We live in Pennsylvania. Looking for advice or experience with PA Medicaid. My Mom’s dementia has worsened. We are looking to have home care for her a few AM hours a day since we can’t be there and trying to keep Mom safe in her home. She needs help some days getting up, washed, dressed, ready and to eat. Some days we call and she won’t pick up and when she does is sleeping til noon. No food or drink yet. Mom receives my dad's postal pension but can’t afford outside agency to come in and want 6-8 hours a day work. We are there in PM after work for dinner and meds. I need guidance/help to see if PA Medicaid will pay for this care. Also if she needs a Nursing home in near future what does Medicaid take? Her pension, her home? It appears we need an Elder Care lawyer too. Any advice or help is appreciated for PA resident and experience with this type of situation. Thank you
She has to qualify for Medicaid to participate in the program and have documented health and mobility issues to apply.
The waiver subsidizes in home care through an agency in their network or you can hire/pick your own caregiver and use their payroll company to schedule your own flexible hours.
You can request however many hours you think mom will need per week/month (go big) on the waiver application and if your app is approved they will dictate your hour ‘budget’. After a time you can request more if needed or health problems increase etc. my mom started with 20 hours a weeks and eventually was bumped up to 36 etc.
it’s a really great concept. We didn’t like the agencies as it was a revolving door of people who broke things etc. and they are not very flexible with shift start times, but we were able to hire independently and the payroll company took care of all the admin stuff beyond basic scheduling. that was easy bc they have an app where the caregivers can clock in/out etc.
Did she work at least 10 years (40 quarters)? If so she is entitled to the SS she paid into.
You need to talk to a Medicaid caseworker at Social Services. Moms house at this point will be an exempt asset. Her pension will need to be under the income cap that is allowed. In NJ its just over 2300. Her assets can't be over the asset amount allowed which in NJ is 2000. This goes for "in home" care and Long term care.
If she receives services, upon her passing her home now becomes an asset. Meaning Medicaid can recover the money they put out by putting a lien on the house which needs to be satisfied at time of sale. There is a lot more to the recovery process but not going into it here.
You do not need an elder lawyer at this point. The caseworker can help you fill out the application.
Guardianship can be a very expensive process done through the courts. I've read on this forum it can be upwards of $10K, and it requires time and effort.
Medicaid is a state-managed program and rules can vary by state. You can consult a Medicaid Planner for PA to see what their Medicaid will pay for if she qualifies. Her local area's Agency on Aging can provide some guidance to resources, they are usually very helpful. If she does qualify Medicaid puts a lien on the home that needs to be satisfied when it is sold. Medicaid plus her SS is what covers the cost of her care at that point, and they take all but a small amount every month, which also differs by state, like $90 or so.
You have your work cut out for you -- I wish you much success in getting her the care she needs!
https://www.dhs.pa.gov/Services/Disabilities-Aging/Pages/MA-and-payment-of-Long-Term-Care.aspx
Have you contacted her local Area Agency on Aging for help?
Does she have Social Security of her own?
She will need to be both Medically AND financially at need to be approved for LTC Medicaid. Have you spoken to her doctor about possible placement? Some doctor's offices have a social worker or Nurse who helps with placement.
If she goes to the hospital for any reason, start an immediate conversation with discharge planning about the fact that she is unsafe at home and needs placement.