Medicaid, part 1 with Jim Koewler

*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 is by Mr Jim Koewler, elder law and special needs attorney, helping and protecting those who need long term care. And welcome everyone to the answers for elders podcast network. And we are here with elder law and Long Term Care Planning Attorney, Mr Jim Koewler from the Koewler Law Firm. And Jim, welcome to the show as we’re going to talk today about Medicaid and specifically in the long term care process, as your aging obviously, Jim, welcome to the back to the show. Thank you, Jim. I you know, there’s a national statistic out there that blows my mind and probably a couple of years old, so it might even be worse now, but it’s stated, I think, something close to about forty five percent of seniors that are in undergoing in some sort of long term care capacity, whether it’s, you know control clinical care or, you know, any sort of supervised care. They’re under what’s called Medicaid. They’ve run out of their own financial aspects and they’re being supplemented in some way by long term you know long term care. Medicaid Coverage, which is stade, is the single biggest payer toward long term care in it God, is not amazing. It’s amazing and certainly something that, you know, we all have to look at, as the baby boomers now are a third of the population of the United States right now and you know we’re it’s going to get more so that way, especially because of, you know, the financial situations of where our country has been. I mean, I look at this personally and I think to myself, how in the world is this country going to pay for so many baby boomers in the future? But it’s going to. That’s going to be a reality and so obviously we have to look at a lot of ours, as we’re living longer, we’re going to outlive our money, we’re going to outlive our assets and the cost of healthcare is overwhelming. So share with us a little bit about how Medicaid comes into play. I would love to have this conversation with you. Okay, Medicaid for long term care is first of all, is make sure we understand it’s different than Medicaid under Obama. Are Right, different than Medicaid for people who have disabilities and the age blind disabled program right, and even the long term care is usually for the aged. They find disabled is still a separate animal those are income driven. There’s some asset driven, but those are SSI dependence of them. That’s pretty right. Okay, Medicaid for long term care. You may have had medicaid for the Obama care. You may have had a blind is able Medicaid before, but once you need long term care, now we’re talking about a separate category, still under the Medicaid umbrella. Right, because the others about healthcare, not long term care. Here’s the difference. You need to get your tonsils taken out, that’s healthcare. You have a heart attack, your treatment is healthcare. You have a stroke, your immediate treatment. It is healthcare. Even when you get to the point that you can’t bathe yourself, dress yourself, groom yourself, toilet. Well, anyone can toilet clean up after toileting by yourself, that’s long term care. Right. Do you have a heart attack and you don’t, you have to meet like two of the seven to twelve or one plus medication management or okay, even how many people are suffering from dementia. You need a safe environment. I mean you could be perfectly able to bathe yourself, address yourself. Bathing Jus the big one, by the way, and do all that, take your medicines on time, but you’re in danger of starting your breakfast and still having the stove on high at three in the afternoon because of dementia. So if you need a safe environment because of a cognitive decline, that by itself is a test for long term Care Medicaid eligibility. Okay, the first have the hate to call it medical need because this is not medical coverage, but you have to have the health need. Okay, help bathing or dressing the will. We call those activity activities of daily living, everything working people do before they walked out the door. Or help with medication management. You can’t remember to take your pills in the proper order and that’s getting more and more complicated. Or medication management plus one activity to living. Okay, those are the eligible criteria to get in. Or you need that safe environment. Okay, that’s now. This is does for Medicaid. Does a Medicaid law differ per state, or is it pretty much uniform? Yeah, yes, and yes, okay, okay, Medica, Medicare. Let’s contrast Medicare here at first. Okay, Medicare, the big Medicare program is uniform across the country because it’s all federal now. The different insurances to go with Medicare require a state license. So those have some slight state differences, but that’s just on the licensing for the supplement or the advantage of plan or the drug plan. Okay, Medicaid is a mix of federal money and state money. Most states, I think there are three or four and I’m not even sure who they are, but their three or four states who do not participate at all. They just leave it to the fats. But all the other states participate. So they put in some of the money if they participate ate and expanded Obama care they put in about a third of the money for Obama are okay on everything else, age, blind, disabled or they don’t do expanded Medicaid under Obama Care, and you know who you are. States that didn’t participate. Yeah, Long Term Care, the state’s put in about half. So because state money is involved, the states get to have some of the rules particular to their states. Most of the states just set out do what the Fed say. It’s just the easiest thing to do. When it Medicaid was initially created, the s of sixteen, Seventeen, eighteen states said we’re going to have slightly different criteria and Ohio, where I live in practice, is one of those states. Those are called two hundred and nine B states because section two hundred and nine and B of the Medicaid Law allow them to do that. Most of the two and nine be states got out of having their own criteria again because of the medic the the better split on Obama care that was available to them. So most states are now thirty four saying will just fallow the federal rules. California is out on its own by itself, and that’s a not surprisingly, they can afford it. They’ve got the like the fifth largest economy in the world, just California. Okay, so they’re still a two of nine be state as I understand it, and there maybe one or two more, but but they still have to stay within certain guidelines. Are Differences, and almost all of the differences, as I understand it, and I’m not an expert on Watchington Medicaid or Massachusetts Medicaid, just Ohio. And I can’t even call myself an expert because I haven’t taken the test to de to estate planning and, as you and I discussed privately, I don’t do a state planning. But I do have a lot of experience in Ohio Medicaid okay, and I think most people trust my opinions, those crazy fools. But as I understand it, most states have their differences on eligibility. Who can get in, how poor do you have to be and what counts as a resource against your eligibility? Okay, those are the differences. Once you’re inside the Medicaid program there aren’t drastic differences. There are some. For example, again, Ohio, being a little more read we’ll call it, has something where they try to control costs on both Medicare and medicate at the same time, and we are the Guinea pig for the entire country of red states looking to do this. But I don’t think there’s a whole lot of differences once you’re in the program. But yes, you can have differences. So what I’m talking about today is, from my knowledge in Ohio, okay, and we’re, if I have no clue how different Texas or California or Massachusetts or to a more you can use these as guidelines because they’re not very far off. Well, and I think it’s interesting too because like here in the in Washington, we call it copes. It’s different. We have a different platform and we have tears of Medicaid, which so it’s interesting that quality Couli flayers and here Medicaid. What’s at your’s of Long Term Care? Medicaid? Oh Wow, oh, okay. Yeah, so you can get, for example, if you still live in your house and you still you know, you own your house or whatever, but it’s you’re not you don’t have cash to get out of it, it will actually pay for you for a certain degree until you know you your house is. So yeah, we we have that in a line. So, but there’s different levels. So at one time here in Washington state, just before some budgetary person just went like this to one classification and that was out all seniors that are on Medicare in our Medicaid in senior living communities, assisted living, and I was just going like what, you can’t do that. So anyway, we we had to fight for that and luckily, you know, got that overturned because that was just a stupid budgetary, ridiculous thing. So those things happen. Obviously, is that you know that they have the flexibility to go back and forth. Yes, and assisted livings are probably the last thing to have joined the Medicaid system in part because of the last thing that appeared in senior living care. Sure, okay, and assisted livings want to be able to say they take Medicaid, HMM, but they may not want to actually give Medicaid very often. But for people who haven’t yet moved in and a worried about outliving their money, the admissions director assistant at living likes to say, Oh, if you’re out of your money, you will consider you for Medicaid, even if they don’t really intend to know. And they can also say, Oh, well, we did, but guess what, we’re only going to do it for a three months longer. So that’s what I wanted my mother. So here, Ohio, they can say, yeah, we considered for Medicaid and we’ll take Medicaid, but not from you. Yeah, exactly, exactly. Yeah, it’s you know, that’s the thing that I think is so important with this, this process. So I’m certainly in there. So in this first segment, obviously you we’re going to talk a little bit about, you know, how to qualify and all this stuff, probably in our next segment, but I want to just overview that. Medicaid is a long term care supplement, but it’s also not necessarily supplement because it could potentially take over or some of your social security benefits would then go away. Is that correct? Yes and no. Get them alert dragon free. Okay. If, as far as I know, every state is what we call an income first state, your income has to go first, before Medicaid or act money. Okay, so you’re so security or your pension or whatever doesn’t go away, but that’s the first thing you have to pay. Yeah, well, you are. You are allowed to keep some income for personal spending that you know, if you’re in a nursing home you don’t need much because your rumined boards covered. Okay, but you may want a candy bar, haircuts, a phone magazine or some outings. Okay. And then, I think in every state you get to keep your health insurance. See, Medicaid doesn’t want to pay all your health insurance costs. So if you can give a care supplement or an advantage plan, they want you to keep it so that Medicaid doesn’t have to pay the twenty percent that Medicare doesn’t cover. Right. Yes, the money all comes from the same pair of pants, but every guardian of an individual pocket is guarding that pocket. Okay, and we and and I know that, like, for example, my mom, she only got nine hundred dollars a month. So security, but when she ran out of money and she was on Medicaid, she actually had to pay her premium for her regions Blue Shield, which is was her supplement. Yeah, that was paid for. And then the remainder of your soul security, with the exception of like sixty dollars a month. Yes, you know, Ohio it’s fifty. Yeah. Now, if your home is like fifteen hundred bucks, you’re just start going to pay the yeah, ass and utilities and buy your own food, etc. But but if you’re nursing home, a sistant living in Ohio, fifty bucks, spending money. Wow, we may have a slightly lower cost of living than Washington does. I’m not sure. Okay, probably one thing I’m to clarify before we go, and I know we’re running out of time. Suzanne’s a reference to a supplement is different than a medicare supplement. Okay, thank you. She was just using supplement small s, yes, not capital as so correct. Keep that in mind, don’t yes, and so we’re going to continue the conversation about Medicaid and number one, we’re going to talk a little bit about how to qualify and there is a process. And so, Jim, we’ll be right back right after this. State of Ohio residence. You have a friend to help you navigate long term care while protecting your assets. You can reach Jim at www dot protecting seniorscom or just email him at j Koewler afe. That’s j Taylor AFE at protecting Seniorscom.