Medicaid for the Elderly Explained in Plain English: When Medicare Won’t Cover Long Term Elder Care

Medicaid for the elderly explained in plain English

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Did you know that if you have an elder parent who needs to get into a nursing home it is very likely that Medicare will not cover it? That means that you may very well need to get them onto Medicaid unless you are essentially independently wealthy, or they set up a long-term care insurance policy, or they have a huge retirement nest egg, as nursing homes cost several thousand dollars a month, as does home health care.

Of course, in order to qualify for Medicaid your elderly parent has to be essentially destitute. The vast majority of our elder parents (and we ourselves) are neither independently wealthy, nor completely destitute and so won’t qualify for Medicaid. This is why trying to get adequate care and placement for our elderly causes us to take out second mortgages, sell off the family home, and go deeply into debt.

After I published my post explaining Medicare in plain English, and how and where to sign up for Medicare, I was contacted by a good friend, whom I trust implicitly, with the following description, shared with their permission, of their experience trying to get an elderly parent into a nursing home when they are on Medicare, and the nightmare that is the Kafkaesque process of trying to get them onto Medicaid (which, again, you’ll need to do because while many nursing homes aren’t covered by Medicare, at least some accept Medicaid).

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According to my friend, make no mistake about it: unless someone has and is prepared to pay many thousands of dollars a month, each and every month, for a nursing home, or for home health care, you will need to get them onto Medicaid before they can get into a nursing home. According to MoneyGeek my friend is exactly right, the average cost per year for a nursing home is about $90,000, 24/7 in-home care a whopping $175,000. And if your elderly parent is having memory problems then caring for them at home without the assistance of home health care can be very daunting and even dangerous, especially as the months pass and they decline.

Here is what my friend said, verbatim, other than to remove identifying information.

Your write up in Medicare was excellent. If you thought that was a mind bender consider Medicaid. This is important because nursing home care is not covered by Medicare. This comes up because with people living longer there are more people with dementia and also significantly debilitating non-neurological disorders. A nursing home can run on the order of $10K – $15K per month. There is talk about in-home care being less expensive. It is not. It can be more expensive for the same level of care. In addition, with the shortage of healthcare workers, in home care may not be available. Care for an elder who has dementia is not just about drugs, taking temperatures, and routine medical functions it’s also about feeding, bathing, and the other biological functions. This requires 24×7 level of help that is beyond most family members’ ability to provide without becoming highly self-destructive of the family member caregiver.

If your elder had a good long term care policy or they have sufficient wealth to cover years in a nursing home then they are very lucky. If they were poor from birth and never had any wealth (in the general sense like “savings”) then getting Medicaid is straight forward. But if your elder is in between those extremes then one has to “qualify” for Medicaid via an application and review process. We enlisted the help of an elder law attorney to assist us in the process which is paper work intensive (imagine trying to track down one’s father’s army discharge papers, or one’s mother’s birth certificate and naturalization papers, and financial details for the last five years, etc.). We have reached the point where all our paper work has been submitted and we are awaiting the outcome of the review process. But that glosses over aspects of Medicaid financial planning.

On top of all this we have a heath care system that is not prepared to deal with large numbers of boomers soon to have many needs. My mother is pre-boomer and 90 years old, and finding her a spot in a nursing home was a harrowing experience. At one point my mother was #10 on a wait list to get into a home. But what that really meant was that 10 people had to die to free up space. I should qualify the above by saying that we needed a home that would accept Medicaid and would not have my sister run home crying and emotionally distraught from the horrors she witnessed.

Keep in mind that “independent living”, “assisted living”, “memory care”, and nursing homes are not the same. My mother started at “independent living”. When her condition accelerated we moved her into memory care and when she started breaking bones and such she was in a hospital until a qualified care facility was available. And my mother’s Medicare Advantage plan tried to deny her coverage. But luckily the hospital’s interests and my mother’s were aligned so the hospital attorneys negotiated with United Healthcare and made what would have been a more that $170k bill be about $2k. {Editor’s note: None of the foregoing were nursing home care, which is why Medicare covered it.}

So getting back to Medicaid I would expect that many people will eventually need it. But the question is are they are prepared with the knowledge to successfully get through the application process?

My main advice to people is to consult with an elder law attorney that specializes in Medicaid planning and the Medicaid application process. If they have older parents, work with an elder law estate attorney on Medicare, Medicaid, estate, power of attorney, and health care directives and such. Advanced planning will make an emotional and broken process survivable.

BTW we are not yet approved for Medicaid. There is a very small but non-zero chance we can be denied coverage.

The fall back is where people try to take care of the elders themselves. For healthy elders this is not an issue. But for elders with dementia it’s almost impossible for non-wealthy people to provide a level of care that does not look like elder abuse. And one consequence is the monthly posts on Nextdoor of the latest elder that got out of the house and is missing. The last few elders in our area that went missing didn’t survive it.

An elder with no support system would be out on the street in many parts of the country. Some of this is state and city specific.

My sister is not in a condition to take my mother in. So I would have to do that. Not sure how I would juggle that and work and life. It would be crushing for the estimated 4-5 years of my mother’s estimated remaining life. BTW that’s a figure that becomes part of the Medicaid process.

Medicaid for the elderly explained in plain English

No ads here, just all me; I try to offer helpful information as I find or figure it out. But it does cost me money out of my pocket to keep the site running (17 years and counting!), so if you find something I've written helpful, please consider letting me know via CashApp, Venmo, or Paypal.

CashApp us Square Cash app link

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Receipts will come from "ISIPP".

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