After the required two-year stay, my sister should be transitioning to a Medicaid pay in March of next year. Her bill from the pharmacy is currently about $250 a month, all over the counter medications prescribed by the doctor on staff. She will also need assistance with bathing and laundry, though not much else at this time if she stays stable.
I understand Medicaid will only allow a small allowance monthly for spending. How are medications and additional care handled?
I am currently having an outside agency handle my sister’s bathing, laundry, and bedding changes because the facility was doing a very spotty job. The outside service also handles transportation to doctors, which has worked much better than my sister taking the AL bus.
I just wanted to tell you that when you meet with your attorney, be sure to ask if your sisters state allows her to keep her Medicare Part B, her MediGap policy and her Part D for drugs. My DH aunt was allowed to keep that coverage. It comes out of her Social Security, as well as her monthly personal allowance. Then the remainder goes for her SOC (share of cost) for her payment to the SNF in your case the ALF.
This allows your sister to continue to see her personal doctors etc.
Medicaid pays for aunts OTC like Benefiber, Perivision, Vit D, etc.
Fingers crossed that they do.
if they don’t, the reasons may be beyond what this AL can do. What is happening is that in some States, Medicaid is shifting the waiver $ that would have gone to new placement in a participating AL to instead go towards funding of PACE system for day centers. Should that be the case, the default will be that she gets her health chart to show sufficient “at need” for skilled care. If this AL has an affiliated NH with LTC Medicaid beds, they hopefully can work in tandem on getting this done for your mom.
So we have the contract, are fulfilling the self-pay obligation (and using literally every cent of my sister’s inheritance to do it.) She is on SSDI—just reapproved—and our current lawyer and a nursing home placement specialist think that’s a guarantee of Medicaid acceptance.
At some point she will no doubt need to transition to a nursing home, but that will have to be medicaid. There is no more money.
long story, but she MUST be in a facility where someone manages meds for her. There aren’t other options, unfortunately. So I’m really hoping this works out for her.
Prescriptions, they would be handled by Medicaid. There should be no bill because the resident should not need to pay for anything. The OTC...my nephew has a feature with his Medicaid that pays for or partially for his OTC.
Personal Needs Acct, Medicaid allows a small amount of SS to be used for things for the resident, my state $50. When my Mom went into LTC on Medicaid, I allowed the LTC to be her payee for her SS and pension. The facility set up her PNA. If you are chosing to continue to handle sisters SS and pay the AL, you can deduct the PN amount your state allows keeping it in her acct but keeping records on how you spend it. This money is considered part of the asset ount allowed, my state 2k. So you cannot go over that 2k. Even if the PNA is handled by the NH.
You may still have to pay for the services you do now. They will not get better because she is on Medicaid. That cost will come out of your pocket. ALs can only provide so much care. There may come a time when sisters needs outweigh the ALs ability to handle. You may want to look around at some nice LTC facilities. The one I placed Mom in was so nice. I noticed the people were clean and fairly happy.
P.S. P.S. ALs usually have a limit on how many residents can be on Medicaid. You may want to check with the Administrator on how Medicaid works at their facility. They may have reached their limit when sister's money runs out.
Even though this is what the contract says, I am afraid that somehow the rug will be pulled out from under her. This was a more expensive facility because of this guarantee.
The elder care attorney I retained to handle my sister’s affairs is retiring, but I am going to find a new elder care attorney to handle the Medicaid application and navigate any legal ins-and-outs with the AL.
Thank you for your response. That is very helpful.