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I'd be interested to know how many nursing homes are 100% Medicaid beds? All the nursing homes I've been to have a set number of Medicaid beds and they are mixed among all the others. People pay until they're out of money and then hopefully a Medicaid bed is open for them to take.
This is key - there should be no segregation in terms of Medicaid facilities vs. self-pay or even Medicaid wings and self-pay wings. The care should be the same...oh I know, if you self-pay you should get room service with a chocolate on your pillow! But considering that most of us will selfpay as long as we can and then still end up on Medicaid for at least a time, there should not be large discrepancies in care - or certainly not MEDICAL care - sure, you can skip the chocolate!
we have many private homes who have very very few initial medicaid beds . they will however take medicaid assignment if you were a paying customer for x-amount of time .
I'd be interested to know how many nursing homes are 100% Medicaid beds? All the nursing homes I've been to have a set number of Medicaid beds and they are mixed among all the others. People pay until they're out of money and then hopefully a Medicaid bed is open for them to take.
This is key - there should be no segregation in terms of Medicaid facilities vs. self-pay or even Medicaid wings and self-pay wings. The care should be the same...oh I know, if you self-pay you should get room service with a chocolate on your pillow! But considering that most of us will selfpay as long as we can and then still end up on Medicaid for at least a time, there should not be large discrepancies in care - or certainly not MEDICAL care - sure, you can skip the chocolate!
Answer to your query likely would involve an extensive state by state search.
Personally don't see how all this can be fiscally sustainable as the vast demographic known as "Baby Boomers" move through middle age and onto senior citizens then elderly.
Here in New York State one third of the population is already on Medicaid, and that number only is going up. Also going up is the costs of Medicaid to federal and many state governments. So just where is all this funding going to come from to provide for all those who "carefully" plan so they can get LTC via Medicaid?
I've been wondering about the same things, especially now that Congress is going to do god only knows what to Medicaid. I've seen estimates that as many as 23 million people could lose their Medicaid coverage depending on what form of "repeal and replace the ACA" is passed. In Colorado this uncertainty has caused the availability and quality of Medicaid coverage to already start to shift downward. If the disabled and children lose their Medicaid coverage, won't that make it harder for EVERYONE to qualify for Medicaid?
I'd be interested to know how many nursing homes are 100% Medicaid beds? All the nursing homes I've been to have a set number of Medicaid beds and they are mixed among all the others. People pay until they're out of money and then hopefully a Medicaid bed is open for them to take.
This is key - there should be no segregation in terms of Medicaid facilities vs. self-pay or even Medicaid wings and self-pay wings. The care should be the same...oh I know, if you self-pay you should get room service with a chocolate on your pillow! But considering that most of us will self-pay as long as we can and then still end up on Medicaid for at least a time, there should not be large discrepancies in care - or certainly not MEDICAL care - sure, you can skip the chocolate!
I've been in dozens of nursing homes over the past 2- years, I have never seen one that's all Medicaid. There are also no separate areas for Medicaid people (there are however separate wings for MediCARE and HMO subacute patients while they are there undergoing rehab (some people mistakenly believe the increased staff on this wing compared to the long term wings is because of money, but it is not, it is because the people on subacute are still medically fragile and need more extensive medical care but above all, because the state requires a higher number of staff on these wings or the home will lose Medicare certification for those beds.
These residents too though will either go home, to another facility or to the long term wing afterward. No one lives on those wings permanently).
Despite the beliefs of some, no one of the direct care staff knows who is paying how (we do in therapy) and above all, no one who cares in the slightest. There is no difference in care I'm happy to say. My mom's care hasn't changed at all since she transitioned to Medicaid, although she may have to share her apartment now that she's on Medicaid (we knew this before she moved in, but so far it; been a year, and no one has said anything about it)
I've been in dozens of nursing homes over the past 2- years, I have never seen one that's all Medicaid. There are also no separate areas for Medicaid people (there are however separate wings for MediCARE and HMO subacute patients while they are there undergoing rehab (some people mistakenly believe the increased staff on this wing compared to the long term wings is because of money, but it is not, it is because the people on subacute are still medically fragile and need more extensive medical care. They too though will either go home, to another facility or to the long term wing afterward. No one lives on those wings permanently).
Despite the beliefs of some, no one of the direct care staff knows who is paying how (we do in therapy) and above all, no one who cares in the slightest. There is no difference in care I'm happy to say. My mom's care hasn't changed at all since she transitioned to Medicaid, although she may have to share her apartment now that she's on Medicaid (we knew this before she moved in, but so far it; been a year, and no one has said anything about it)
Probably closest historically you'll find to "all Medicaid" or at least majority would be a charity care places run by religious organizations or affiliates. But even then highly doubt there are many if any nursing homes/rehabilitation facilities that survive (or even could) on all or majority Medicaid. The system just does not pay anywhere near enough.
Case in point charity care/hospitals of last resort are closing all over the USA. We lost the last Catholic hospital in NYC (the historic Saint Vincent's in Greenwich Village) a few years ago. They were a place with a large percentage of Medicaid patients (wealthy and or those with good insurance stayed away), and in the end just couldn't make a go of things.
To be fair Medicaid and to an extent Medicare were created in part so those who have such coverage could go anywhere for care.
Just as with hospitals would think nursing homes/rehab facilities try to strike a balance in patient mix; that is have enough with good insurance and or self paying to offset the shortcomings of Medicaid or Medicare reimbursement rates.
Probably closest historically you'll find to "all Medicaid" or at least majority would be a charity care places run by religious organizations or affiliates. But even then highly doubt there are many if any nursing homes/rehabilitation facilities that survive (or even could) on all or majority Medicaid. The system just does not pay anywhere near enough.
Case in point charity care/hospitals of last resort are closing all over the USA. We lost the last Catholic hospital in NYC (the historic Saint Vincent's in Greenwich Village) a few years ago. They were a place with a large percentage of Medicaid patients (wealthy and or those with good insurance stayed away), and in the end just couldn't make a go of things.
To be fair Medicaid and to an extent Medicare were created in part so those who have such coverage could go anywhere for care.
Just as with hospitals would think nursing homes/rehab facilities try to strike a balance in patient mix; that is have enough with good insurance and or self paying to offset the shortcomings of Medicaid or Medicare reimbursement rates.
It's very common in poor areas for the majority or even all of the long term residents to be Medicaid, but the home is never all Medicaid. That home will still have a subacute wing with Medicare patients (don't forget, even the poor elderly get MediCARE as health insurance even though Medicaid is paying their room and board in the nursing home - it is not the same as Medicaid for people under 65 who must use Medicaid health care facilities).
In the better areas, most of the long term residents become Medicaid at some point. We have residents who have been in LTC for a decade, who may have been wealthy when they arrived but ran out of money long ago. So in all areas, Medicare beds are what keep the homes going for the most part.
I may be missing something here, but wont that 100K plus income still count as income for assessment of an ACA subsidy.... and mean no subsidy? Even though you don't pay federal tax on capital gains, ACA still assesses all of that as income.
no , it is only taxable income that counts towards the magi . . roth income , living off cash , and borrowing over funded life policies is not taxable income .
you can go up to 65k or so in actual taxable income and still get something as a subsidy . .
Last edited by mathjak107; 07-26-2017 at 10:59 AM..
I just found myself in a health crisis and was eating up my medicare for the long hospital/rehab stays...found I had to apply for Medical and I did and was approved but when the money was being applied to the outstanding bills, I found "my share of cost of medical" was $1005 for each month/each place.
If one can live with little to show. If govt does what they do with our money, why not us to help ourselves in tight situations.
The Medical case worker NEVER told me about the "cost of share" and it depends on how high or low one comes in on the low income status. One has to be on the streets to have "no share of cost".
Just like one has to be about dead to get legal case against medical provider.
Last edited by jaminhealth; 07-26-2017 at 11:09 AM..
Long ago I had to counsel elderly couples, loving long married couples, that the only way to "beat" the system was for them to divorce to save some assets for the person staying in the home while the other went into a nursing home. Imagine the angst and heartbreaking scenes because of the ancient laws concerning medicaid eligibility. A loving husband who cared deeply for his wife had to divorce her to save himself.
Things have changed, thank goodness, for the better.
it isn't easy to get what is called a medicaid divorce in many states which is usually what is done when a major health event happens .
two very powerful laws here in ny have been upheld and according to our estate attorney who is one of the biggest in ny there are very very few medicaid divorces .
all court actions are now pretty much based on right of refusal .
our two laws that pretty much killed off medicaid divorce are :
(1) Section 5-311 of the General Obligation Law which provides that except as provided in Section 236 of the Domestic Relations Law, a husband and wife cannot contract to relieve either his or her liability to support the other in such a manner that he or she will become incapable of self support, and therefore likely to become a public charge; and
(2) Family Court Act Section 415 which provides that the spouse or parent of a recipient of public assistance or care, or of a person liable to become in need thereof, or a patient in an institution in the department of mental hygiene if of sufficient ability, is responsible for the support of such a person. The Court has the discretion to require any such person to contribute a fair and reasonable sum for such support (child up to 21 years of age).
also if it is eventually determined that a divorce is to be pursued, the divorce needs to satisfy all of the requirements of the Domestic Relations Law, such as establishing one of the requisite grounds for a divorce. This may be difficult to accomplish because of the illness or disability of one spouse
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