 LTC Bullet: Go Fund What? Friday, April 1, 2022 Seattle— LTC Comment: Would you contribute to a GoFundMe account intended to buy someone better long-term care than what is readily available from Medicaid? Asked and answered after the ***news.*** *** THE BIDEN ADMINISTRATION, in a surprise announcement, today abandoned its no tax under $400,000 income pledge. Talking off script, the President said “We have no choice but to charge everyone, regardless of income level, this new 8% and rising tax (aka inflation) to pay for recent extremely generous federal benefits and subsidies.” (See details below.) *** *** CENTER’S 24TH ANNIVERSARY. Stephen Moses and David Rosenfeld co-founded the Center for Long-Term Care Reform (formerly Financing) on April 1, 1998. Happy birthday, Center. You might ask “what have you done for us lately?” Check out “LTC Bullet: LTC Center Standing Guard” for the history of our efforts to fight for better LTC financing policy and against bad reform proposals. Read 1,330 LTC Bullets here. Join the Center team with an individual or corporate membership here. Check out all the membership options here. Contact Damon at 206-283-7036 or damon@centerltc.com for details. *** *** FEDPOINT (formerly LTC Partners) is celebrating its 20th anniversary. The company’s Federal Long-Term Care Insurance Program has over 260,000 enrollees and has paid more than $2 billion in LTCI claims to date. FedPoint has grown, become more sophisticated, and has diversified its business portfolio by taking a significant role in the electronic enrollment and premium administration business for the federal government. Congratulations to CEO Paul Forte and the whole, amazing FedPoint team! *** *** APRIL FOOLS re the Biden
announcement above: *** LTC BULLET: GO FUND WHAT? LTC Comment: We’re indebted to syndicated financial columnist Terry Savage for tipping us to this story. She wrote: “Steve — read ALL the answers to the item about using a GoFundMe to finance nursing home care. You will see the reality of what you have been saying all along — no incentive for insurance!” Boy, was she right! Read on to see what we mean. Q: Has anyone used GoFundMe to help pay assisted living costs? Click that link and you’ll find this question followed by 39 replies: “I am trying to find additional money to help pay for my brother's assisted living bills. He has vascular dementia and Alzheimer's Disease. He also has Major Depressive Disorder. He is medically eligible for Medicaid, but I would have to move him to the skilled nursing portion of his care facility to apply for Medicaid. He would have to move out of his comfortable room into the hospital ward-like beds of skilled care. His clinical depression is eased somewhat by the pleasant surroundings of his assisted living room. If he moves to the clinic-like skilled nursing section, I'm concerned that his depression would increase and his decline from his dementia would only get worse. I am his financial POA, and I need an additional $1,600 a month added to his social security and pension to keep him in his assisted living room. I have been dipping into his savings to pay the current bills, but his money will soon run out. I am 70 years old and retired with health problems of my own and have no assets I can use to pay my brother's bills. I am considering using GoFundMe to do fundraising for my brother. Has anyone gone this route? Any suggestions or opinions? Thanks very much.” LTC Comment: I’ve culled some telling excerpts from the replies, organized them by topic, and offered a little LTC commentary. Medicaid and Quality “If he's eligible for Medicaid and you are his POA [Power of Attorney], start looking at different care facilities for him so he won't have to go to the ‘nursing home’ part of the facility he's in now. If he has Alzheimer's and vascular dementia he should be in a memory care facility. Most of them accept Medicaid.” LTC Comment: Most memory care facilities accept Medicaid? Hardly. Compare these answers. “I thought memory care is considered assisted living and not covered by Medicaid? Is your [brother] getting memory care within a skilled nursing facility?” “I am wondering if you have contacted your county dept. on aging. In many states, there are some memory care facilities that accept Medicaid. However, there aren’t many.” “You mean the plight of many families that are forced to care for an elderly position? The story is not unique or compelling, and funding options exist it is called Medicaid. They are essentially saying their [loved one] is too good for Medicaid and is entitled to ‘better’ quality facility.” “As a number of people have suggested, your best alternative, unfortunately, is to enroll him in Medicaid for long term nursing care. Keep in mind, when you do, Medicaid only pays for multiple bed rooms. If the facility is older and has an exemption, that usually means 3 beds to a room. A newer facility has to meet a higher standard of 100 square feet per person plus 6sf for storage. … There are assisted living places that do accept Medicaid, but they are far and few between. Also, I doubt you could get people to contribute on an on-going basis even if it were legal. Medicaid pays about $200/day so you'll find the level of service very inadequate. Be prepared to fight every day to have his needs taken care of. I know - I've been an advocate for my brother in a nursing home paid by Medicaid in California for over 3 years. It's brutal. There are no good alternatives. Good luck.” “Look into care homes, they will sometimes be covered by Medicaid.” LTC Comment: This is Medicaid truth right from the mouths of consumers actually experiencing it. Forget about obtaining quality in special memory care units. Plan on getting whatever Medicaid pays for at rates literally less than the cost of providing the care. Can’t find an assisted living facility that will accept Medicaid or a decent skilled nursing facility, then look for a “board and care home.” That is a house with a few beds presided over by a caregiver getting a pittance from public welfare to help some nearly helpless, often bedbound patients. You get what Medicaid pays for and don’t expect much. Medicaid and Income Eligibility “Just FYI, you cannot do both, GoFundMe and Medicaid. I think you may know that.” “Once he's on Medicaid, he could not receive any money from a go fund me source if it went toward his housing, food, or medical expenses; this is illegal. People can only pay expenses that are not in these categories.” “The GoFundMe donations would eliminate your brother to be eligible for Medicaid. Those donations are considered income by Medicaid eligibility. In other words you cannot use GoFundMe and Medicaid together. Medicaid does limit the choices for your brother, but as long as he is well cared for, you have to accept the skilled nursing facility.” “The money for the GoFundMe will be designated (by your own words when you post it) for your brother's care --- this would be income for your brother. It could raise issues for Medicaid (maybe, maybe not) and a question to ask an attorney before you step into that mess.” LTC Comment: Think you can improve what Medicaid provides by paying extra? Forget about it. “Family supplementation” is not allowed because it would let the rich buy better care than the poor receive. That’s equity by the lowest common denominator, a characteristic of socialism. Selfishness “If he’s eligible for Medicaid WHY would you do a go fund me? Don’t you think it’s insulting to expect others to pay for his care so he can be more ‘comfortable’? Really ??? His care will be paid for by Medicaid. I just don’t get it . There are people with NO help out there. Sounds selfish but just my opinion.” “If he's on Medicaid which is publicly funded by taxes, why give to a Go Fund Me so he can have a nicer room? Seems selfish to me too.” “In this day and age when times are quite tight for most individuals, it seems inconsiderate at best to ask strangers to pay for your brother's health care needs since you've already stated that Medicaid is a viable option.” “A nice try, but why would you expect other people to pay for your brother's care when other people need their money for their own and their own family's care?” “Unfortunately, not using Medicaid because you don't want to move your brother to skilled nursing isn't going to fly. Taxpayers will already pay for his care with Medicaid, yet you're asking for even more. It won't work.” Medicaid Planning “I have been paying for my mom’s incidentals for the last ten years. Toilet paper, shampoo, soap, socks, underwear, haircuts, etc... I did that hoping to preserve mom's savings for as long as possible so that she could afford the AL [assisted living]. She will run out of savings later this year. We will need to apply for Medicaid and create a Millers trust with an elder lawyer. She will need to move to a facility that accepts Medicaid. The Millers trust is a way to funnel the money mom does have coming in to the nursing home [so] Medicaid will hopefully pay the difference. I don't want to move mom from the private pay memory care, but we do not have a choice. I also dread managing the trust and the flaming hoops that I am sure Medicaid will make us jump through.” LTC Comment: The Miller income diversion trust is a legal device to shelter income above Medicaid’s allegedly “low” income threshold so that people with substantially higher incomes can qualify for LTC benefits. Miller trusts are used in “income cap” states to achieve the same purpose of allowing higher income people to qualify as in “medically needy” states. Medically needy states simply deduct all private health and LTC expenses from income before assessing eligibility. The rule of thumb in all states is that anyone with income below the cost of a nursing home is eligible. Hardly low income. “Any chance your brother was a veteran during a war?? If so, look into Aid and Attendance thru the VA. It would provide enough funds to keep him at his current facility.” LTC Comment: If one welfare program won’t pay, try another. VA benefits now have an asset transfer penalty similar to Medicaid’s. “My brother just passed in a skilled nursing center. He was covered by Medicaid which left a small allowance $30, from his social security check that went to [the] facility. With multiple childhood disabilities, polio, etc., it took months to be approved after I cashed his life policy, prepaid his funeral, and spent down the funds in bank. If your brother has more than $2,000 total in assets, bank, real estate, whole life insurance, etc., he will not qualify for Medicaid. They can look at records years back. From what you describe, he will not be going home. With Alzheimer’s, depression and dementia, its questionable he can appreciate (or cares about) the difference in surroundings. His assets should be liquidated and utilized for the level of care you think he should have. Then apply for Medicaid when his asset level meets the requirement. My brother had no mental impairment, and I did the best I could with what we had to make him as comfortable as possible, as his multi conditions made bringing him home impossible. My other siblings did not offer assistance. Starting a ‘Go Fund me’ for someone with available fund sources, is improper.” LTC Comment: This is the “Medicaid trap” people get caught in who have low income and resources and lack the advice of a financial planner or lawyer. Middle class and affluent people routinely avoid the inconvenience of “spending down” to qualify for Medicaid LTC benefits. “If he qualifies for Medicaid you need to move him into a nursing home. My elder attorney advised me to be sure I can self-pay several months at a nursing home. That way you can choose the NH. Otherwise if he has no money left but his Social Security ... good luck in even getting him into one. I took his advice and when my mom only had about $27,000 I placed her in a NH I was referred to by her Hospice nurse. That paid for 3 months. She then was able to stay there while she was Medicaid pending. I applied for Medicaid when she only had $5,000 left. It took Medicaid 5.5 months to approve. She was just approved this past week. They will go back to 11/11/21 and back pay the facility. I know this isn't the ideal decision for you. But sometimes you just have to do what is financially in yours and his best interest.” “If he is running out of money your only choice is placing him in LTC. If he has enough for one or months in a nice LTC, get him placed. Then apply for Medicaid. If the facility helps you with the process, keep on top of it. In my State you only have 90 days to spend down and get info needed to the caseworker. With my Mom I started the application process in April. She paid 2 months privately for May and June. I confirmed in June with the caseworker, that Mom was spent down and he had all info needed. Medicaid started July 1st.” “Contact a care placement specialist. They can get you on the right track. Personally, if he has dementia, he needs to be in memory care. My mom is in memory care, She has her own private room and Medicaid covers it 100% … Find a memory care facility first so Medicaid doesn't try placing him first. You've got a better chance of getting what you want. “It is best to move him in the SNF while he still has funds. If a Medicaid bed is not available when he needs it at the last minute, there is a possibility that he will have to move to another facility not of your choice.” “I would consult with a Medicaid Planner for his state. FYI in addition to having to financially qualify he also has to medically qualify for LTC, and in my experience ‘just’ having dementia doesn't require LTC but rather MC [managed care?]. You don't get to make that LTC decision unless the facility is willing to give that assessment just to keep him there. Every state has different rules about Medicaid and that's why you need to talk to a professional who knows your state's rules inside and out. Then depending on what you find out, it may be helpful to consult an elder law attorney.” LTC Comment: What these commenters are saying is what Medicaid planners call “key money.” Save out some hard cash so clients can pay privately for a few months. That will get them into the very best facilities which cannot expel them just because their payment source changes from private pay to Medicaid at a fraction of the private rate. This is how middle class and affluent people co-opt Medicaid for their own benefit at the expense of the poor people Medicaid was intended to serve. Medicaid as Last Resort “Sorry it has come to this, but I think applying for Medicaid will keep him with a roof over his head.” “If you do decide to use GoFundMe to
find money for your brother, let us know how it goes. LTC Comment: For too many, Medicaid has become just another form of mendicancy. Its easy availability after care is needed and long after it could have been planned, saved or insured for, makes it a trap too many people fall into. Do you still wonder why so many people fail to save, invest or insure with long-term care risk and cost in mind? |