People often call a geriatric care manager when they are in crisis. Unfortunately, lack of information or faulty information about Medicaid often contributes to the crises.

For example, George’s 85-year-old father, Tom, who was healthy and living alone, was out shopping when he stumbled, fell and could not get back on his feet. A passerby called 911. An ambulance took Tom to the emergency room, where an X-ray revealed that he had a broken hip. He was admitted to the hospital. One of the ER workers called George in California. George caught a flight to New York and went directly to the hospital.

George and Tom, whose names were changed for privacy reasons, met with a hospital social worker, who told them that after surgery and a brief recuperative stay, the hospital would discharge Tom to a rehabilitation facility for physical therapy. However, after completing the rehabilitation, he would likely need daily home care for a number of months, perhaps longer.

Tom had a Medicare Advantage plan that would pay for his rehabilitation. But he would need a good deal more home care than the 12 hours a week for two weeks that his plan would cover. His doctor said that he would likely need at least six hours of home care a day for a number of months.

Tom’s income of $1,300 a month barely covered his monthly expenses. He also had about $20,000 in a savings account. He would very quickly run out of money if he had to pay for the additional home care he needed.

The hospital social worker told Tom and George that Tom had too much money to qualify for Medicaid. Perhaps Tom could move to California and live with George? George said that wouldn’t work. He lived with his wife and two children in a small home; they’d either have to get a larger, more expensive place, which they could not afford, or get Tom another apartment, which they also could not afford. Both George and his wife worked full-time; they didn’t have enough money to hire aides.

Tom firmly said that he would not agree to move to California. The social worker said that another alternative would be for Tom to stay in a nursing home until he was able to come home without home care.

“But that could be three months or more. He might lose his apartment. And then what would he do?” George said. The social worker remembered that she had the name of a geriatric care manager who knew a lot about Medicaid. Perhaps they should give him a call.
George called the geriatric care manager and arranged for him to come to the hospital to meet with him and Tom. The geriatric care manager told them that Tom did have assets and income over the Medicaid limits, but that he could still become eligible to apply for and receive full Medicaid benefits. With the help of the geriatric care manager, Tom:

• Put $6,000 of his assets into an irrevocable funeral plan, which brought his total assets to below the $14,250 Medicaid asset limit
• Applied for Medicaid

• Joined a pooled income trust and deposited the $500 of his income that was over the Medicaid limit into the trust each month. He had the trust use the $450 left after deducting the monthly administrative fee to pay his monthly bills for utilities, cable, telephone and food. Once Medicaid determined him to be disabled and recognized his deposits into the trust, they subtracted the $500 a month from their calculations of his income, which brought him down to the Medicaid income limit, providing him with full benefits.

• Received enough home care paid for by Medicare and Medicaid for him to return home and to remain there once he had finished a month of rehabilitation in a skilled nursing facility.
Roy Herndon Smith, Ph.D., is with Community Geriatric Care (communitygeriatriccare@gmail.com), a subsidiary of Foremost Home Care.

Many older people live alone and do not have a close family member or friend living nearby who can help them if they become ill and unable to do all the tasks necessary to maintain their lives at home. They or a family member will sometimes employ a geriatric care manager.

A geriatric care manager can perform a range of needed tasks, such as helping with paying bills; planning for medical care and ensuring that a client goes to doctor’s appointments; working with doctors, nurses and social workers at hospitals and rehabilitation centers to ensure that a client receives the best possible medical care; arranging for and supervising home care aides; and working with a client to maintain his or her quality of life.

For example, a professional colleague referred me to Ms. D, who lives alone. She had been a professor until she was diagnosed with Alzheimer’s disease.

The first time I met her, she told me that she had been having increasing trouble remembering how to pay her bills. Sometimes she got disoriented on the subway, even when going to a familiar place, and panicked when she realized she did not know where she was. She needed help logging on to check her email. She did not remember how to tell the time from a digital clock. She did not know how to retrieve messages from her answering machine. She was overwhelmed, uncertain and close to despair.

Since that first meeting, I have met with her in her home for two hours a week. As I help her go through her mail, pay bills, check her email and do other tasks, I repeatedly confirm what she can do. She is a witty conversationalist. She has become active in the senior center and is going to be teaching a writing class there. She maintains close friendships.

By the second or third meeting, she had become more confident. She has stopped getting lost or panicked on the subway. She continues to have difficulties with other tasks, but, as I help her with them, her lack of ability rarely overwhelms her. She is enjoying her time at the senior center and conversations with friends.

This case illustrates a principle in working with someone suffering with dementia: Help with the specific tasks with which she is having difficulty, but repeatedly and consistently confirm her remaining abilities and help her find others who will appreciate what she knows and can do.

Roy Herndon Smith, Ph.D., is with Community Geriatric Care (communitygeriatriccare@gmail.com), a subsidiary of Foremost Home Care.

Myth: I cannot become eligible for Medicaid because my assets are too high.
Fact: Applicants for Community Medicaid in New York State must have less than $14,250 (for a single person) or $20,850 (combined assets for a married couple).
An applicant’s residence does not count as an asset if the market value of the home, minus the amount mortgaged, is less than $750,000.
Applicants with assets higher than the Medicaid limit can reduce them by spending them down to the limit or by transferring them to a trusted family member or an irrevocable trust. If you have significant assets, you should consult with an elder care attorney about how best to reduce them.
Once you have reduced your assets to under the limit, you are eligible to apply for Medicaid in the following month.

(By Roy Herndon Smith)

Myth: I cannot get Medicaid because my income is too high.

Fact: The Community Medicaid income limits are $792 a month for a single person and $1,159 for a married person.
You can still apply and qualify for Medicaid if you have income over these limits. Medicaid treats such “surplus” or “excess” income as a deductible. For instance, if you are a single person with an income of $1,292 a month, you have a surplus of $500. If you have $1,400 of medical expenses, including home care, in a month, Medicaid will only pay for $900 of those expenses; you will be billed for $500.
However, you can use a pooled income trust to protect your surplus income. Once Medicaid recognizes that you are disabled and are depositing your surplus into a pooled income trust, it will pay for all the covered medical expenses, including home care. You will not be billed for the surplus amount. You can have the trust use almost the entire surplus to pay for your regular bills, such as rent and utilities.

New York City’s Human Resources Administration can take a long time, sometimes over 3 months, to approve Medicaid and Medicaid home care. Applicants, especially when they have surplus income and are using a pooled income trust, often face delays and difficulties and need expert help to deal with them. For these reasons, if you foresee needing Medicaid to pay for home care in the future, you should start preparing to apply now by calling a knowledgeable geriatric care manager or social worker.

Roy Herndon Smith, Ph.D., is with Community Geriatric Care (communitygeriatriccare@gmail.com), a subsidiary of Foremost Home Care.