Benefits of a Medicaid waiver?

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Benefits of a Medicaid waiver?

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Hi, everyone. The Medicaid Waiver saga continues for us. I’m still not sure I want to “go for it” because I don’t understand how or even if it will benefit us.

Will this wavier pay for my husband’s Medigap Insurance? Will it pay for his medications so he will no longer need Part D? We are supposed to open a Miller Trust and deposit $245 a month into it. I was told I can access that money but it has to be used for his needs. It would cover his Medigap and medications and that’s about it. What’s the sense in opening that trust account? Seems to me it’s like robbing Peter to pay Paul. What happens when the money in that account is used up each month? And, it’s our money. It’s not like Medicaid would match the funds.

I was also told he'd have to pay to pay a premium to Medicaid every month. At one point, the agent told me it could be as much as $1,000. WTH? What’s the sense of having Medicaid if you have to pay through the nose for it?

We don't need (or want) in-home Health Aides. With the exception of a new mattress for his hospital bed, we have all the DME that will fit in our house. Seriously, all I really want is to have his incontinence supplies paid for and maybe his meds.

I’m just totally in the dark with this Waiver thing. I have the feeling, without knowing what it will cover, that it’s not going to be worth the hassle of getting it. Thanks in advance for your help.

Medicaid Paying for Care

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Here is how the waiver benefits us and you compare to your situation.
My mom lives with me. She receives SSI of $750 a month. She receives traditional Medicaid, meaning I only pay the copay for her meds which is $3 each.
Her incontinence are paid for by Medicaid and shipped to me.
Her large shower chair, half in and half out of the tub, I bought used.
I bought a transport wheelchair for her to get around the house by herself, removing the foot pedals.
Medicaid purchased the portable commode next to her bed. She can stand and pivot well enough to use the bathroom on her own. Her supplies hang in a shoe rack behind her door in arm reach, baby wipes, pull ups, garbage bags for her can where all paper products go into, her deodorant, etc. so she can be as independent as possible.
Her health both mental and physical qualifies her to live in a nursing home. Her doctors completed paperwork to attest to this.
The medicaid waiver saves Medicaid the close to $50,000 a year from living in a nursing home to the $14,400 a year to live in our home.
I quit working when she had open heart surgery. Really didn't think 5 years later she would still be here.
Financially we live within our means so the $40 a day is paid to me as her caregiver. The daily rate depends on how much hands on the patient needs. I have certain restrictions regarding administering her meds but other than that, this is what the waiver does.
I have a 2 minute report to complete on line and they even give you a tablet to do this on. This is the state of Indiana.

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Wow. We’re “next door” in Ohio, but that sounds like a great deal. As I said, my biggest concerns are his supplemental ($150), Part D ($50) and his meds ($113). That would more than beggar the QIT of $245. Plus, this is just taking our money from one account and putting it into another with a fancy name. This is our money, funds not provided by Medicaid. He pretty much has all the DME he needs and we have room for. He needs 24/7 complete care; everything except feeding. $40 a day=$280 a week and that’s definitely preferable to a poke in the eye.

Ideally, the waiver would, from Medicaid/Government funds, NOT our’s, pay for his Medigap, Part D and co-pay for meds. Incontinence supplies are around $100 a month. If those are all Medicaid would pay for, it’s hardly worth the $245 a month and whatever else we’d have to pay. However, thinking into the future, he will at some point have to go to a facility. Perhaps already having the trust in place would make this easier.

Thanks for your answer. I appreciate it a,

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I’m not sure why they steered you to a waiver and the whole Miller Trust thing. Those are both related to long term care nursing home type Medicaid and in home care. If you were on regular community medical Medicaid it would pay for Depends. Medicaid would replace his Medicare supplemental insurance. Depending on your income it might also pay his Medicare premium that comes out of his Social Security check. I’m not sure how it would affect you. I’ll do some research in my Medicaid manuals. I’ve never heard of anyone paying a Medicaid premium. Only exception is a Medicaid buy in. Not sure if those are available in Ohio. I’ll get back to you.

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Thanks, Becky!

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Said premium could be $20.00 a month up to 2% of income. But everything I found regarding Ohio was pending. But maybe something new has passed. In Maine the waiver is for children whose parents want to keep them at home and it is very limited with long waiting lists.

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Yes, I understand about the pending thing. They’re restructuring the food stamp program here as well. Thanks for your research. I’m calling the agency tomorrow and your answer has helped!

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I don’t know what a Medicaid waiver is, but be sure you know if there is Estate Recovery upon death. I saw that someone mentioned “recovery” but be sure you know how that works , if it even applies here. It means that Medicaid will want to be paid back when the person passes on - if there is any money in the estate to be had.

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Thanks. I believe that’s known as MERP. There is no estate to recover as we owe more on our house than it will be worth in a few years and there’s nothing else. Medicaid can put all the leins on our house they want, bit they won’t “recover” anything. Sad, but true.

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I’m in a nursing home. If I chose to transition to a residence or apartment Medicaid would continue to pay my benefis, not medigap, but there’d be no Miller Trust and they would pay for limited nursing and CNA care. Plus if any residence modification were necessary, they would pay for that to make the house truly handicap accessible.

I’m in the beginning part of the process.

my prayers are with you as you decide what to do.

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I know it’s a pain in you know what! I am on the same boat because I am disabled with cerebral palsy. I get $1,028 a month, which is not enough to pay bills, and since my parents have passed away, I get 24/hour care by using the Medicaid waiver in FL.

Talk your dad’s social worker and then she would make the change regarding incontinence supplies, and meds. He should be able to get them by Medicaid waiver.

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Where do you live, do we can look up the rules. Have you applied for Extra Help thru Social Security??
That will pay for you MEDICARE Part B Premium, and most of your co- pays. Medications drop to $3.65-$8.35 a month.

If some of their RXs are not on the formulary, than there is probably a good medical reasons for that. Ask your doctor to explain why he is not on an older cheaper drug. (Allergies, only BP meds that does aggrivate neuropathy or Raynaud's,...)

This is an issue I have with how Drug plans are recommended. They go by the current list of RXs. Well only the most expensive plans cover my migraine pills, but I am allergic to the common drug, so I don't bother listing it, or list the one most companies cover. There are 2 or 3 Osteoporosis Rx out there. A few companies cover neither, but most cover one or the other. So if I put in drug A, it kicks out great plans because of the cost of this one drug, and Visa versa. My doctor thinks it is good to alternate every few years, so again, I run my search twice. Once with drug A, once with drug B. Print out the details, and know where the other pieces fall!

If it is a newer medication, contact the Manufacturer. The income limits for Prescription Assistance Programs are more generous than you might think.

It sounds like you never had Supplemental Insurance. THIS IS A NOTE FOR EVERYONE. There is a very narrow window of 3 months before and after, inclusive of month you qualify for MEDICARE, or if disabled, again when you hit retirement, to get Supplemental Health Insurance no matter your pre-existing conditions. Most people don't realize that if the wait, mild chronic conditions, or a serious illness long in remission ( in my case sudden onset Kidney Disease), means going thru underwriting. Most of the hundreds of programs won't take you. Those that do, charge the same premium as someone 991/2 or older. ( Actually a quick way to screen for premiums & plans is put your age in as 100.)

Is there anything your LO can still do? Write a business letter, fold clothes or see on buttons ( Vets are great at that). A hobby people might pay for. Many states have gone to work for Medicaid. I was told 3 years ago my premium would be $700 (56% of my income). But I work an hour a month for $10 and pay nothing! I am an independent contractor, report my income, but it is so small I don't have to pay taxes on it.

Lastly, if you don't go through Medicaid, you can hire help directly, rather than going through a Medicaid Approved Service, which usually costs double because of the paperwork and overhead! College Students, Retirees, and simple independent house cleaning company, may be much cheaper.
All things to weigh in on your decision.
Good luck!

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I did apply for Medicare “extra help” and just like with everything else, our income is too high. Not enough to pay our bills but too much to qualify for aid.

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What you wrote above I don’t even understand where you’re coming from??? I have a medicaid waiver, at least I think that’s what it is called,,,,more specific a HCBS waiver, mom is on medicaid...she also has LTC diversion...I live in FL.. I get paid 12 hrs a week to care for her as a home health aide, we get free medical supplies including incontinent supplies, they fitted our bathrooms for the things an elder needs, I also get 7-14 days a year for respite care so I can take a break. She also has medicaid managed care. She gets 35.00/month in OTC products of our choosing. IT also pays for her all prescription medicines. WE don’t have to pay for medicaid - Ive never heard of anything like that before and we didn’t have to open a Miller trust or any trust. She doesn’t pay for her medicare and she doesn’t have to pay for her supplemental insurance though I keep it and pay for it since the doctors are more accessible. Back before Rick Scott was governor and he changed the healthcare to not be a benefit to the Seniors, we did use the supplemental insurance through medicaid and she could see all her normal doctors and I didn’t have the AARP Supplemental Insurance. We have been nothing but 110% happy with it. Oh and ....I forgot, we get free transportation. Here’s a link so you can understand maybe: https://www.special-learning.com/blog/article/53

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Thank you for your help.

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Who is helping yo with the waiver? Ask that person all your questions. Your Area Agency on Aging also has case managers very knowledgeable about all this. But you may have to accept certain conditions to be eligible. They want people to really need their assistance. One of the major advantages, though, is that half your joint assets - your half- will be immune from Medicaid counting them as part of your husband's assets. This is a major advantage - for you personally. If you were to use up all of his half, through the waiver program or nursing home care, he would be eligible for Medicaid to pay for his nursing home costs, if it came to that, The trust accounts also protects your money . You must have fairly high assets, or else they would not be talking about $1000/ month. . I would stop being so picky about how you want things, and be grateful any help is available for you at all. Find out everything you will be getting through this option, before assuming it is "not worth the trouble". I don't mean to sound harsh, but isn't keeping half your joint assets safe from your husband's future expenses worth it? You still have yourself to worry about, you know.

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I am working with our local Medicaid office. We have no assets other than our house and we practically owe more on that than it’s worth.

I’m certainly not being “picky”. I’m just trying to understand so I can make an informed decision. And I am grateful for any help we receive from anywhere.

Thank you for for your response.

Benefits of a Medicaid waiver?

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