Jewish World Review Jan. 10, 2005 /29 Teves, 5765
Jan L. Warner & Jan Collins
How can we afford my husband's rehab?
Q: My husband, after suffering a stroke and being treated for five days in the hospital, was discharged to a nursing home for rehabilitation. I was told he required not less than six weeks of rehabilitation, that Medicare would pay for the first 20 days and, if necessary, part of the next 80 days. We have a Medigap policy that would pay the part that Medicare did not pay. But after 11 days, the nursing home told me that my husband was not progressing, that Medicare would not pay any more after the 15th day, and that my husband would either become a private pay patient or be discharged. We are not wealthy people, and I certainly can't afford to pay $175 per day for his room for too long. Is there anything I can do, as I thought he was doing better with the rehabilitation?
A: The nursing home has notified you that, according to its initial determination, Medicare will not cover your husband's care because he is not making progress. If you choose to dispute this assumption, first contact the facility administrator and find out why. Next, if you believe the facility is wrong, you have the right to request that the nursing home submit a "demand bill" to Medicare. While waiting for Medicare's response, the facility cannot force you to pay the amount set forth in the demand bill.
However, you should be aware that if Medicare determines that your husband's condition does not meet Medicare's rehabilitation results-oriented guidelines, you and he will owe what's due.
We strongly suggest that you contact a professional geriatric care manager in your area (www.caremanager.org) to assess your husband's condition and independently determine whether your husband will benefit from more rehabilitation, and what level of care he needs. You should also contact an elder law attorney (which may be located at www.naela.org) to determine if and when your husband might qualify for Medicaid. Be warned: governmental cutbacks expected in this area will test the mettle of many seniors who are not prepared to deal with these important issues.
Q: My husband has been in a nursing facility for rehabilitation for almost three months, all of which has been paid for by Medicare and our Medicare Supplement policy. At the last care-plan meeting, I was told that even though he would not be able to come home, Medicare would stop paying for his care at the end of this month, and I would have to make other arrangements. We own our home and have only $60,000 in savings. His total monthly income from Social Security and his pension is $1,600; my Social Security is only $400 per month. How can I afford to pay for his care privately?
A: You can't. That's why you should consider Medicaid as a pay source. Federal Medicaid laws provide special economic protections for spouses of nursing home residents (called the "community spouse"); each state has established different levels of asset and income protections.
Here's how these protections work:
Asset Protection: By federal law, an institutionalized spouse seeking Medicaid benefits can retain $2,000 of "countable resources" and certain "non-countable" resources. As a community spouse, you can keep the amount of "countable" resources established by your state along with certain "non-countable" resources, such as your home. Assuming your husband qualifies medically, he should qualify for Medicaid once your countable resources have been reduced to the level established in your state.
Income Protection: By federal law, if your spouse becomes eligible for Medicaid, all of his income, less certain deductions, will be paid to the facility. These deductions include a monthly personal needs allowance, a deduction for non-covered medical costs (including medical insurance premiums), and, since he is married, a monthly allowance to you as the "community spouse." Your income will not be used to support him in the nursing home. Your share of your husband's income each month called the "minimum monthly needs allowance" (MMNA) will vary in amount from state to state and will be determined by a formula based on your expenses.
Taking the NextStep: Seniors from throughout the country have contacted us regarding their long-term-care options, many too late to exercise options available to them. At a minimum, check with your state agency that handles qualification to find out these amounts so you can begin the planning process. Exercise your options before you spend all of your money and leave yourself destitute.
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JAN L. WARNER received his A.B. and J.D. degrees from the University of South Carolina and earned a Master of Legal Letters (L.L.M.) in Taxation from the Emory University School of Law in Atlanta, Georgia. He is a frequent lecturer at legal education and public information programs throughout the United States. His articles have been published in national and state legal publications. Jan Collins began co-authoring Flying SoloŽ in 1989. She has more than 27 years of experience as a journalist, writer, and editor. To comment or ask a question, please click here.
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© 2004, Jan Warner