Staffbull18 Asked January 2018
We live in Wisconsin and the benefit specialist is talking about a year and a half waiting period for a benefit for long term care. Any suggestions?
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Does anyone know what other Medicaid long term care benefits are available besides a nursing home? Is their a waiting list for assisted living benefits in Wisconsin?
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Short term? Consulting a lawyer specializing in Elder Law in WI might help maximize your chances of getting what is available.
Or due to a penalty that needs 18 mos to get past? If it’s this, family either needs to private pay for care in a facility till past the penalty period or have them continue to live at home. If a transfer penalty has been placed, choices are stark, either family pays for their care, or they let their elder become a ward of the state with a state appointed guardian who takes over all. Guardian can seek whatever legal remedy to get whomever benefited from the transfer to pay..... like file charges against you for taking advantage of vulnerable elderly. Stuff like this morphs, you don’t really want to go there....
If your ? Is more about what else besides NH will Medicaid pay for..... States can choose to divert NH skilled care facility funding to instead go to AL or MC. It’s done via waivers. WI Medicaid website should have info on waivers & eligibility requirements. Most states Medicaid waivers do not cover AL or if they do it’s a very narrow, limited program. So a participating AL may only have 5 Medicaid beds out of 50. It’s one of the reasons why you hear that the AL requires a couple of years of private pay as the probability is there will be a spot on the waiting list after 2 or so private pay years as folks move from AL to NH or MC, or move out to stay with family or die. If there’s a penalty placed, it doesn’t matter if thier applyinh for AL or NH, their ineligible till penalty period is over.
What I’d suggest first is for dad to get a needs assessment done. There will be an Area on Aging for your region. You can google to find & this site has state by state listing as well. The AoA in many ways acts as a clearinghouse for all things elderly for your state. Ask how to get a needs determination done that the state can use to see what program he might fit. And then ask what community based programs are in your area. A note from his MD in & of itself will not be enough but a note with detailed info on diseases/co-mobidities and current lab results will be helpful. There’s going to need to be documented health issues. Please realize that if it is that he’s kinda iffy on his ADLs, needs help with medication management & other routine age decline that alone will not show “need”. That’s one hurdle.
The other will be what WI does for community based programs and what eligibility is like for the programs. What is the trend is for PACE type of day programs that are community health & day centers that they go to 2 -5 days a week (# of hours is dependent on need assessment) and they remain living at home with family or private paid caregivers for all other times including evenings & weekends. I’m pretty sure for PACE they have to be “duals”.... that is on Medicare AND Medicaid as services get billed to both.
Based on what others have posted on this site, most community care seem to 3 or 4 times a week during the day caregiver for 4 hrs. If your hoping that state will provide 5 day a week 10 day caregiver that will not happen; for that it’s dad or family private pay for it. It’s not cost effective once over 28-34 hrs a week, if they need that many hrs a week hands on care they kinda need to be in a facility.
He has some sort of income, like SS and perhaps other income and assets. Medicaid expects them if there’s income and nonexempt assets to spend down to pay for care. If it’s about care in a NH, then it’s basically get to spend down to be impoverished. But for community based programs, he can keep most of his income as he’s expected to have costs to live in the community. He can do a personal services contract with family to pay family to caregive. It needs to be all aboveboard, legally drawn up contract so no issues for Medicaid later on and that’s best done by elder law atty.
For those living at home or in an IL, to get their health chart to show need can be a challenge. He may need to switch MDs from the family medicine practice guy to a gerontologist who in addition to a regular practice is also medical director of a nursing facility as they understand the required “at need” aspects of Medicaid medical review. That’s what I did for my mom and was able to get her from IL to a NH making the jump without an AL phase.
Why fund programs in a state like WI, as really what you just do is have a place in another state that’s more attuned to the needs of elder population. Like FL. So Yeah it really really does matter who you vote for and support for office.
Sounds like there was $ spent and your parent gets to pay for it again by not being able to get LT care. The family will have to step up & pay until then.