Spending Down For Medicaid: One Caregivers Personal Journey
My experience with the complexity of Medicaid began when my uncle called me one day and said, Your aunt just got lost again and I cant take it anymore. The time had come to place her in a long-term care facility. Even though my aunt and uncle had accumulated a little nest egg, we knew these funds wouldnt last long due to the costly care she required. That is where Medicaid planning came in.
Medicare Supplement Insurance Plans
Supplemental Medicare plans such as Medigap or Dual Eligibles assist beneficiaries with out-of-pocket costs that Original Medicare doesnt cover. Supplement plans may assist beneficiaries with certain home health care costs that arent covered by Medicare. However, since these plans are provided by private health insurance companies, they may require beneficiaries to use providers or prescription drugs that are in-network.
What Are The Physical And Mental Demands Of Caregiving
Participants in the paid direct care worker groups described daily caregiving work involving a variety of physical demands. Typical tasks include helping clients with eating, bathing, and toileting preparing meals, doing laundry and other household chores and managing medications. They described the physical demands of their jobs, including lifting and transferring patients in and out of bed and wheelchairs. Other common job characteristics included long hours and unpredictable schedules.
The physicals demands. . . include the transporting of the. . . patients. . . who were bedridden we didnt have the bed lift to really lift them up, we would have to do it ourselves and. . . it would be a lot. 21-year-old male paid caregiver in New York
The most strenuous job was when would have her behavior, she would lay down on the ground and she was 250 pounds and just lay there. 51-year-old female paid caregiver in Florida
Its hard to get a break, and eventually you just kind of get worn out over the course of the day. 78-year-old male paid caregiver in California
Mentally, you just feel like. . . you can never just sit down and. . . regroup. . . You always feel like theres something to do, especially with COVID adding more things onto your daily schedule. . . its very hectic. 21-year-old male paid caregiver in New York
Its always a challenge. It is tiring emotionally, physically. 51-year-old male unpaid caregiver in California
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Getting Paid As A Family Caregiver Through Medicaid
Caring for an ailing family member is difficult work, but it doesnt necessarily have to be unpaid work. There are programs available that allow Medicaid recipients to hire family members as caregivers.
All 50 states have programs that provide pay to family caregivers. The programs vary by state, but are generally available to Medicaid recipients, although there are also some non-Medicaid-related programs.
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Medicaid’s program began as “cash and counseling,” but is now often called “self-directed,””consumer-directed,” or “participant-directed” care. The first step is to apply for Medicaid through a home-based Medicaid program. Medicaid is available only to low-income seniors, and each state has different eligibility requirements. Medicaid application approval can take months, and there also may be a waiting list to receive benefits under the program.
The state Medicaid agency usually conducts an assessment to determine the recipient’s care needse.g., how much help the Medicaid recipient needs with activities of daily living such as bathing, dressing, eating, and moving. Once the assessment is complete, the state draws up a budget, and the recipient can use the allotted funds to pay for goods or services related to care, including paying a caregiver. Each state offers different benefits coverage.
For more information about these programs and other ways to be paid as a family caregiver, and here.
Adult Child Caregiver Exception
Details on Medicaid’s live-in child caregiver exception is detailed at the link. This benefit allows the transfer of a home to a caregiving child if that child provides care giving services to their elder parent for two years or more . This is a nice way for my Medicaid-planning clients to leave a legacy for their child without triggering the five-year look back gift penalty rule.
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Does Medicaid Pay Family Caregivers
Is your parent under Medicaid? You might be eligible for benefits. Each state differs. Self-Directed Medicaid Services programs give your parent the option to manage their finances. This can include paying for family caregivers. To find out if your parent is eligible for this program, speak with your parentâs local Medicaid office. The Self-Directed Medicaid Servies program gives your parent significant freedom in paying for services and goods.
Look into the Medicaid Home and Community Based Services . The HCBS program allows Medicaid beneficiaries to opt for local help, like a family caregiver, instead of being in isolated nursing facilities. The HCBS program primarily aids individuals with mental illness, physical disabilities, intellectual disabilities, and significant physical disabilities. The goal is to provide your parent with caring support at home instead of in an impersonal institution. Family caregivers may also receive other types of support like training and individualized guidance.
Community First Choice option gives beneficiaries the option to pay family caregivers from their budget. Your parent will work with a fiscal intermediary to manage taxes and hiring. This is ideal for patients who can self-direct their care.
Caregiver Savings
The Last Resort A Gofundme Campaign
Then theres the last resort method my friend Sharon used to find much-needed funds to care for Rose, her 95-year-old mother: GoFundMe.
Roses health had been deteriorating, and early this year, Sharon began taking care of her mom full-time instead of working. Sharon tried helping Rose apply for Medicaid, but her mother didnt qualify.
Desperate for financial assistance, Sharon decided to put up a GoFundMe crowdsourcing page. It included a photo of Rose with her beloved dog Sheba and explained Roses situation. To date, the effort has raised $1,300, which has let Sharon hire a respite caregiver for several hours a week.
A recent search on the GoFundMe site revealed several other similar COVID-related caregiving funding requests.
If youd like to find out whether you can get paid to be a family caregiver, Lisa Gurgone, executive director of Mass Home Care recommends contacting your local Area Agency on Aging/Aging Service Access Point. You can find your agency by entering your ZIP code into the federal governments online Eldercare Locator.
Once you find your local agency, Gurgone says, ask to speak with the Information and Referral Department about Medicaid and non-Medicaid programs letting family caregivers receive compensation or respite services.
If a family member needing care is a veteran or the spouse of one, contact your state Veteran Affairs Office and ask to speak with a Veteran Service Officer who can help you identify resources.
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Looking To Hire A Private Caregiver
Hiring a caregiver may be the perfect option if you are looking for a dedicated professional to provide private care and companionship to your elderly loved one at home. Finding a great caregiver that you can trust doesn’t have to be a complicated process. We’re here to help you find the care you need for your loved one. Compare caregiver profiles, read reviews from other families, and search by experience or rates to find your perfect match.
How Much Does Home Care Cost
According to the Genworth Financial Cost of Care Survey, in-home care costs about $24 an hour. That comes out to $1,950 per month for 20 hours of care a week, or $3,900 per month for 40 hours of care per week. Home health care is slightly more expensive at an average rate of $25 an hour.
These figures are the national average, so average costs in your state or city may be quite different. For example, in Vermont, where senior care tends to be more expensive than the national average, 20 hours per week of in-home care costs an average of $2,362 per month, about $400 higher than the U.S. average. Meanwhile, in Louisiana, the same amount of in-home care costs just $1,463 per month, on average.
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Does Medicaid Cover Home Health Costs
Again, Medicaid payment amounts, covered services, and eligibility requirements vary state to state, but Medicaid can cover the costs for home health services for recipients that need them. Recipients primary doctors often assess their need for these services. In a number of states, home health only covers part-time care with a limited number of service hours per day.
States That Pay Family Caregivers
Several states offer some form of compensation, benefits, or support to family caregivers under qualifying circumstances and eligibility factors. For instance, California, New Jersey, New York, Washington, Oregon, and Hawaii are a few of the many states that pay family caregivers and provide ongoing caregiving resources and support.
On average, many states with paid family caregiving incentives can provide anywhere from $600 a week to $1,000-plus in family leave support. In particular, California is a standout state when it comes to supporting family caregivers. For instance, the California Paid Family Leave Act provides benefit payments to those who temporarily leave a job to care for a seriously ill loved one.
Additionally, California employees can receive up to 60-70 percent of lost weekly earnings between five to 18 months before the claim start date, according to the Employment Development Department for the State of California. The state also has a unique program known as Family Caregiver Services, which helps coordinate services for respite care as well as in-home or out-of-home assistance. These services are provided to adult family members or informal caregivers who are 18 or older and provide care to individuals who are 60 or older.
Did You Know: Did you know that many states will pay for respite care? To learn more, read my guide: What Is Respite Care?
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How To Qualify For Medicaid Long
To be eligible for Medicaid programs that pay for personal care assistants, applicants must meet two requirements:
âFinancial requirements:âThere are limits on both the income and assets an applicant can have to qualify for Medicaid. The income limit varies by state, ranging from less than $1,000 to more than $2,000 per month for an individual. The asset limit is typically $2,000 for an individual, but assets such as a home that is an applicantâs primary residence, an automobile, personal belongings and prepaid funeral expenses are exempt.
âFunctional requirements: Typically, states require that applicants need assistance with a certain number of activities of daily living, which include bathing, eating, dressing, toileting, and transferring in and out of bed or a chair.
How Much Do Family Members Get Paid For Caregiving In Florida
How much family members get paid for caregiving in Florida depends on the program they are participating in.
- The HCE program pays, under the basic subsidy, $160 a month. Caregivers are not compensated directly for the care they provide, but rather for equipment and supplies.
- The SMMC LTC program requires caregivers to accept the Medicaid hourly compensation rate between $9-$13 an hour.
- The VDC program pays caregivers an hourly rate set by the Veterans Health Administration and adjusted for local geographic factors. The hourly rate is called the reimbursement rate, and caregivers are paid in the range of 50-75% of theaverage hourly rate for care in their area. Generally speaking, this may be between $8 and $21 an hour.
- The VA Aid and Attendance program maximum benefit amount for aveteran who does not have a spouse or dependent child is $23,238 a year or $1,936 a month. The maximum benefit amount for a married veteran is $27,549 a year or $2,295 a month.
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How To Find A Caregiver
To locate a caregiver in ones community, beneficiaries can use Medicares provider search tool or the U.S. Administration on Agings search tool. These tools will allow individuals to find providers near them, compare those providers, narrow their search by agency or care type, and more.
Its important when searching for a caretaker to evaluate them regularly to ensure they are a good match for the beneficiarys needs. Use tactics such as interviewing or assessment sheets like Medicares home health agency checklist to gauge if the caregiver is well-suited for the individuals healthcare wants/needs.
Hcbs Waivers And 1915 Waivers
The first and most common Medicaid option is Medicaid Waivers. These are often called HCBS Waivers, short for Home and Community Based Services, or 1915 Waivers or occasionally Section 1115 Waivers. Waivers allow states to pay for care and support services for individuals residing outside of nursing homes. Commonly, they pay for personal care and chore services provided for elderly or disabled persons who live in their homes or the homes of family members.
Most states Medicaid Waivers have an option called Consumer Direction. Consumer direction allows the beneficiary to direct or choose from whom they receive care services. With this option, the care recipient can choose to receive care from a family member, such as an adult child, and Medicaid will compensate the adult child for providing care for the elderly parent. In most cases, the adult child / caregiver is paid the Medicaid approved hourly rate for home care, which is specific to their state. In very approximate terms, caregivers can expect to be paid between $9.00 $19.25 per hour.
It is important to note that the phrase consumer direction is not used in all states. However, the concept of consumer direction is available in all states. A variety of other terms or phrases are employed to describe this same concept. Depending on ones state, alternative language may include Participant Directed Services, Self-Directed Care, Cash and Counseling, Choice Programs, and Self-Administered Services.
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How Much Does A Chore Provider Get Paid
2 State of Michigan Chore Provider Salaries State of Michigan Chore Providers earn $24,000 annually, or $12 per hour, which is 18% higher than the national average for all Chore Providers at $20,000 annually and 93% lower than the national salary average for all working Americans.
How do I get paid for taking care of a family member with Medicare?
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Getting Paid By A Family Member
If the person needing assistance is mentally sound and has sufficient financial resources, that person can choose to compensate a family member for the same services a professional home health care worker would provide.
If you and your loved one are exploring this route, try these steps to establish a proactive employer-employee approach, which can minimize stress and family tension.
⢠Put aside any awkward feelings about discussing what you both need. Talk about wages and paydays, health risks, scheduling, and how respite care and caregiver sick days will be handled.
⢠Draw up apersonal care agreement that will serve as a contract between the caregiver and the care recipient. It should spell out wages, what services will be provided and when, and the length of the agreement, among other terms. Consider involving other members of the immediate family in working out terms so they are not surprised later.
⢠Consult an elder care lawyer to review your contract to make sure it meets tax requirements and deals with inheritances. All other interested parties, such as siblings, need to approve it.
⢠Beware of emotional pitfalls. If family members seem uncomfortable with the arrangement or disagree with the plan, consider a session with a neutral party, such as a family therapist or family mediator who specializes in elder care.
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Family Caregivers Getting Compensation For Their Support
The most common program that pays loved ones for caregiving is a Medicaid option program known as Medicaid Waivers. These Waivers are also referred to Home and Community Based Services Waivers, 1915 Waivers, or even Section 1115 Waivers. Waivers, under broad federal guidelines, allow states to pay for certain support and care services for persons that reside outside of long term care facilities such as nursing homes or assisted living.
In most cases, they pay for personal care plus household services offered for older adults or disabled individuals that live in their own homes or the homes of loved ones or family members.
Veterans Aid & Attendance And Housebound Pensions
The veterans pensions, which are called the Aid & Attendance and Housebound benefits, are programs specifically designed for wartime veterans and their spouses. How they can be used to pay individuals to provide care for their aging parents is a little complicated. It is important to understand that the dollar amount of pension that a veteran or their spouse receives depends on their current, non-pension related income. The second important factor is when calculating income, the Department of Veterans Affairs allows the beneficiary to deduct all care related expenses from their income. This can include the cost of personal care assistance provided by an individual or home care agency. Therefore, an aging parent can hire their adult child as a private caregiver. The adult child invoices their parent for their caregiving services, the parent deducts those invoices from their income, and the VA increases their pension check by the amount of the invoices. While confusing and seemingly roundabout, this approach is well documented, legal, and encouraged by many VA benefits experts. Learn more about the Aid & Attendance and Housebound Pensions or connect with a VA Pension planning expert to determine if your family is eligible and to discuss if either of these approaches can work for you.
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