Help please w/ medicaid eligibility requirements

I'm so confused!
This is for my dad who is elderly - he's bored at my house - nothing to do - we found a place that is "independent living with support services" - ie: the place itself doesn't provide the services (like nursing care or any medical care) but you can have up to 24 hour home health care services in the place. It's like an apartment complex for seniors, and those that need an aide have to get an aide.

It was to my understanding that medicaid does not really look at ASSETS when someone is applying for community based care, ie: home health aides. On the other hand, if we were applying for my dad to go into a nursing home, then medicaid DOES look at assets, but not so much what his monthly income is. Am I correct in that? That was what I got out of all that I read online. If anyone knows if that is the case, I'd appreciate it if you could let me know. Or if I'm wrong. I've read the NYS website - maybe I'm just so overwhelmed by it all but that's what I got out of it but it's still so confusing to me.

So now.....he can't go into this place beucaseh he NEEDS a home health aide. He would never remember to take his meds (we know this for definite) and he doesn't shower when he should, only when prompted, and even then he gives me a hard time about it.
It's more just reminders, that sort of thing, but I can't go 3x daily to give him his meds and neither can DH once he is back in the workforce (right now he's staying home to care for dad but we can't afford to live on 1 income).

We just found out that because his income is too high to qualify for medicaid. Even though all his monthy pension and soc sec. income would go to the apartment - it's not "medically necessary" for him to live there and therefore mediciad would not be approved for home health care. GREAT!

Yet he would be ineligible for nursing home care because he had assets up to a few years ago - some he spent but some he gave away and I know that would make him ineligible for X months of care through medicaid. We or he cannot afford $7000 a month for a nursing home on our own! And I don't think he's quite at that stage yet, and if he were to go in and see others with full blown Alzheimers it would depress him more.

So I'm stuck - I was told something about the Pooled Income Trust Program but again - he may not qualify.

So my 77 year old father who has early onset dementia and walks with a walker is basically STUCK at my house.

The only other option is to privately pay for home health care to come to the house every morning (which we didn't wnat to do - I'm not thrilled about having a stranger in our house when we are not there), get dad up and dressed and go with him to a county run senior center (which is basically free, small donation is all they ask for) but it's not the same as going to live in that other place that has tons and tons of fun activities and movies and stuff. this county run place doesn't even let them watch TV that much, and I don't think they do movies at all.

I think I need to find myself a private social worker to help me find the best solution. Are they expensive?!?

Sorry - I know this is more of a vent than anything else. What bugs me the most is that my sister has her MSW and hasn't really helped at all in this process, I don't think she wants to or somethign...I don't know. It's just annoying because I think she would know more about this but has'nt offered any suggestions or anything, just said "oh he's not eligible for medicaid" months ago but then someone else told me no for nursing home care he may still be, check into it.
She hasn't called anyone other than the VA nursing home near us, suggested anything or said she'd help out by calling anyone else or any other agency. I just feel so overwhelmed and not knowing what do for my dad

thanks for reading.

Message edited 4/11/2008 9:16:04 AM.

Re: Help please w/ medicaid eligibility requirements

so sorry you are dealing with this. I'm going to try to help. I'm waiting for a call about who we used and where we got them from.

He may qualify for medicaid. You really should talk to an eldercare attorney and a social worker. This is too much to navigate alone. We used both.

Your father should qualify for nursing home care, unfortunatley, you may have to deplete his assets before medicaid would pay. There are so many rules around this.

The medicaid pooled trust is good and they do a 3 month look back. Nursing home medicaid does a 3 year look back.

It takes a while to get these things going. As soon as I get the info, I will pass it on.

Re: Help please w/ medicaid eligibility requirements

Hi, thanks for the info. I believe that medicaid lookback for nursing homes is 5 yrs now (that's a new thing, used to be 3). Medicaid for home health care - they look at 3 months worth of bank statements.

Dad never thought he was going to be needing care like this, he gave us $ for different things that may not be something that is 'ok' with their rules.
So I think he'd be ineligible for awhile for medicaid.

I did however find a website in the meantime for geriatric case managers - I called two but neither have called back so I have to call some more.

I also live in Putnam County so anyone in Nassau would not work for me, each county is a bit different in terms of medicaid processing, I just found out.

I think my post was more of a vent..

But thank you so much I'll let u know how it all works out.
Mary

Re: Help please w/ medicaid eligibility requirements

yes, the counties are all different. Here it is a 3 year look back. But who knows, medicaid is so confusing. I hope you find someone to help you navigate it.

We found out the community medicaid that my brother is applying for will be able to get him to qualify for the TBI waiver. There are 100s of waivers for medicaid. We set up a special needs trust for his income. You may be able to set up a pooled trust.

If he needs nursing home care, then maybe you will have to spend some of his money for this.

Re: Help please w/ medicaid eligibility requirements

I don't know where you live, but on Long Island, the Legal Aid Society has an elder law section in Suffolk County and in Nassau County, Nassau/Suffolk Law Services has the senior citizens project. Queens also has an agency dedicated to legal services for the elderly. I'm sure they could help you figure out eligibility etc.

Re: Help please w/ medicaid eligibility requirements

You need an elder care attorney and if you can get one from Legal Aid or Legal Services that is all the better. Also, if your father is a vet, he should take advantage of the VA's services. Your sister who has the MSW might not specialize in anything related to Medicaid. The rules can be very tricky and only someone who works with those rules every day can keep up with them.

Message edited 4/14/2008 5:38:27 PM.