Medicaid (with assets depleted) if also have health insurance

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Medicaid (with assets depleted) if also have health insurance

Post by ResearchMed » Tue Jul 11, 2017 9:55 am

I'm not sure if this is more consumer issues or personal finance...

The recent thread about "Is Medicaid eligibility based only on income or are assets included too?" got me thinking about the difference between Medicaid only for "medical care" vs. Medicaid for "custodial care", which presumably includes any necessary medical care.

I'm not interested here on how the eligibility varies for the two types of programs.
Let's assume that the person involved has minimal income/assets and "qualifies" at the lowest level (that is, for "anything/everything" that is Medicaid). Social Security and a very small TIAA pension total very little, and other assets are gone.

Now... that Person also has private health insurance, e.g., from employer/retiree or spouse/widow(er) of same.

How is the actual "medical care" handled, at a custodial facility that is paid entirely by Medicaid, when Person has good private medical insurance?
Suppose Person had good history/relationship with health care provider (especially PCP, but also hospital stays at major hospital), right near the custodial care facility?
Can that all be kept?

In the specific case of interest (MIL), if she survives to outlive her money, the current facility will "keep" her.
They put such residents into the smallest unit of the appropriate area (e.g., assisted/memory/full nursing).

A separate question isn't quite relevant: How would someone still able to be in "assisted care" (but not meeting the Medicaid "daily functions of living assistance") "qualify" for Medicaid.
That's unlikely to be relevant for MIL as she is rapidly declining physically (mentally, still up for as many daily bridge games as she can find!), so chances are good that by the time the money runs out, if she is fortunate enough to still be "with us", then she'd already be "appropriate" for Medicaid services in terms of physical disability.

As an aside, we (DH and I) are starting to take a look at this same facility, thinking of ourselves (in more than a few years and who knows what will change).
We've seen this one up close and personal in many ways now, and it seems very special. Not surprisingly, there is a *very* long waiting list. The only thing that keeps the waiting list from being ridiculously long is that one must be vetted financially to get in. No surprise, that, as they'll "keep you" if the money runs out.


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Re: Medicaid (with assets depleted) if also have health insurance

Post by littlebird » Sun Jul 16, 2017 4:41 pm

Not absolutely sure I understand your question, but:

Assuming the person is over 65, isn't she on Medicare (primary), with private medical insurance (secondary)? Medical care costs paid to an outside provider who comes to the facility is a separate issue from long-term care, which, if she has depleted her assets will be paid by Medicaid.

If she didn't have the private secondary insurance, Medicaid would step on that also, but it's not the best situation.

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Re: Medicaid (with assets depleted) if also have health insurance

Post by sport » Sun Jul 16, 2017 4:47 pm

I know of someone who was in a nursing home and depleted all of her assets. She went on Medicaid to pay for the nursing home. Of course, she had to sign over her SS to the nursing home, and Medicaid paid the difference. However, she was allowed to have some of her SS pay for her BC/BS supplemental medical insurance. She was also allowed to prepay her funeral before her money ran out. She was also allowed a small allowance for personal needs.

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