This is the first in a series of blog posts which will provide an overview of qualifying for Medicaid nursing home benefits in Michigan.
Long-term care is expensive, whether at home, in assisted living, or in a nursing home. With nursing home care costing about $6,500 a month or more in the Oakland, Macomb and Wayne County areas of Metro Detroit, many people cannot afford to pay for nursing home care for a very long time.
These costs, for the most part, are not covered by Medicare. They are, on the other hand, covered at least partially by long-term care insurance. Unfortunately, few of today's seniors have such insurance. Fortunately, the Medicaid program is there to help. Medicaid is a government benefit program that pays for part of the cost of a senior's long-term care in a skilled nursing facility, but only if various income, asset and other criteria are first met.
Qualifying for Medicaid can be an extremely complicated process because Medicaid is a federal program administered by the State of Michigan. As such there is the federal Medicaid law, federal Medicaid regulations, Michigan Medicaid law, and Michigan Medicaid regulations that must be complied with. Medicaid is so complex that the United States Supreme Court has said the Medicaid Act is "an aggravated assault on the English language, resistant to attempts to understand it."
Medicaid's complexity causes problems for seniors and their families confronting the challenge of how to pay for nursing home care: well-meaning people give wrong advice that if relied upon, can cause a senior to become impoverished when they otherwise would not have had to.
My elder law practice is focused on helping seniors and their families navigate the Medicaid Planning and Medicaid Application process in Metro Detroit, but I also help clients located throughout Michigan. I guide my clients through the complexities of Medicaid and I help my clients take advantage of what the system has to offer and how to avoid the many traps and pitfalls.
First, it can be helpful to distinguish the Medicare program. Medicare is the federal government's principal health care insurance program for people 65 years of age and over. Medicare will pay for doctor and hospital bills and may pay for up to 100 days of skilled rehabilitation services in a nursing home. Medicare may pay for all of the first 20 days of the skilled rehab. care. If you still need rehab. in a nursing home after 20 days, Medicare will pay for part of an additional 80 days, but there is a significant copayment of $141.50 a day. This copayment will frequently be covered by a Medigap insurance policy, provided the patient has one. After 100 days, Medicare pays for no further nursing home care unless a new "spell of illness" begins. A new spell of illness can begin if the patient has not received skilled care, either in a skilled nursing facility (SNF) or in a hospital, for a period of 60 consecutive days.
What is skilled rehab? The classic example is physical therapy for someone who fell and broke their hip. Another example would be someone who had a minor stroke and needs some physical therapy in order to regain their strength so that they can return home. The difference between skilled rehab and custodial care is an important point. Custodial care is assistance with the activities of daily living such as eating, bathing, getting dressed, transferring, help in the bathroom, medication management, and the need to be in a protective and secured environment. People with dementia often need custodial care in a nursing home because they need lots of assistance with the activities of daily living. Medicare does not pay for any custodial care for people with dementia, only skilled rehab.
Medicaid will pay for custodial care in a nursing home, but only after the six tests to qualify for Medicaid are met, which I will describe in the next post.
Andrew Byers is an Elder Law attorney in Auburn Hills, Michigan who assists seniors and their family with Medicaid nursing home benefits.