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  • Writer's pictureAlan D. Feller, Esq.

Is Community Medicaid Right For You?

New Yorkers take pride in their ability to find a better way to do something. Wasting time or money is not just an inconvenience. Assets are finite and if they are squandered bad results usually follow. When illness becomes a fact of life, our resourcefulness is tested in a variety of ways. Healthcare is a minefield of insurance obstacles, overburdened providers and poorly understood rules. Guiding an ill loved one through this process requires education first and patience second. Nowhere is this more evident than the Long-Term Health Care System.

Long-term care refers to an individual’s ongoing need for supervision due to an illness, injury or chronic condition. Feeling sick and following a treatment plan with antibiotics is not long-term care. Degenerative diseases such as dementia, Parkinsons, ALS, and MS are illnesses that require long-term care. Falls or injuries leading to loss of mobility also require long-term care. Slow recoveries from heart attacks or Cancer treatments may require long-term care to manage activities of daily living.

Though Nursing Homes provide necessary long-term care for those who are unable to remain at home, receiving care at home is the stated goal for many clients.

Supervision at home, in a long-term care context, means home health aides and caregivers providing physical support, feeding, dressing, bathing and other related assistance. Paying for supervision can involve private pay directly from the consumer, Long-term care insurance payments or Community Medicaid. Medicare has limited short term coverage for home health services.

The two most common approaches for paying for care is private pay and Community Medicaid. Privately paying for home health aides is an expensive proposition – costs can run north of $26.00 per hour. Long-term care, as the name implies, can last for a long time. Illnesses with slow trajectories may take years to reach a critical juncture, but still require regular paid supervision. Spending thousands of dollars each month on care that probably was not budgeted will put a financial strain on any family.

Community Medicaid has eligibility requirements plus an enrollment process with assessments and paperwork. Once approved, Medicaid will pay for home health aides for the approved hours assigned to the ill individual. Medicaid also has a Consumer Directed program in which certain family members or other chosen friends and neighbors who agree to be caregivers can be paid by Medicaid. Consumer Directed has become increasingly important in the Hudson Valley. The need for home health aides has outpaced the supply of available workers in our area. Establishing even an informal caregiver network to provide some coverage could mean the difference between safely remaining in the home or not.

Some families can weather a crisis financially better than others. Privately paying for long term care is sometimes necessary before a proper plan is formulated. Once families realize that Medicaid can subsidize the cost of care at home then additional flexibility can be achieved. Contact the professionals at Sloan and Feller today to go over long term care options.



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