Medicaid spend down takes pre-planning and knowledge. Get 13 insights about choosing a care home when planning a Medicaid spend down.
Avoid the stress this family experienced.
A Medicaid spend down plan – you think you’re doing it right
A family friend called. Four years ago, she and her siblings found an adult care home for their aging mother. They agonized over making the right decision until they found one that seemed like a perfect match. The peer group, location, and care level fit their mom's needs.
The oldest son, Jeff, handled mom’s finances. She had money in the bank from the sale of her home and property. Mom was physically healthy but pleasantly confused. He knew she’d out-live her assets and would need Medicaid to pay for her care in the future. To qualify for Medicaid, she had to spend all her money on care and medical costs first until it was almost gone.
Jeff asked all the right questions and was honest with the provider about how much money his mom had.
The care provider assured them that when their mother ran out of money, he would accept Medicaid. The owner didn’t have a Medicaid contract at the time but said he’d be willing to sign one when the time came.
My friend’s family is large so every day someone visited mom in her beautiful new home. They enjoyed the birthday parties and outings the caregivers hosted for the residents. Families were always welcomed. The caregivers treated their mom with love and kindness.
My friend and her siblings sighed with relief, grateful for the care their mom received.
Jeff thought the monthly rate of $7500 was high but worth it. And besides, he believed mom could stay in the home on Medicaid. The owner had verbally promised.
Mom spent down. It's time to apply for Medicaid.
Now, after living in the home for 3 ½ years, Jeff told the owner he was applying for Medicaid soon. Mom was running out of money. They had spent $315,000. Only $25,000 was left in mom’s account. He reminded the owner that he'd promised to open a Medicaid contract.
Right away the owner began making excuses. He said the timing was bad for him. He wanted to open a second care home and couldn’t afford a Medicaid resident. He didn’t want to hassle with the extra Medicaid oversight and paperwork.
At one point, the owner hinted he’d consider a Medicaid contract if the family paid the difference. (Medicaid reimbursement is much lower than private pay open market rates).
My friend and her family panicked. They started searching online about what to do. They talked to friends, social workers, and the visiting nurse. Could they enforce the verbal Medicaid spend down agreement with the provider? If they could, should they? Would the providers become angry and treat mom poorly? How could they find a new home on such short notice? Were there any nice homes that would take Medicaid right away?
Jeff called a family meeting to discuss the situation. His brother yelled about the deceiving, cheating owner. His sisters cried. They worried about how to tell mom that she was moving. How would she react to a new home? Would another move cause more memory loss?
Get help choosing a care home that takes Medicaid
I recommended they call a registered local referral agent for help.
The referral agent understood all their concerns. She reassured them that there were available options. In fact, within a few days she had homes for them to visit.
All the care homes she referred were pleasant and clean. Perhaps a little more modest than mom’s current home. But the providers were friendly and had good references. Most importantly, they already had a Medicaid contract. So a short Medicaid spend down wouldn’t be an issue.
The good news! - my friend’s mom transitioned to her new place without any problems. She’s even made friends with another resident on her first day. Her family is grateful for that.
But they wonder how this stressful situation could have been avoided. How could the Medicaid spend down planning work better? They don’t want other families to go through this stress.
What is Medicaid and how do you qualify?
Read more: Oregon Medicaid Eligibility: 2019
How do you plan for Medicaid?
Medicaid takes a lot of pre-planning - the devil is in the details. Don’t find yourself disqualified, with no money, and needing care. Work with a Medicaid case worker at the Department of Human Services.
It’s also recommended you work with an elder law attorney to properly spend down.
Do all care homes accept Medicaid?
How to choose a care home when planning a Medicaid spend down?
What you can do when a provider makes false promises:
In a situation like my friend's, filing a formal complaint with the State won’t have much effect. There’s nothing a licensor can do about verbal agreements.
But you can file a complaint with OSRAA. Here's our Contact Us page
If you have a negative experience with a provider making false promises, we want to know. Our members will be cautious in referring that home. Especially to someone needing future Medicaid.
Finding the right care home for a loved one is stressful enough. Avoid the type of situation my friend and her family faced. Follow the advice above. Work with a registered OSRAA referral agent member.
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