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Background Story Part VII

The cost of the adult day center was reasonable, much less than  home care or a nursing home. Most adult day centers charge the same amount today that they charged in 2007 because Medicaid has not given them an increase in their reimbursement rate in over 10 years. Medicaid pays 10.28 per hour, and most adult day centers charge a maximum of $65 per day no matter what the payer source. However, we would have had to pay for transportation and care at home. We qualified for the Wheels bus, and it would have been about two dollars a day. We also needed someone to be with Milford in the mornings to help get him ready to go, and someone to be with him at night because he wasn’t sleeping all night and I needed to sleep so I could work the next day. I hired our son to be with him at night when I just had to have a good night’s sleep in order to function, and paid him out of our own pocket. Milford and Marjorie only had an income of $2000 per month.  Adult day center attendance would be approximately $1300 per month, plus transportation $80, plus a home care person for 8 hours at $8 per hour equaled $1,920, making the grand total $3300, and that did not include food at home or medical insurance, co-pays for office visits and prescriptions.

I didn’t know back then that Milford and Marjorie would have qualified for what is called a “Home and Community Based Waiver” from the Kentucky Cabinet for Health and Family Services. Medicaid is a combination of a federal and state entitlement program that pays for medical care for people who cannot pay for it themselves and it is supported with our tax dollars. In order to make those dollars go farther, there are incentives to keep people in the community where it usually costs less for their care than in an institutional setting. Nursing homes costed about $5,000 a month for a shared room in $2007.

The process of qualifying for Medicaid is daunting, to put it mildly. What you don’t know CAN hurt you. Please find out all you can while you can, just in case you ever have to access Medicaid dollars, to avoid losing thousands of dollars and/or suffering from lack of services and funds to pay for services. It is best to go to the Medicaid office as soon as possible if there is any indication that long term care (translated: help for the aged and infirm) is a possibility to establish a “starting point”.

What follows is a quote from the government website: “If you find that you need long-term care, you should apply as soon as possible because it may take some time for the state to process your application and make an eligibility determination. For the most part, the date you become eligible is based on the date you apply for Medicaid, assuming you meet all of the eligibility requirements when you apply. The longer you wait to apply, then, the later your date of eligibility will be.

The Medicaid agency usually has 45 days to process your application. If the application requires a disability determination, the agency can take 90 days. But, it may take longer for the state to determine your eligibility if you do not provide the required documents on time. If Medicaid thinks that you are not cooperating, it can deny your application for failing to cooperate. If this happens, you may have to start your application over again once you have your documents in hand. This will delay the date you become eligible for Medicaid even longer.”

So you can see that like most government programs, it is a hassle. Lots of red tape and hoops to jump through. And when one is in the throes of caring for a loved one who is ill and/or disabled, the process is a living nightmare.

Did you know that even a funeral and burial policy purchased must be an irrevocable policy or it will be counted as an asset by Medicaid and added to the allowable amount of assets owned by the person applying for Medicaid? Which is only $2000 for a single person, by the way. There are so many rules and regulations concerning Medicaid that it will make your head spin and I will not begin to explain them here. You can access the website named above and research on your own. Let it suffice to say that I did not know about any of it back in 2007 and had no desire to learn because it was just too overwhelming. I barely had time to sleep, let alone learn something new. But it was a moot point, because no one told me about the Home and Community based waiver program. At that time I thought Medicaid only paid for nursing home care.

We limped along from Thanksgiving break until Christmas break, with the VA’s home care person coming a few hours a day, and me doing everything else and paying my son to sit with Milford a couple of nights a week. There were five doctor office visits during that time, one was unplanned and had me sitting with Milford in the emergency room for six hours after a day of teaching. Not fun.

Then Christmas break happened. And there was a wedding to plan and execute.

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