The Problem
Will you rely on Medicaid to fund your long-term care needs in the future? If so, it is important to understand the process.
Long term care providers abide by specific regulations, which dictate when and why they can discharge a resident. While these requirements vary by facility, transitioning from private pay to Medicaid funding is never an acceptable reason to discharge a resident.
Nonetheless, many Adult Family Homes discharge seniors every day, for this very reason.
Breaking It Down
Jim’s Story
In April 2014, I received a call from Jim. The Adult Family Home where Jim’s 92-year-old grandmother moved less than a year ago had served her a discharge notice.
The reason? Jim’s grandmother was transitioning to Medicaid funding.
While I am not an attorney and cannot provide legal advice, I want to help you avoid reliving Jim’s story. The only way do this? Learn from Jim’s missteps.
So, let’s look back at Jim’s story.
Before moving into the Adult Family Home, Jim knew his grandmother had enough money for around twelve months of private pay care (valued at four thousand dollars per month). This was equivalent to the monthly care fee at the Adult Family Home.
Jim addressed this issue with his referral agency – a well-known senior placement agency in Seattle, WA.
The agency’s owner assured Jim he should not worry. After all, Medicaid funding transitions are common and the referral agency had worked with that provider in the past. Thus, there should be no problem staying in that Adult Family Home after transitioning to Medicaid funding.
However, when Jim received the Adult Family Home’s residence agreement on move-in day (Jim was not advised to request it earlier), and carefully read it his stomach dropped. The agreement read: “We can only care for a resident on Medicaid if a third-party pays the difference between the private pay fee and the Medicaid reimbursement rate.”
This type of policy is not unusual or inappropriate. Although this policy’s specific wording does not comply with regulation.
But the real problem occurred when Jim called the referral agency for advice and once again, they encouraged Jim’s grandmother to move in regardless.
So despite feeling uneasy, Jim signed the legally-binding contract.
Now, with his grandmother’s funds exhausted, Jim applied for Medicaid funding. But unfortunately, she only qualified for $53 per day – less that $1600 per month.
Understandably, the Adult Family Home provider could not sustain a 60% income reduction, and attempted to enforce the “third party supplementation” clause. Sadly, Jim was unable to financially comply.
The Results of Signing The Dotted Line With Unanswered Questions
During our conversation Jim discovered the referral agency collected a placement fee equal to 100% of the monthly care fee, in this case $4000, when Jim’s grandmother moved in. There was a long silence on the phone when Jim realized the implications of that incentive to move his grandmother to the Adult Family Home.
For elderly folks, an involuntary transfer or discharge is stressful and disruptive at best, and can be traumatic.
One can obviously appeal the discharge through legal channels, but it is important to recognize that doing so also induces stress. Moreover, tension and animosity may result between the care provider and you: the family member.
The Solution
Prevention is in the fine print…
Once you have signed a contract and moved into a care facility, it is too late to address an issue like Jim’s.
The key is to read the actual residency agreement, and specifically the Medicaid policy, before you sign anything, and definitely before you move in. Ideally, you should read each facilities residency agreement before making your final placement choice.
You must not rely on the placement service to answer your questions on behalf of the care provider. Senior placement services are not familiar with specific facility’s policies or residency agreements.
It should be crystal clear whether or not your loved one can remain in their chosen care facility after transitioning to Medicaid.
Here are four key questions to help clarify the facility’s Medicaid policies:
- Do you accept Medicaid?
- Is there a minimum period of time my loved one needs to pay privately before they can transition to Medicaid?
- If and when my loved one transitions to Medicaid funding, would they have to move to different room?
