Trying to decipher Medicaid and care as you age, or senior parents? Start here

For aging seniors and the adult children caring for them, the thought of deciphering care at home and long-term care facilities and the finances and planning that goes with it can be daunting.

I sought out some advice from two good local sources: Sam McCoy, senior vice president of elder rights at Direction Home Akron Canton Area Agency on Aging and Jaclyn Palumbo, a probate attorney and chair of the Akron Bar Association’s Estate Planning, Probate and Elder Law Section.

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This will be a two-part column. This week will cover the basics of Medicaid for seniors and some myths and facts about Medicaid eligibility and care. Next week will look at some advice from Palumbo as an elder law attorney.

Direction Home Akron Canton is a nonprofit agency that helps older adults find programs to age at home or in long-term care facilities.  The agency’s Aging and Disability Resource Center has representatives who can help families find out whether they qualify for various programs. Call 877-770-5558.

But first, let’s start with some basic questions I asked McCoy:

What's the difference between Medicare and Medicaid for seniors?

According to the U.S. Dept of Health and Human Services, “Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions. Medicaid is a joint federal and state program that gives health coverage to some people with limited income and resources.”

There are two ways to obtain coverage under Medicare. One is through traditional Medicare by using your red, white and blue card to obtain medical services under Parts A & B, and may require a separate Part D plan for prescription coverage. Persons with traditional Medicare can also chose to purchase a private Medicare supplement policy, sometimes referred to as Medigap, to cover out-of-pocket expenses.

The second way to obtain Medicare coverage is by joining a Medicare Advantage plan, which is managed care. You must have Parts A and B to join a Medicare Advantage plan. These plans often include drug coverage and additional benefits not covered by traditional Medicare. Many of these plans require members to use in-network providers or pay extra to go out of network. You cannot have both a Medicare Advantage plan and a Medicare supplemental policy.

You can change your Medicare coverage each year starting in October for  coverage the next January. There are other enrollment periods for persons new to Medicare. To check these enrollment periods, go to www.medicare.gov.

Medicaid access requires an individual to qualify and is designed to help individuals with limited income. Older adults requiring nursing home level of care (hands-on help with at least two activities of daily living) can use Medicaid to pay for home care or nursing home care through Medicaid. Medicare does not traditionally cover ongoing home care such as home health aides, Meals on Wheels, or emergency response systems.

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Isn't Medicaid for people who struggle financially?

I hear people pretty constantly talk about Medicaid in a derogatory sort of way or a less than positive kind of way. Seventy percent of our older adults and individuals in long-term care facilities are on Medicaid.

I hear people say: 'I’ll never go on Medicaid. That’s for poor people. My family always paid its bills.' Sometimes that pridefulness prevents folks from getting the care they deserve.

Here are some common myths and facts having to do with Medicaid eligibility and nursing home care:

MYTH: I’ve been my mother’s caregiver for several years and it’s really becoming a struggle.  I’ll never admit her to a nursing home because only the worst homes accept Medicaid.

FACT: With only a few exceptions, practically all nursing homes accept Medicaid as payment for care of eligible residents. However, keep in mind that if a facility prioritizes skilled short-term Medicare admissions, access to the facility for a long-term stay may be limited.

Nursing homes typically are “dually certified” to accept both Medicaid and Medicare funds. Access to the best performing nursing homes is not limited by Medicaid enrollment. In fact, at any one time, up to 70% of residents in Ohio nursing homes rely on Medicaid to help pay for their care. On the other hand, many fewer assisted-living facilities accept Medicaid as payment.

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MYTH: My mother definitely would benefit from living in a setting with others; she’s so isolated in her home.  However, she’s doesn’t seem ready to live in a nursing home.  There’s just no other options, I guess.

FACT:  Many assisted-living facilities participate in the Ohio Assisted Living Waiver Program, which pays for care in assisted living.  Also, don’t fail to consider the option of receiving care in the home through PASSPORT, Ohio Home Care Waiver or MyCare Ohio.

MYTH: My husband and I share a comfortable home where we’ve lived for many years. He’s been failing the last several years and really needs to get care in the nursing home. We’ve exhausted our savings but I’ll be left homeless if he has to go the nursing home.

FACT: Medicaid will not take the home away from a spouse as long as it is occupied by the spouse.

MYTH: I want to leave my home to my kids. I cannot do that if I get on Medicaid.

FACT: That is not necessarily true.  Estate planning and long-term care planning are important for folks to do ahead of time instead of waiting until they are sick

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MYTH: Medicaid will take everything I have, so I should go without help instead of applying.

FACT: If people forgo Medicaid assistance for long-term care needs, especially at home, they run the risk of injury, limited independence, and a potential lack of safety. If people need help, getting it early can be a key to enjoying life rather than making do with what they can. A lack of long-term care supports can lead to hospitalization and the need for institutional care, which would require Medicaid application for payment in many cases.

MYTH: Medicaid will put a lien on my house.

FACT: Medicaid’s Estate Recovery program does seek to obtain repayment for the Medicaid services utilized once the Medicaid-enrolled individual is deceased. However, Medicaid only has an interest in property that the person owned the moment before death. Any other asset is not subject to Medicaid estate recovery. There are ways to plan around this, and still do gifting, even after someone is on Medicaid.

MYTH: I don’t have to plan for when my parents get older because they have Medicare.

FACT: False! Medicare doesn’t cover many services that can keep someone in their home. Ongoing personal care, homemaking, meals, and other options aren’t covered in most cases and can only be accessed by out-of-pocket funds or Medicaid.

Beacon Journal consumer columnist and medical reporter Betty Lin-Fisher can be reached at 330-996-3724 or blinfisher@thebeaconjournal.com. Follow @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ To see her most recent stories and columns, go to www.tinyurl.com/bettylinfisher

This article originally appeared on Akron Beacon Journal: Start here for help figuring out Medicaid for yourself or aging parent