Ask Mike - Mother's money will run out in two years

Dear Wondering what to do in Wichita,

You write that your 92 year old mother lives in a nursing facility and that she will spend down all of her own money in two years; at which time she will become Medicaid eligible. The problem is that the facility she is in will not accept Medicaid. You want to know if they have to continue to take her and what you should be doing to help.

The situation you describe is, unfortunately, all too common. People rapidly lose their property and life savings. They spend their way into poverty; something they never think will happen. Once all the money is gone, Medicaid becomes the payer of last resort. This is why Medicaid is the largest payer of long term services, both institutional or facility-based and home and community-based, in the country. So, even though Medicaid is the largest payer of nursing facility services, many of the best nursing facilities do not accept Medicaid because the reimbursement rate is too low. This also happens with assisted living, by the way.

Nursing facilities and assisted living facilities do not have to accept Medicaid; nor do doctors, therapists, pharmacists, etc. The number of providers who are refusing to accept Medicaid reimbursement is a growing problem. The providers claim the reimbursement rate is too low; that they cannot afford to lose that much money. This phenomenon is getting to the point that in some areas, consumers simply cannot find certain services. In your case, your mother very well may have to move to a different facility. Depending on what you decide to do (see below), you probably should start looking for a replacement facility now! Do not wait the two years until all of the money is gone. You do not want to end up in a rush having to hurriedly make a move because the current facility has given a thirty day notice or some such thing. Make sure and keep track of the expenditures and the remaining balance in your mother's account. Sometimes, the facilities deduct extra expenses for services they do not cover with the base payment. Examples can include certain pharmaceuticals, mobility aides or medical expenses.

Have you ever considered home and community-based services ands supports? Kansas has a pretty good Home and Community-based Services (HCBS) program called a "Frail Elderly" (FE) Waiver administered by the Kansas Department on Aging. The FE Waiver provides an individualized array of services designed to protect and promote the health and safety of people age 65 and older who would otherwise qualify for nursing facility levels of care. This program allows people to stay at home and receive the care they need instead of entering a nursing facility. Additionally, Kansas has a program called "Money Follows the Person" that provides assistance for people who move from a nursing facility back into their own homes and communities.

You could also consider using home and community-based services and/or home health services and/or assisted living services right now instead of the nursing facility. Many times, these services can meet the needs of individuals with the same, or even better, outcomes as nursing facilities, but at a fraction of the cost of a nursing facility. Without knowing more about your mother and her situation, however, it is not possible to say what the most appropriate setting for her is. The good news, however, is that all of these services, from the HCBS Waiver, to Money Follows the Person, to assisted living, to nursing facilities, are administered by the Kansas Department on Aging (KDOA) right across the street from my office. Just go to http://www.agingkansas.org to find all sorts of information including their address and toll free number in the bottom left corner of the homepage.

If all of this sounds complicated, start with the KDOA website. Good luck to you and your mother!

Mike Oxford