Why is it important to know the difference between Medicare and Medicaid?

This article discusses the difference between Medicare vs Medicaid medical insurance in long-term custodial care, also known as nursing home care, in Michigan. It is important to understand these distinctions as they can significantly impact an individual's ability to access the health coverage needed for necessary medical treatments. Medicare health insurance only covers up to 100 days in a skilled nursing facility.  Most people will need the assistance that Medicaid coverage provides.

This article is not intended to provide legal advice.  It is for general informational purposes only.

Summary

• Long-term care prices in Michigan are increasing more than the national trend, which means that someone just using Medicare might not be able to afford the treatments they need while in the facility. 

• Medicare part A only covers up to 100 days in a skilled nursing facility, and any services provided...

Avoid Nursing Home Poverty & Spend Down - Jane's Story

The story below has been changed in order to protect the client's confidentiality, while retaining the truth of the details.  While the Family & Aging Law Center cannot guarantee results, we can say that the results below are typical for our office. 

Video Transcript:

Hi everybody, Attorney Nicole Wipp here with the Family & Aging Law Center.

So, today, I'd love to share with you a story about our client, Jane (*not her real name!). Jane, like so many of our clients, needed nursing home level care. Yet, her family was so scared - because they did not know what to do, just like so many people don't know what to do. They had been being told, "you HAVE to do a spend down, you have to spend down her money to $2,000 before she can receive benefits for care...she can't have two houses (which is what she had). She can only have one house! You've gotta sell one!" All of these things were being told to the...

150 gifts.  Dozens of donors.  7 facilities.  

One of the thing that happens as a result of being an elder law attorney is that I often see the "darker" side of being elderly in society today.

The truth is, our clients are often truly blessed people - because they have loved ones that care enough to come to us when things go wrong, and/or they take care of business so their kids don't have issues when bad things happen.

Yet, not everyone is in this position.  Many elderly people are alone, for many reasons - some within their control, but so often due to circumstances completely out of their control.  For these seniors, being "abandoned" in a nursing home is the writing on the wall.

I think we can all agree that that has to be one of the worst possible results we can imagine, at the end of life.

This Year, We Wanted To Brighten Up These Senior's Holiday Season 

I got the idea that we should make sure that every single senior in the...

With PACE, teams of health care professionals focus on the unique needs and circumstances of participants, and their families, to make sure participants receive the coordinated care they need.

The Program of All-Inclusive Care for the Elderly (PACE) is a program that helps seniors meet their health care needs at home & in their community as an alternative to a nursing home or other care facility.

SERVICES

With PACE, an individualized plan of care is developed and maintained by a team of health care and service professionals to meet specific needs. These services include all Medicare and Medicaid-covered services and may include, but are not limited to:

• Primary and Specialist Care (including Women's Health)
• Medications
• Medical Transportation
• Therapy (Occupational, Physical, Speech)
• Recreational Day Center Activities
• Home Care
• Hospital & Emergency Services
• Dental
• Vision
• Hearing
• Foot Care
• Nursing Home
• End of Life Supportive Care

In Michigan, the areas serviced by PACE...

What Are the Rules for Medicaid Qualification (Part 6)? - Some Simple Planning Options

Below are possible options to keep in mind when considering Medicaid planning. As in part five of our series, your Medicaid planning advisor can best help you determine how the rules apply to your specific circumstances in your specific locality. Before you get into the specifics, however, it’s always a good idea to familiarize yourself with the general federal guidelines for Medicaid qualification that apply everywhere.

Let's Continue...

• If you are married, your home is exempt and cannot be taken if one spouse applies for Medicaid. If you are single or widowed, up to $636,000 of equity in your home is exempt (many states have raised the limit even higher). Some states permit a “Homestead Exemption” which protects a married or single applicant’s home regardless of value. Transferring your home to your children will result in immediate ineligibility for...

What Are the Rules for Medicaid Qualification (Part 5)?

As in part four of our series, your Medicaid planning advisor can best help you determine how the rules apply to your specific circumstances in your specific locality. Before you get into the specifics, however, it’s a good idea to familiarize yourself with the general federal guidelines for Medicaid qualification that apply everywhere.

Let's Continue....

Do I Have to Wait 60 Months?

The Asset Transfer "Box”

Many people believe that if you give your assets away, you must wait 60 months to qualify for Medicaid. This is not the case. The 60 month requirement only applies to the financial disclosure you must provide, not eligibility.

Think of it this way: When you go to apply for Medicaid, imagine you’re bringing a box with you. In that box is every financial transaction you’ve made for the previous 60 months. That is all you need to provide – if you made a transaction 61 months ago, it’s not...

As in part two of our series, your Medicaid planning advisor can best help you determine how the rules apply to your specific circumstances in your specific locality. Before you get into the specifics, however, it’s a good idea to familiarize yourself with the general federal guidelines for Medicaid qualification that apply everywhere.

Let's Continue....

PROPERTY LIENS

In addition, the state can place a lien on an unmarried Medicaid recipient’s home, unless certain dependent relatives live on the premises or the state permits a “Homestead Exemption”.

Sale of the property, while the person receiving Medicaid is still living, could result in the loss of Medicaid coverage (due to excessive assets) and an obligation to use the sale proceeds to satisfy the lien that Medicaid places against the home.

There are exceptions to this rule. Satisfaction of the lien is not required if the applicant returns home prior to their death or one or more of the following...

What Are the Rules for Medicaid Qualification (Part 2)?

As in Part One of our series, your Medicaid planning advisor can best help you determine how the rules apply to your specific circumstances in your specific locality. Before you get into the specifics, however, it’s a good idea to familiarize yourself with the general federal guidelines for Medicaid qualification that apply everywhere.

Let's Continue....

ESTATE RECOVERY

What happens to a Medicaid recipient’s estate when he or she passes away? Like so much else, that depends on whether they have properly planned to protect it.

When a Medicaid recipient dies, the state may attempt to recover the benefits paid to that individual from his or her estate – that is a requirement under federal Medicaid law. However, the state cannot proceed with this recovery process if any of the following applies:

• if the recipient’s spouse is still living
• if the recipient has a child under age 21
• if the recipient has a...

What Are the Rules for Medicaid Qualification (Part 1)?

Medicaid is a federal program that provides health coverage for people with limited assets and incomes. It covers the cost of nursing home care for those who meet the program’s economic requirements for eligibility, and in several states, it will also pay for care in your home!

Though it’s a federal program, Medicaid is administered by the states. Federal law empowers each state to enforce Medicaid eligibility rules according to its own interpretation. This means that application of these rules can vary significantly from state to state and, in some states, from county to county. Qualification for care in your home is also different for qualifying for care in a nursing home.

Your Medicaid planning advisor can best help you determine how the rules apply to your specific circumstances in your specific locality. Before you get into the specifics, however, it’s a good idea to familiarize yourself with the general...

One of the things that we hear (a lot) from clients is how panicked they are when a loved one that has been in rehab is being suddenly discharged - but the family doesn't think they're really ready to go home - or, even worse, the family is told that their loved one is being discharged but needs 24/7 care or supervision.

Very few families are ready for this. The logistics of getting care for a person in a home environment may seem easy (just hire someone!), but most families, when faced with the cost, realize that this is not a long-term solution. That's when the questions start:

• Should you quit your job, to care for your loved one?
• Should you hire someone anyway, even if you (or they) can't afford it long-term?
• What benefits might be available to pay for care?
• How long will it take for benefits to kick in?
• What happens if benefits aren't enough - or if there are no benefits available?

Timing: Seeking Answers Before Your Loved One Is Discharged From Rehab Is Crucial

It is...