Medicare/medicaid help - newly paralyzed

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nyclon
Posts: 360
Joined: Fri Oct 02, 2015 5:30 pm

Medicare/medicaid help - newly paralyzed

Post by nyclon »

Hi everyone! My father was diagnosed with idiopathic transverse myelitis and is paralyzed from the waist down. He's incontinent and catheterized. Once he's finished with rehab, he'll be coming home and we need to plan and hire in home care professionals.

The cost of at home care is of course going to be expensive. Currently his SS income is about $2300 and other assets are a vanguard account of about $107k (from sale of his home) and checking account with $4500.

He's got medicare + an aarp type g supplement.

I'm currently seeing if medicaid can help.

If anyone has suggestions on this situation, much appreciated. Thank you
mkc
Posts: 221
Joined: Wed Apr 17, 2013 2:59 pm

Re: Medicare/medicaid help - newly paralyzed

Post by mkc »

I'm sorry about your dad :(

Medicaid would be once assets are "spent down", depending on what state you are in. Each state has their own guidelines. For example, IIRC my mother was allowed a total of $14K in assets in order for Medicaid to pick up assistance. 100% of her SS and pension was taken first (less $50/month for personal needs), then Medicaid paid the balance of nursing home costs.

We were on private pay as a result for several years until she'd "spent down" her assets.

The Medicaid application, at least in NY, was a daunting one, requiring a 5 year "lookback" at all accounts (even closed ones). We were lucky to find a good elder care attorney whose fee was well worth his guidance in this.
mur44
Posts: 700
Joined: Tue Feb 27, 2007 9:30 am

Re: Medicare/medicaid help - newly paralyzed

Post by mur44 »

Yes, Medicaid is the best option. Find a good attorney and
apply for Medicaid.
fortunefavored
Posts: 163
Joined: Tue Jun 02, 2015 8:18 pm

Re: Medicare/medicaid help - newly paralyzed

Post by fortunefavored »

Very sorry to hear about your father - I have dealt with similar issues.

You absolutely must consult with a medicaid attorney on the best way to spend down his assets. Ideally you will want to spend on things like wheelchair lift, vehicle, etc. They can guide you on the things that are not covered for by Medicaid, it is best to use up those assets to get him set up as best as possible vs. monthly fees. Then medicaid + you will have to cover the difference. Medicaid will vary by state, where I am it will pay 40 hours/week at minimum wage maximum for home assistance. The rest you will have to pay out of pocket - which is significantly more.

You don't say what your family & financial situation is - this can be very expensive unless a family member is willing to live full time with your father and do all the care giving. You may be looking at a nursing home instead. I assume he is in a recovery hospital right now, they should have a social worker who can also offer advice.

All the best.
Topic Author
nyclon
Posts: 360
Joined: Fri Oct 02, 2015 5:30 pm

Re: Medicare/medicaid help - newly paralyzed

Post by nyclon »

Thank you for the replies and for your sympathies. This situation is new to us and I'm quickly trying to learn how to manage it.

I have been advised by an agency that an irrevocable trust or escrow account may help and avoid the Medicaid lookback period in Florida, where he is located. The fees for this service are around $4,000. From what I'm reading on the internet this approach is commonplace to obtain eligibility while protecting assets.

It appears that we are looking at two things for Medicaid:
1. Eligibility based on medical need; my father will be prioritized based on his condition. Waiting times in Florida range from weeks to years - they're saying weeks in this case but let's see.
2. Eligibility based on assets; although he is ineligible with his current assets, it seems that a Medicare-experienced elder law attorney can help to move his assets into either an escrow account or irrevocable trust account to make him eligible. If this happens, I'd open a new account with Vanguard for the trust with myself as the trustee.

Any thoughts appreciated.
renegade06
Posts: 285
Joined: Sat Jan 12, 2019 3:00 pm

Re: Medicare/medicaid help - newly paralyzed

Post by renegade06 »

mur44 wrote: Fri Oct 16, 2020 6:22 pm Yes, Medicaid is the best option. Find a good attorney and
apply for Medicaid.
+1... very sorry to hear about your dad.
Carefreeap
Posts: 2863
Joined: Tue Jan 13, 2015 7:36 pm
Location: SF Bay Area

Re: Medicare/medicaid help - newly paralyzed

Post by Carefreeap »

nyclon wrote: Sat Oct 17, 2020 3:05 pm Thank you for the replies and for your sympathies. This situation is new to us and I'm quickly trying to learn how to manage it.

I have been advised by an agency that an irrevocable trust or escrow account may help and avoid the Medicaid lookback period in Florida, where he is located. The fees for this service are around $4,000. From what I'm reading on the internet this approach is commonplace to obtain eligibility while protecting assets.

It appears that we are looking at two things for Medicaid:
1. Eligibility based on medical need; my father will be prioritized based on his condition. Waiting times in Florida range from weeks to years - they're saying weeks in this case but let's see.
2. Eligibility based on assets; although he is ineligible with his current assets, it seems that a Medicare-experienced elder law attorney can help to move his assets into either an escrow account or irrevocable trust account to make him eligible. If this happens, I'd open a new account with Vanguard for the trust with myself as the trustee.

Any thoughts appreciated.
First, my condolences for your father's condition.

Yes, seeking Eldercare with Medicaid expertise is the way to go. Your father doesn't have a whole lot of assets to protect so I would think the strategy is to get him the best care you can. Is he living with someone? It sounds like he's going to need 24 hr care and that is probably best handled by a facility rather than a series of caregivers coming to the house.

We were fortunate that earlier this year when my father broke his third bone in a year due to a fall that the skilled nursing doc would not release him to go home (to his 83 year old gf) and they had a male medicaid bed. In San Diego that bed was costing 7+k/per month. If I were in your shoes I would be looking for a place like that.

Good luck with this tough journey.
Every day I can hike is a good day.
The Stone Wall
Posts: 49
Joined: Thu Mar 22, 2018 1:18 pm

Re: Medicare/medicaid help - newly paralyzed

Post by The Stone Wall »

I realize you are looking for home care, but skilled nursing care might be in the future. Many 'skilled' facilities have limited 'Medicaid' beds. This will limit the choices of facilities for your father (and many are dreadful). It may be easier to start in a better facility as a full pay resident and transition to a Medicaid resident in that better facility. Just something to think about.
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