If You Want Medicaid to Cover Long-Term Care, Get Ready to Hire a Lawyer

On this episode of The Long View, Director of Content Strategy for Daughterhood.org and host of the Daughterhood the Podcast, Rosanne Corcoran, discusses the financial, physical, and emotional impact of caregiving for an elderly loved one, and the state of long-term care for retirees.

Here are a few highlights from Corcoran’s conversation with Morningstar’s Christine Benz and Amy Arnott.

Does Medicare Cover Long-Term Care?

Christine Benz: There’s also widespread confusion about what Medicare covers in the context of people who need long-term care. And the short answer is that it doesn’t really cover long-term care. I feel like there’s so much confusion about this.

Rosanne Corcoran: Because Medicare will cover a rehab stay that happens in a skilled nursing facility after a hospital stay, after a three-day hospital stay, and they will cover it for up to 100 days. But of course, after 20 days, patients are partially responsible. Again, there are a lot of things that go with it, but they do not cover long-term care. They cover some durable medical equipment, but not the actual care. That’s where Medicaid comes in. And unfortunately, people interchange them, and they’re not interchangeable. So yes, to your question. No, they do not pay.

If You Want Medicaid to Cover Long-Term Care, Get Ready to Hire a Lawyer

Amy Arnott: Can you talk a little bit about some of the limitations of Medicaid for long-term care, and what are some of the things people need to know there?

Corcoran: Every state has its own requirements. You have to meet specific income, asset, and functional needs, and each state sets up its own system. There’s a five-year lookback also that goes into this. We’ve all heard about the people who gave away their money so that they could qualify for Medicaid. I don’t know if that’s accurate, but there is a five-year lookback now. It’s very difficult. And even that changes—some states have a longer lookback. It’s very hard to try to skirt that. But Medicaid coverage options are also managed by each state. There are different programs that they have. There’s a PACE program for dual-eligible people, meaning they have Medicare and Medicaid combined. But again, there are certain requirements that you need to meet for that. When it comes to Medicaid planning, the best thing to do is to contact an elder-law attorney who specializes in Medicaid because there are just too many issues, and there are too many things to try to keep up with, and things change quickly. There’s also, you don’t know how many people are waiting to be on that eligibility list. There could be hundreds of thousands of people in front of you.

Why It’s So Hard to Find Caregivers

Benz: In addition to the financial challenges of long-term care, my understanding is that there’s a shortage of caregivers available, especially to provide in-home care.

Corcoran: Yes.

Benz: And even if someone has the financial wherewithal to pay those caregivers out of pocket, they may have trouble finding them. Can you discuss that dimension? Why that’s happening? Why do we have that shortage?

Corcoran: There’s just such a high demand for long-term care. The demand is there. It’s hard work. It’s expensive. And a lot of these caregivers could make more money at McDonald’s than they do being paid caregivers. I mean, that’s the reality. It’s very hard to find them. And that’s where we’re at. Covid exacerbated all of it, but we are well past that time now. It’s very hard. And then it’s hard with caregivers to, when you finally admit that you do need help, to then say, OK, I’m going to have somebody come in. And then you call the agency, and it could be $40 an hour with a four-hour minimum. So that’s if you brought somebody in five days a week, it’s $800 a week. And to look at that and think, wait, I can’t pay that money, even though it’s helpful to the caregiver on so many levels, they can’t. It’s almost untenable. There’s so much that goes into that. And then the fact that there’s nobody to come in to help you, it adds to that isolation and the overwhelm that the caregivers feel.

Where to Find Caregivers for Long-Term Care

Arnott: If you are looking for a caregiver, can you talk about some of the agencies and geriatric care managers that you might be able to get in touch with to help you find someone to fill that role?

Corcoran: The Aging Life Care Managers, their website is a great resource. It’s aginglifecare.org. It’s filled with resources, and they have a locator so that you can find an aging lifecare manager in your area. They’re great because they come in and they can give you an overview of what your parents need. They can also be the bad guy for you instead of you saying, “You know, mom, you really need bars to go up the steps.” They can come in, so you don’t have to play that role. I know there are people who use the online platforms to try to find somebody— care.com. But you always have to check and double-check when you’re not using an agency. I always tell people if you live near a teaching hospital or a nursing college, to check with them and see if there’s any nurses that are looking for hours for their coursework, or if they’re looking for some companion care work, because sometimes, they are.

And you always ask your friends and relatives because it doesn’t take you too many questions to get to somebody who’s a caregiver or knows somebody who’s a caregiver. And if they had used somebody or they used an agency that they liked, it’s really hard with the agencies because of the shortage, these workers are really—people want them so they can move from agency to agency. It’s hard if you had somebody that you really liked and now, they left that agency and went somewhere else. And it’s hard also with trusting that they’re trained in what you need them to be trained in. It’s really been a challenge, and it’s, again, it’s wearing on the family caregiver because they don’t have that break, because they can’t get the break even if they wanted it, they can’t get it.

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