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Old 10-02-2017, 04:01 PM   #41
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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
I understand that Medicare can no longer cut a patient off from therapy because they plateau. The court found that it is normal for progress not to be in a straight line.
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Old 10-02-2017, 04:19 PM   #42
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And by Illinois you mean Chicago.
But there amongst the hills and hollers don't you just render a hog and bite the heads off a few chickens to pay for LTC? Or maybe sell the tanned hides from a few relatives?
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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.
That's my point. Here, better NH's want you to start out as private pay and many only accept patients who begin as private and can show resources that will allow them to be private pay for some time, usually at least a couple of years. Of course if some folks live long enough to run out of money, the NH accepts Medicaid for the balance of the time. But the point is that in better NH's (here at least) the limited number of Medicaid beds in better facilities are occupied by folks who started as private pay and outlived their money. The "Medicaid from the get-go" folks wind up in facilities that have a high percentage (up to 100%) Medicaid beds and operate at lower standards because they have much less income to work with.

If you're in a situation where you can hide your assets and qualify for Medicaid LTC and not be at a disadvantage vs. the private pay folks in finding top quality care, you're fortunate. Here, it's really a challenge to be broke, need full NH care and get the same quality as folks with the ability to private pay do.

When NH shopping, it really helps to be able to private pay for at least a couple of years or to have some source of ongoing income, such as a pension, that covers a significant portion of the cost.
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Old 10-02-2017, 05:05 PM   #43
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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.......
I guess you're being sarcastic because as you know, it does not work that way! The primary earner gets his full social security check. The divorced spouse or the wife gets half of what he gets. It does not decrease his amount and it does not increase her amount when one is divorced. You get the same amount as if you were married. The only time Social Security pays out more is if spouse A remarried spouse C. Let's say A&B get a divorce, and A marries C. If A's amount is the highest, then A gets full SSA, B&C each get half of that amount provided that is more than what they would gain by claiming on their own account. You don't double up

If you're still talking about making yourself medicaid-eligible, the way it works in California is that I heard there is still a look back. However the spouse gets to shield $53,000.

The real thing that keeps me puzzled as why would anybody want to go into a Medicaid facility?
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Old 10-03-2017, 07:06 AM   #44
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in these parts we don't have specific medicaid facilities . in fact the homes we spoke to said if you are a paying patient for 2 years they will take medicaid assignment .
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Old 10-03-2017, 08:50 AM   #45
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I guess you're being sarcastic because as you know, it does not work that way! The primary earner gets his full social security check. The divorced spouse or the wife gets half of what he gets. It does not decrease his amount and it does not increase her amount when one is divorced. You get the same amount as if you were married. The only time Social Security pays out more is if spouse A remarried spouse C. Let's say A&B get a divorce, and A marries C. If A's amount is the highest, then A gets full SSA, B&C each get half of that amount provided that is more than what they would gain by claiming on their own account. You don't double up

If you're still talking about making yourself medicaid-eligible, the way it works in California is that I heard there is still a look back. However the spouse gets to shield $53,000.

The real thing that keeps me puzzled as why would anybody want to go into a Medicaid facility?


Because most private pay SNF's also accept Medicaid. I believe in order to get Medicare dollars, the SNF must also take Medicaid. As other posters have said, most SNF's can't survive on private pay alone. Staffing and treatment of patients is the same regardless of payer source, or maybe even better if Medicaid covers some benefits that private pay/insurance doesn't.

I know one couple who divorced as a strategy to cover LTC expenses. They are not wealthy but the wife gets s decent pension, not nearly enough to pay for a SNF plus an independent person's expenses. They divorced, husband is in a SNF with Medicaid paying, former wife lives off her pension and pays for former husband's incidentals not covered by Medicaid. This strategy works well for them. Not sure if this is viable for couples with large portfolios as it might be difficult to justify why one half of the couple is destitute while the other half has seven figures.
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Old 10-03-2017, 01:29 PM   #46
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I know one couple who divorced as a strategy to cover LTC expenses. They are not wealthy but the wife gets s decent pension, not nearly enough to pay for a SNF plus an independent person's expenses. They divorced, husband is in a SNF with Medicaid paying, former wife lives off her pension and pays for former husband's incidentals not covered by Medicaid. This strategy works well for them. Not sure if this is viable for couples with large portfolios as it might be difficult to justify why one half of the couple is destitute while the other half has seven figures.
This was a strategy DH and I discussed but never implemented. When we married, he as 65 and I was 50, and I brought nearly all of the invested assets into the marriage and continued to work FT for 11 more years. The nightmare scenario for both of us was that DH could linger for years in an expensive nursing home, endangering my financial security.

I suspect the 5-year lookback would apply to divorces so you'd have to plan ahead.
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Old 10-03-2017, 01:33 PM   #47
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in most states medicaid divorces are out . here in ny they can't be used at all for the most part .

it isn't easy to get what is called a medicaid divorce in many states which is usually what is done when a major health event happens .

two very powerful laws here in ny have been upheld and according to our estate attorney who is one of the biggest in ny there are very very few medicaid divorces .

all court actions are now pretty much based on right of refusal .

our two laws that pretty much killed off medicaid divorce are :

(1) Section 5-311 of the General Obligation Law which provides that except as provided in Section 236 of the Domestic Relations Law, a husband and wife cannot contract to relieve either his or her liability to support the other in such a manner that he or she will become incapable of self support, and therefore likely to become a public charge; and

(2) Family Court Act Section 415 which provides that the spouse or parent of a recipient of public assistance or care, or of a person liable to become in need thereof, or a patient in an institution in the department of mental hygiene if of sufficient ability, is responsible for the support of such a person. The Court has the discretion to require any such person to contribute a fair and reasonable sum for such support (child up to 21 years of age).

also if it is eventually determined that a divorce is to be pursued, the divorce needs to satisfy all of the requirements of the Domestic Relations Law, such as establishing one of the requisite grounds for a divorce. This may be difficult to accomplish because of the illness or disability of one spouse
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