July 1, 2019

Your Advocacy

By Kathy Nitz
Lead Benefits Advocate
GolderCare Solutions

Medicaid and “the spenddown”

At GolderCare, we get many calls where someone says something like: “I know I have to spend all of Mom’s money until she has nothing left, and then I’ll just let the State take over.” This is such a frustrating statement to hear. This is NOT true. Knowing the rules is half the battle, the other half is taking action – the right action at the right time. And, the State does not just take over. It is your responsibility to get Mom qualified for Medicaid.

A common scenario we hear from our clients: Mom fell, broke her hip. She has been in the hospital and is now transferring to a rehab facility for therapy. You’re told Medicare will be paying for her rehab. What the facility tells you but you may not fully understand is that Medicare will pay ONLY so long as Mom continues to qualify for skilled care. When Mom is considered “rehabbed” you will lose this payer source resulting in her going to private pay status. But, she is not ready to go home. Now you’re thinking, “How am I going to pay for the Nursing Home?!”

Long Term Care Medicaid may be an option. You may know of someone who’s been through this maze built on a minefield. Mom is currently in a nursing home in Illinois but her home is in Iowa. Do you apply in Iowa or Illinois? Does Mom meet criteria to be able to apply? When do you apply? If you apply too early it could cost you thousands of dollars that otherwise could have been preserved. If you apply too late, it could result in a lack of payer source thus exposing Mom to a possible discharge.

Now, you’re staring at your computer because you have been told you must apply online. There are no local long term care Medicaid offices. The local area’s Illinois office for long term care is in downtown Chicago; the local area’s Iowa long term care office is in Council Bluffs. If you call DHS, you often get put into a general voice mailbox and nobody ever calls you back.

The terminology a/k/a language that the Department of Human Services speaks can be confusing at best and misleading causing you to be denied because you don’t understand the language, such as:

  • What is a “property transfer”?
  • What’s an exempt asset vs. a non-exempt asset?
  • My Aunt said I can keep the house but my sister’s, friend’s, mother told me that her hairdresser’s, grandmother’s house was taken by the State. Should I sell the house first and then apply? How do I pay the utilities?
  • Has she made any gifts? What’s a gift? Are they really asking about Christmas gifts? What are the ramifications of these gifts?
  • What is this 5 year look back period everybody talks about?
  • You managed to submit the application and months have gone by. What is happening?
  • You send things that you think they want but they keep
    asking for the same thing. Why?
  • They are asking about things that you don’t know anything about. What now? “I don’t know” is an automatic denial!
  • You receive a Notice and it says Mom has a “spenddown”. What is this?

We’ve got answers. GolderCare Solutions Unlimited can help you navigate not only Medicaid, but we can also be the voice you need in a care-related crisis. Everyone has the right to know.

GolderCare’s July Senior Empowerment Series, Medicaid and the Spenddown, is a free seminar on basic Medicaid for Nursing Home Care. We will discuss the basic overview of Medicaid for the nursing home/assisted living, a definition of terms, the basic criteria for both Illinois and Iowa and some landmines to avoid.

There are two options to attend. These events are free and open to the public.

  • Wednesday, July 3 at 10 AM – GolderCare Education Room, 1900 State Street, Bettendorf
  • Wednesday, July 17 at 10 AM – Moline Public Library, 3210 41st Street, Moline

GolderCare is an independent advocacy group for seniors and those who are disabled. In the absence of local long term care Medicaid offices, too many people inadvertently make mistakes in the process and are denied benefits to which they are rightfully entitled. The GolderCare team has extensive experience interfacing with both Illinois and Iowa Department of Human Services. We look forward to meeting you and learning more about your situation. We are here to help you and your family with your senior-related needs.

Kathy Nitz is the Lead Benefits Advocate for GolderCare Solutions. She uses her wealth of knowledge and experience in benefits planning to advocate for seniors and those who are disabled. To reach Kathy or learn more about GolderCare visit www.goldercare.com or call 309-764-2273.

Filed Under: Finance