Joanna Van Hollebeke at Swedish Medical Center Seattle talks about Medicaid and seniors.
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*The following is the output of transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors.
The following podcast. He’s a presentation of answers for elders featuring the Swedish Hospital financial department. Welcome back to the program everyone. I am so glad we again have our friend Joanna Vanhala back here from Swedish Hospital. She is a patient financial advocate and we’re going to talk today about Medicaid and seniors. Joanna, welcome to the program. Thank you, Susan. Thanks for having me. You know, Joanna, there are so many low income seniors out there today, and a lot of them us are confused. Obviously, we’re concerned about our parents running out of money, number one, and making sure that they get the proper care in their aging years, and so I’m glad you’re here to kind of answer some questions from the healthcare side with certainly would in basically stretch over into into assisted living and that type of care as well. So I’m just curious tell us a little bit about how Medicaid intersects with seniors. So Medicaid is a wonderful program for seniors and for basically all low income or under insured people that qualify. You can use it as a primary insurance if you don’t have coverage or if you have primary insurance, such as Medicare in the you know, in the examples will be talking about, it can work as a great supplement for Medicare. So basically, you know, as you know, Medicare doesn’t cover everything when you go to the doctor hospital, unfortunately, and so oftentimes, you know, Medicare recipients or seniors or whoever the case may be are, you know, can be stuck with leftover bills and so on. What Medicaid is wonderful for is it will pick up the tab for whatever Medicare does not cover. And so, you know, if if somebody has a leftover bill for, you know, twenty percent of whatever there, you know bill was, then Medicaid would cover that and they wouldn’t have anything that they would have to pay right and and I you know, that’s really exciting for some people, because a lot of people don’t even know about Medicaid and and how it can be used, especially, you know, our our seniors, and so that’s kind of where I come in. I can, I help with that. That’s amazing. So I know when I was taking care of my mom and I started to see her bank balance go down and down and down, and she was paying the high cost of assisted living and she was outliving her money. Yeah, it was clear, but she also needed help and she needed care, and you’re exactly right. She did have eight she did have a healthcare supplemental policy, but what was interesting is she was also able to qualify from Medicaid and they actually kept her healthcare policy in intact. They actually had us pay that and then give Medicaid the difference out of yourself security, which I thought was kind of interesting. Yeah, so they do work with you, even though you have different options and different types of of you know, ways, and I love the flexibility of Medicaid and how it can help seniors get the care that they need. Absolutely and and to your point on that, there is a wonderful program through DSHS called the Medicare Savings Program and it is a Beta, basically a medicaid supplement that, if you qualify based on your income, it will pay your monthly Medicare premium for you so that it’s not deducted from your monthly social security benefit and so it’s more money in your pocket if you qualify. Wow, that’s awesome. Yeah, so, if I have let’s just say, for example, you know, I’m looking at, you know, my bank balance up. What are the qualifying factors that you look for that might qualify for a senior from Medicaid? Well, it’s basically what it comes down to is just income and resources. So okay, yeah, so you have to meet, you know, certain income criteria and and also resource criteria. And you know you can’t have, unfortunately, you know, thousands of dollars in the bank and then, of course, yeah, and then qualify for Medicaid. Right, but the those are the two main things that they look at. Also, in addition to, you know, whether or not you are related to the program or not, a you know, at SSI, a related medical program, for example, you have to be aged sixty five or older or disabled as deemed by the Social Security Administration. So those are the main qualifying factors and all you have to do is just fill out an application online at the Washington Connections website. That’s actually www.WashingtonConnection.org, or you can go into your local DSHS office and apply in person. Wow, so, as far as understanding that can medicate also pay for like long term care? Yes, in fact there is a long term care program through the home and Community Services Division through DSHS. And basically what that does is it’s a it’s a good solution for seniors and disabled that it tailors to fit individual meet individual needs and situations. So in many cases it enables people to continue living in their homes and, you know, with help to meet their physical and mental, medical and social needs, and then when those needs can’t be met at home, then care and a residential or nursing facility is available as well. So the Long Term Care Program encompasses, you know, that whole umbrella and and you know, you just you would just need to apply for that and then they would make the determination as to whether or not you qualify. And most people do actually qualify, you know, which is very positive. Well, it’s interesting at it. Yes, they do, but there’s also the other side of it is it’s very complicated process, very complicated process, and that’s why I can’t really you know, I can talk about it kind of vaguely, but I can’t really here get into specifics because it’s it’s very tailored to each individual person. I remember a story. You told me a little bit about term and you you’ve used a term with me called spend down. Oh yes, and before we get into that, I want to I want to talk about that, but first I want to tell we are talking to Joanna van Hallaback from Swedish Hospital. She’s a patient financial advocate, and we are talking about Medicaid and long term care funding for for healthcare. And so let’s talk about the spend down term, because I’ve heard it thrown around and I don’t necessarily know what that means. Yeah, it’s incredibly complicated and that’s kind of what I’m here for. But so, basically, spend down is a program for people that are over the income limit for the regular Medicaid programs. And you know, since the income limit is so low, it’s it’s possible that you are more more likely than not to be put on a spend down but time than anything. And so what that is is basically a program for people who it’s like it’s like having an insurance deductible that you would have to pay before your insurance pays. So so your spend down amount is determined by the amount of money that you are over the income limit by every month. And I know that sounds so confusing, but so, for example, I have an example here. Yes, so the income limit for a Medicaid recipient for classic Medicaid to seven hundred thirty five dollars a month. Okay, it’s very, very low. Yeah, very low. So let’s say your monthly social security benefit is one thousand one hundred sixty six dollar, which is actually, I think, about the average. Yeah, it’s it is about the average. Yam. So in this particular instance you’d be over the income limit by about a four hundred and eleven dollars, because DSA just regards twenty dollars of your social security, or social security benefit. So you can either choose a six month or three month base period and this example will just use a six month period. So you take the amount that you’re over the income limit, in this case four hundred and eleven dollars, and you multiply it by six for the six six months. Yeah, for six months, which would give you two thousand, four hundred and sixty six dollars. So in this case this is called your spend down amount. This is the amount that you would have to prove to SSN that you oh or have recently paid in medical expenses before they will start to basically pay for the rest of your expenses and what kind of expenses would that entail? Does that MEAN DOCTOR VISIT TO Z? That me US any other type of even like massage or wellness type expenses? Does that count? You know, I’ll have to get back to you on the massage part. I’m not quite sure of that, but I do know that it does entail, you know, doctors visits, hospital visits. I believe in some cases you can even count your your miles to and from appointments for Gas, uh huh. And so you know, there’s there’s a lot of things home count. Homecare, like non medical home care, if you’ve got a caregiver that come in. Yeah, this, you can use that. Absolutely. So you just basically have to put all your bills together, show them to the DSAHS and say, Hey, I’ve met my spend down amount, and then at that point they would start to pay for the rest of your medical expenses until the end of your base period. That’s awesome. Yeah, and it’s great, but confusing. Yeah, I know. So. So once you do that, then they would bring you that paperwork. is a correct and then what happens from from that point? So it’s submitted to SSN and then SSN looks at it and and they determine okay, this person has met their spend down and then they will start your start the Medicaid basically for the remainder of the certification period. So in the example we used it would be for six months. So sure it would be for the remainder of that period and then you’d have to reapply. Okay, so this is like a short term. So what about US long term? Obviously, let’s say Mom or Dad needs assisted living or skilled care of some sort living forward. There’s a program out there. I believe it’s called copes. Is that correct? Yes, so that is also through DSHS. It’s part of the Home and Community Services Division, also called long term care. That’s all under the same umbrella and, like we discussed earlier, all of that particular program is so individualized it’s really hard to exactly to kind of talk about, you know, the specifics of that. But but they do look at income, they look at you know, obviously they look at your resources, they look at what you know, what kind of medical needs that you have, they look at property that you own. They kind of look at all of that. Well, I’m not only that, but they will go back. I believe it’s between five and six years of your spending. Yes, if you gifted any money to a friend, our relative, that money will have to be paid back. Yeah, so there’s a lot of different varying factors. For me, I’m a huge advocate in this is just Suzanne, you know, input here. Anybody that’s taking care of a senior parent. You have to have a separate check in account and run every single bit of your finances through that separate, separate account. Hike for that main reason, because, I will tell you, one of the biggest sticking points is going to be if you have to qualify your parent for Medicaid, any check that your parent has written to you, let’s say to repay you for groceries or for clothes you bought or anything like that, that is a red flag. They are going to ask you, as their caregiver, what was this money for, and either you’re going to have to produce a receipt or something separate. If you get a separate account, what that really does is it really puts things together. So that’s and and I completely agree with you, it does seem very invasive and in a lot of ways, but you know, it’s a wonderful program if you qualify, which most people do. So I’m a huge advocate for that, and you can apply for that using the same website. So give us your contact info. Oh, so I can be contacted at my direct number, which is zero six, seven eight, one six, one hundred and eighty eight. Perfect, Joanna. Thank you so much, and Swedish hospital for being on the program thank you so much, Susanne. This podcast is a presentation of answers for elders. To learn more about answers for elders, go to AnswersforElders.com.
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Originally published April 11, 2017