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Old 09-11-2017, 12:28 PM
 
Location: Wisconsin
17,112 posts, read 17,439,125 times
Reputation: 41724

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Quote:
Originally Posted by superk View Post
Correct. And remember that the state usually decides where the patient will be placed, so don't assume the patient will continue to reside near their spouse.

Also Correct.

Also note that, whether a LTC policy is used, or Medicaid is used, by law the level and quality of the care must be exactly the same.
Quote:
Originally Posted by LTCShop View Post
That's not 100% true. That's only true for facilities that take Medicaid patients and private pay patients.

The best facilities don't take Medicaid. Period.

Also, there is usually a long waiting list to get into a facility if you are relying on Medicaid. There is rarely a waiting list if you are using long-term care insurance.

Also, if you are relying on Medicaid you'll have to share a room with someone else. If you pay privately you don't have to share a room.

Lastly, it's a lot harder to get care at home if you're relying on Medicaid. Although there are Medicaid programs that can and do pay for care at home, those programs are very limited and have long waiting lists.
While your experience may be different, when we were searching for a facility for my husband (after I started treatment for Stage IV cancer) we contacted sixty plus facilities in an ever widening circle from my home, and with an ever lowering rating and quality of care. Of the over sixty facilities that we contacted only two accepted Medicaid patients.

And, the facility that we selected had very strict rules. Medicaid patients could only live in one of the very few studio apartments on their assisted living facility floor and not in a one-bedroom or two bedroom apartment (some of which were vacant). And, in memory care, Medicaid patients had to share a microscopically tiny room, whereas private pay residents could have the same size room all to themselves.

So, while it was true that my husband, and others on Medicaid, received the same meals and care, it was clearly obvious to anyone (staff, other residents or visitors) who was on Medicaid and who was private pay by who was in what size rooms. In fact, there were times that staff even made reference to "determining" who was or was not on Medicaid by what room they were in (in Memory Care "facility towels" were provided for Medicaid residents but private pay residents needed to provide their own towels).

I am not complaining, because I am very happy that we found a place for him, but just pointing out that that sometimes/often Medicaid & private pay residents end up in very, very different situations. I also believe that in some states they have special Medicaid wings or floors in facilities.

BTW, Hubby was later transferred to a different facility, a one and half to two hour round trip from my home, which was a significant problem while I was recovering from surgery and undergoing chemo-therapy.

(Clarification, some facilities had a couple of Medicaid beds but they were reserved for their current residents who had private paid for two years, or in some cases for three years). The law in my state recently changed and those facilities are not required to keep those residents once they needed to transfer to Medicaid. That happened to the mom of a friend. After private paying for three years in a top ranked facility she was given less than a week to move out because the very few Medicaid beds in that facility were already taken by other long-term, originally private pay, residents.

Last edited by germaine2626; 09-11-2017 at 01:13 PM..
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Old 09-11-2017, 05:43 PM
 
Location: R.I.
987 posts, read 611,083 times
Reputation: 4286
Quote:
Originally Posted by txfriend View Post
I always forget about VA benefits, I have never used them for medical reasons. I did buy a house using a VA loan. Last night my wife reminded me that it’s been 50 years this month that I returned from Vietnam. Why should I get VA medical benefits if I was not wounded.
I am a VA nurse and I can tell you there are many Veterans that obtain their care at the VA were not wounded in combat and they never saw combat. Many Veterans get ill or injured while on non combat duty, and often these are deemed service connected. Also, there are many Veterans that may have not been physically wounded in combat, but for example they were exposed to chemicals such as Agent Orange that many years later developed various cancers and other illnesses such as diabetes as a result of that exposure. Most are awarded 100% service connected disabled, and not only do they receive a disability pension, their spouses upon their deaths inherit a portion of that pension.

Whether you saw combat or not, or were injured or not, you served your country and if you were honorably discharged you do rate a certain level of VA benefits which can range from a burial plot for you and your spouse at a Veterans cemetery to healthcare and various other benefits.
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Old 09-12-2017, 01:43 AM
 
Location: Texas
1,972 posts, read 1,381,194 times
Reputation: 6760
Quote:
Originally Posted by Nightengale212 View Post
I am a VA nurse and I can tell you there are many Veterans that obtain their care at the VA were not wounded in combat and they never saw combat. Many Veterans get ill or injured while on non combat duty, and often these are deemed service connected. Also, there are many Veterans that may have not been physically wounded in combat, but for example they were exposed to chemicals such as Agent Orange that many years later developed various cancers and other illnesses such as diabetes as a result of that exposure. Most are awarded 100% service connected disabled, and not only do they receive a disability pension, their spouses upon their deaths inherit a portion of that pension.

Whether you saw combat or not, or were injured or not, you served your country and if you were honorably discharged you do rate a certain level of VA benefits which can range from a burial plot for you and your spouse at a Veterans cemetery to healthcare and various other benefits.
Thank you for the information, I never researched VA benefits since I never needed them or even thought about them. For the last year of college, my company helped with that. Now that Iím on medicare I see no need.
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Old 09-12-2017, 03:53 AM
 
Location: R.I.
987 posts, read 611,083 times
Reputation: 4286
Quote:
Originally Posted by txfriend View Post
Thank you for the information, I never researched VA benefits since I never needed them or even thought about them. For the last year of college, my company helped with that. Now that Iím on medicare I see no need.
I can tell you there are many Veterans that receive most if not all their care in the community and opted out of taking a Medicare Part B supplement that covers medication because they instead wanted to utilize the VA pharmacy to obtain their medications. Depending on a Veterans eligibility and income, a Veteran as I believe I mentioned in my previous post may be required to pay a copay for their medication, but these copays for some Veterans may be less that what they would be with a Medicare Part B supplement.

Although at this time you do not feel the need to access the VA for your care, I still recommend you research what you would likely be eligible for because if you do need to access it some time in the future you will have a knowledge base to start with.

Thank you for your service to our country.
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Old 09-12-2017, 06:56 AM
 
Location: Charleston, SC
1,371 posts, read 773,574 times
Reputation: 2428
LTCShop--
Thank you for your comments on this thread. Your experience in this area is very helpful.

I think I need clarification on one of your points.....

The IRA RMD's will need to be taken each year and counted as income for each spouse. The savings accounts will be added up and essentially half of that amount will need to be spent on the nursing home care.

In your examples, the Couple was said to both be in their 60's. Are they forced to take RMD's early in this situation ??
Also, you said the "savings accounts will be added and half will need to be spent" Are you using savings accounts to indicate just IRA's in this context ?? Or will all Savings being added together and Halved ??
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Old 09-12-2017, 07:45 AM
 
Location: RVA
2,175 posts, read 1,275,056 times
Reputation: 4501
And how are Roths treated in this scenario?
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Old 09-12-2017, 07:53 AM
 
72,037 posts, read 72,068,214 times
Reputation: 49605
the same . retirement accounts count as assets toward qualifying for medicaid and have to be spent down . what ever rules apply for spend down apply to roths , traditional accounts and 401k's
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Old 09-12-2017, 12:51 PM
 
Location: LTCShop.com
236 posts, read 113,529 times
Reputation: 151
Quote:
Originally Posted by FiveLoaves View Post
LTCShop--
Thank you for your comments on this thread. Your experience in this area is very helpful.

I think I need clarification on one of your points.....

The IRA RMD's will need to be taken each year and counted as income for each spouse. The savings accounts will be added up and essentially half of that amount will need to be spent on the nursing home care.

In your examples, the Couple was said to both be in their 60's. Are they forced to take RMD's early in this situation ??
Also, you said the "savings accounts will be added and half will need to be spent" Are you using savings accounts to indicate just IRA's in this context ?? Or will all Savings being added together and Halved ??
They are not forced to take the RMD's but they are better off taking them.

Generally, all of the following assets, regardless of which spouse owns the asset, need to be counted as a resource available to pay for the spouse's nursing home care:

savings accounts
checking accounts
money market accounts
C.D.'s
Deferred Annuities
Cash value life insurance
401k, 403b, traditional IRA's
Roth IRA's
Health Savings Accounts
Stocks
Bonds
Mutual funds
second car
second home
boat


Add up all those assets, and divide them by two. The healthy spouse can keep assets totaling no more than $120,000 (anything over that has to be spent down on nursing home care). The spouse applying for Medicaid can keep about $2,000. (anything above that has to be spent down on the nursing home care.)

Regarding the IRA's, by turning the IRA into "payout status" most states will not count it as an asset anymore, but they will count the income towards the income limits.

Since Roth IRA's don't have required minimum distributions, the Roth IRA would need to be spent down, just like any other asset.


Elder Law Answers has an excellent article on this topic:

https://www.elderlawanswers.com/can-...gibility-14544



I hope this answers your question.
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Old 09-12-2017, 12:54 PM
 
Location: LTCShop.com
236 posts, read 113,529 times
Reputation: 151
Quote:
Originally Posted by Perryinva View Post
And how are Roths treated in this scenario?
Roth IRA's need to be spent down just like any other asset.
Roth IRA's do not provide any special protection from Medicaid.
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Old 09-12-2017, 01:16 PM
 
Location: Texas
1,972 posts, read 1,381,194 times
Reputation: 6760
Quote:
Originally Posted by Nightengale212 View Post
I can tell you there are many Veterans that receive most if not all their care in the community and opted out of taking a Medicare Part B supplement that covers medication because they instead wanted to utilize the VA pharmacy to obtain their medications. Depending on a Veterans eligibility and income, a Veteran as I believe I mentioned in my previous post may be required to pay a copay for their medication, but these copays for some Veterans may be less that what they would be with a Medicare Part B supplement.

Although at this time you do not feel the need to access the VA for your care, I still recommend you research what you would likely be eligible for because if you do need to access it some time in the future you will have a knowledge base to start with.

Thank you for your service to our country.
Wow, thank you again. I just picked up my monthly medicine from Costco last Friday at a cost of $565 with a part D supplement. I believe the reason for the high cost now is that Iím in the doughnut hole.
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