Using Medicaid to Get Needed Home Care

Written by NY Press on . Posted in Healthy Manhattan, News Our Town, News West Side Spirit, Our Town, Special Sections, West Side Spirit.


By Roy Herndon Smith

People often call a geriatric care manager when they are in crisis. Unfortunately, lack of information or faulty information about 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 (communitygeriatriccare@gmail.com), a subsidiary of Foremost Home Care.

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