The Ethics of Adjusting Your Assets to Get Medicaid (retiree, respect, cancer)
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Right, but I think this thread has gone off in two directions, one about managing assets so that an elderly person going into long term care can qualify for medicaid, and the other topic seems to revolve around people between 55 and 65 who have little if any earned income but plenty of assets who manage their 'income' so that they can qualify for an ACA plan which is not really medicaid, it's just like any other ACA plan but is paid for by medicaid. If they don't claim enough income they couldn't get an ACA plan, they would have to get straight medicaid which isn't nearly as good, this is possible because unless you are a dual eligible medicaid is not means tested. Mathjak please correct me if I'm wrong about that.
If I am correct, then I think in the first case trying to get medicaid to pay for nursing home care by sheltering assets is dumb because medicaid care generally sucks. In Northern California there almost all LTC facilities have medicaid beds and medicaid wards where the care is definitely not the same as it is for self pay patients.
In the second case, taking advantage of MAGI qualification in order to get a free ACA plan paid for by taxpayers, many of whom can barely pay for their own health insurance, while not illegal is unethical and makes me wish that they would means test all medicaid recipients.
Again there is no such thing as a "medicaid ward". There are short term wings for rehab(Medicare/Insurance) and long term wings, period. If you are in a nursing home on Medicaid, then you have a stroke and are sent to the hospital, when you come back Medicare A will be your payer source and they will most often put you in the subacute wing while you undergo rehab and need more intensive nursing care. They keep your bed open in the LTC wing. When you are discharged from therapy, you go back to the long term wing, regardless of payer source.
Medicaid as a payer for LTC care doesn't suck, it was Medicaid as health insurance, for those younger than 65, that sucks. The subacute wing is always better than the LTC wings, by state certification rules the ratio of care staff needs to be higher in order to have the beds certified for Medicare. But the LTC wings suck in comparison regardless of payer source. My nursing home has maybe 1-2 people who pay privately, and they are in the same hallway even if in a private room. Their care is no different. None of our rooms has more than 2 beds.
My mother is on Medicaid in a very beautiful ALF, every month I get a bill for over $9,000, and then I send them a check for $1144.00 from her SS (they calculate how much, it is all her income minus her small stipend) because now she is on Medicaid and that is the amount Medicaid told me I have to pay them. She private paid for about 2 years (was $3600 when she moved in, climbing yearly and then quickly as her care level rose), and we had an agreement upfront that after she private paid for 18 months, she earned the right to stay on Medicaid. She was supposed to have to move into a shared apartment when that happened, but it's been about 18 months now and she is still in her same apartment by herself.
Medicaid does not mean you are going to be languishing in a pit of hell. ALL facilities are subject to state inspection and rules. It is the state that dictates how many nurses and CNAs must be on each wing at all times. If the state says a nursing home has to have 1 CNA for every 8 residents, that is what they must have. The state does not however, dictate CNA salaries, corporate bean counters do. That is why most nursing homes suck. Being a CNA is a job that is hard on your body, disgusting, and mentally draining, they get screamed at and bitten and called racist names by residents, and by family member of residents, all for the same amount of money or a couple dollars more than they'd get working at Walmart. IMO their job is much harder than mine is.
If you have only a couple of hundred thousand or less though, and you choose to hide it, you forever remove any carrot you have to get into a nice place. My mom is in her place because she had enough money to private pay for awhile at a time when they had (per corporate) too many empty apartments (they didn't say that, but I know how corporate health care operates, and also that Admissions people get paid by commission). We hired someone to help find her an ALF that would accept her knowing she'd outlive her money, as many will not.
She had about $70,000 and a house worth about $50,000. If she had given it away (which she does feel badly she has nothing to leave me and my brother), she would have had to go into a nursing home rather than assisted living (due to waiting lists), and even with that would have had to go into whatever one had an empty Medicaid bed, even if it was 50 miles from us an had a horrible reputation.
I think this is a topic that has no right answer. .....Of is it your responsibility to take out insurance to protect against the cost of long term care? Of course that is the ideal plan, but 2 thinks come up: 1-the cost of long term care insurance is outrageous and it rarely covers the cost of the care and second, by the time you realize you need it, often it is too late. Most of us just hope we never have to make that decision
Besides the ridiculous cost of ltci now that would almost impoverish most, it's annual rate of cost goes up more than the rate of inflation & also the companies that offer it sometimes go out of business, not something I want to deal with when I am ill & in my 80's after paying & sacrificing for 20+ years for it. This is the one area I am not paying for in advance, I can't afford to. Que sera sera.
I'm not sure how that is anymore ethical than a SNAP recipient selling their food stamps for cash. If you have the money to pay for health insurance it's your obligation to pay for it.
no one said it is ethical , it is just legal .
many people just feel the gov't takes enough from them and if they can take something back legally they will .
Besides the ridiculous cost of ltci now that would almost impoverish most, it's annual rate of cost goes up more than the rate of inflation & also the companies that offer it sometimes go out of business, not something I want to deal with when I am ill & in my 80's after paying & sacrificing for 20+ years for it. This is the one area I am not paying for in advance, I can't afford to. Que sera sera.
i never look at it as paying in advance . i am paying to be covered now . each year that goes by and i don't need it i look at it like my house or car insurance . my co-worker fell off a ladder painting. he broke his hip and had a stroke at age 55 during hip surgery . his family is now impoverished as he is paralyzed in a home .
i never look at it as paying in advance . i am paying to be covered now . each year that goes by and i don't need it i look at it like my house or car insurance . my co-worker fell off a ladder painting. he broke his hip and had a stroke at age 55 during hip surgery . his family is now impoverished as he is paralyzed in a home .
What are your thoughts on LTCi for a single person?
It just seems hard to be wealthy and pretend you have no income at the same time.
I don't know about that. How about if they have the kind of income that just isn't counted toward eligibility?
Although you would think that if they're THAT UBER wealthy they'd still make to much to qualify, but who knows.
I don't know about that. How about if they have the kind of income that just isn't counted toward eligibility?
Although you would think that if they're THAT UBER wealthy they'd still make to much to qualify, but who knows.
All income counts toward eligibility. I still don't think anyone wealthy would want crappier insurance just to save some money. Wealthy people get to go to whatever medical facilities they want to, and to the doctors who are in the city magazines under "2017 Top Docs" issue kind of doctors. Why would they want something as restrictive as ACA Medicaid if they could afford otherwise?
It'd like going on food stamps when you're used to steak.
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