in the nursing home was fairly short and remaining assets were adequate to cover her stay.
<snip>
Many moral questions of a similar nature. How about those that divorce continue living together so they can claim higher Social Security? Had a previous co-worker that strategically did just that.
My uncle is in a nursing home with Alzheimer's; my Aunt took care of him at home as long as she could but it became too much. The money they have is what's left of an inheritance from her family and it will likely be spent down to the Medicaid minimum. She's got advance colon cancer so, sadly, may not last long anyway, but this scenario is one of the reasons I'll never remarry unless the guy can provide for his own LTC.

On the SS dilemma- when my Grandpa and his second wife married (both widowed), Grandpa wanted the priest to marry them but not report it to the state because their combined SS benefits would be higher. Apparently that's illegal. They had a church ceremony.
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Old 10-02-2017, 06:53 AM   #35
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As to the Medicaid question, perhaps if there is a trailing spouse assets can be protected for that spouse but not just to pass the kids? Might make the Social Security Gamers think twice about divorcing if their assets are at risk:-).
There are protections for the trailing legal spouse. However, if the trailing spouse does not understand them and does not engage someone who does, they could make the wrong choices.
At least in may states the community spouse can keep the house and a larger amount of $ than the medicaid spouse. This amount in my mind is not enough to support the community spouse long unless there is other income.

There is another thing called a Medicaid Annuity. Not because is screws medicaid, but because it complies with medicaid laws. IIRC that community spouse can fund this with assets, it is an immediate single payment annuity, must pay out at least over the expected lifetime of the community spouse, and the primary beneficiary must be medicaid. This way medicaid has a potential of recovering expenses before the heirs. However, if the community lives their normal life expectancy or longer, medicaid would loose out.
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Old 10-02-2017, 01:16 PM   #36
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Blue Collar Guy, did not realize that! Thought it only covered medical and nursing ..... not social visits and meal delivery. But it makes sense as its cheaper to supply meals in someone's home than pay for a nursing home
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Old 10-02-2017, 02:02 PM   #37
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Note......

Medicaid NH results seem to vary from state to state. Some of what you're saying for NC is NOT true for Illinois. It really pays to research your own state and keep the state to state variability in mind when ready comments on this, or other on-line forums.
And by Illinois you mean Chicago.

Sure, in the largest, wealthiest cities like Chicago, NY, LA there will be private-pay only nursing facilities (not talking about assisted living)

But the reality is most skilled nursing facilities (SNFs) simply can't survive without Medicaid dollars even when many of the residents started out private pay.

And SNFs often are not avoidable. Here a resident must leave an assisted living facility for a SNF once they need more than a certain level of assistance.

I bet that's even more the case in those states that are more heavily-regulated than mine.
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Old 10-02-2017, 03:12 PM   #38
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+1, When I went to the social services office at the hospital, to arrange for a private "nurse"(aide) for mom, the lady told another patients family, "get medicaid, its the gold standard. They pay for everything". Maybe they got a nurse for free, I had to settle for an aide that we pay for. BTW the term Gold Standard was her words not mine.
It gets even weirder:
Let's say that you're in a SNF and getting therapy.

Once your insurance stops paying for therapy (maybe you're not progressing fast enough), in Massachusetts it is against the law for you to self pay for therapy. No therapy for you! The SNF cannot accept any self pay for therapy at any price once insurance stops paying for it.

(Believe me, I tried. The law was explained to me and in an extremely convoluted logic only someone from Mass could come up, with I can see the reasoning)

If, on the other hand, you come into the SNF on Medicaid (aka MassHealth), your therapy is covered for a long as you are SNF eligible.

Again every state is different. YMMV
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Old 10-02-2017, 03:47 PM   #39
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This seems to vary state to state. From personal experience I've found that Mass seems to make no distinction between payers and Medicaid. My brother (self paying at $600 a day) shared a room with a Medicaid drug addict who was hit by a car. What was different was that the drug addict got more therapy.

His therapists urged me to try and get him on Medicaid. "We'd be able to give him so much more time; he shouldn't be paying!"

IIRC, 97% of NH patients in Mass are paid by Medicaid, hence, few, if any NH's make the distinction.

YMMV.
Sounds like we should all be investigating residency requirements and other factors to qualify for LTC via Medicaid in Mass!
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Old 10-02-2017, 03:59 PM   #40
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How about those that divorce continue living together so they can claim higher Social Security? Had a previous co-worker that strategically did just that.
Yes! If you divorce but continue to live together, the SS folks triple your payments and give you the keys to a luxury condo in the Virgin Islands for the winter! What a scam! We should all divorce but continue to live together for these immoral benefits.......
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