LOUISIANA LONG-TERM CARE MEDICAID DISASTERS

(The following information pertains only to long-term care Medicaid in Louisiana according to 2006 guidelines.)
 

1. “We have a large nest egg and can easily afford long-term care costs.  We do not need Medicaid.”
   The average cost of room and board for Louisiana nursing homes is $3000 per month, the least expensive rate in the entire U.S. (Some private facilities that do not accept Medicaid payments charge much more than this, over $5000 per month in some cases.)  In-home sitter services range from $10-$13 per hour plus mileage to and from the home.  (True home health care involving medical services in the home is a great deal more expensive.) 
   
   Example:  Mrs. H. saw the $1 million that she and her husband had worked a lifetime to accumulate disappear before her very eyes as her husband received24-hour in-home care for 2 years before he entered a nursing home where he lived for 8 years. 
   
   Sitter costs
   $11.50/hr x 24hr/day x 365 days/yr x 2yrs.= $201,480 for 2 yrs.
   
   Nursing home costs         
   $3000/hr x 12mo/yr x 8 yrs= $280,000 for 8 years
   
   In addition to these costs, there were many other costs for prescriptions, physical therapy costs, Medicare supplement insurance for both Mr. and Mrs. H, some private nursing expenses, and other medical expenses not covered by Medicare or insurance.  Mrs. H had to pay for her living expenses at home, including home maintenance and homeowners’ insurance, as well as car maintenance and car insurance that could not be paid out of the meager $1600 in combined monthly income she and Mr. H received.   Mrs. H was devastated by the loss of her husband and the comfortable retirement that they had worked so hard to provide. She was also concerned about her own declining health and her ability to cover her own medical needs.   Medicaid Planning strategies would have protected the majority of the retirement savings and developed strategies to cover the long-term care needs of both Mr. and Mrs. H. 
   
   
   
2. “I will just listen to the nursing home staff.  They will guide me through the application process.”
   Some nursing home staffs at Louisiana facilities are knowledgeable of the Medicaid application process and provide reliable guidance to their patients.  However, this is not true across the board in all Louisiana facilities and following advice from unreliable sources can have detrimental consequences.
   
   Example: When Mrs. J put her husband into the nursing home, the staff there assured her that he would qualify for Medicaid.  They said that the prenuptial agreement that she had signed would protect her assets from being counted for his Medicaid eligibility.  When she applied for Medicaid for her spouse as instructed by the nursing home staff, the application was not only rejected but Mr. J was penalized with a 96-month period of ineligibility because of his spouse’s resources that were not protected by the terms of the prenuptial agreement.  (Louisiana long-term care Medicaid does not recognize any prenuptial agreements.)  Applying for Medicaid when the nursing home staff advised costs the J family over $288,000 in nursing home fees.  They could have saved a large portion of this amount by applying for Medicaid after Medicaid planning strategies were implemented.
    
   
   
3. “My widowed father is already in a nursing home.  It is too late to do anything but spend down all his money on nursing home care until he reaches the $2,000 individual asset/resource maximum.”
   The earlier that Medicaid planning begins, the greater the number of options for saving assets/resources.  However, it is never too late to save.
   
   Example: Mr. S went into the nursing home with over $100,000 in assets.   He paid the nursing home for his care for over a year before his family decided to consult Medicaid planning professionals. By following the designated strategies, the family was successful in qualifying Mr. S for Medicaid within a few months and over $54,000 in private payments was saved.  If the Medicaid planning was done before he went into the nursing home, he possibly could have been Medicaid eligible from the start of his nursing home stay. Medicaid Planning could have resulted in significant savings for this family.
    
   
   
4. “I am making private payments to a nursing home facility for my wife’s care.  I am not sure when she will qualify for Medicaid but I do not think that it matters much when I apply.”
   Unfortunately, Medicaid does not return money for private payments made for the months when the individual receiving care actually qualified for Medicaid.
   
   Example:  Mrs. T had been in the nursing home for 18 months and Mr. T had made private payments for her care for this entire period before he applied for Medicaid for her.  During the Medicaid application process, he learned that she was eligible for Medicaid coverage 6 months prior to the month of application.  However, Mr. T could not recoup the $18,000 he had made unnecessarily in private payments. Guidance in applying for Medicaid at the right time could have saved this family over $18,000.
   
    
   
5. “My mother-in-law went into a nursing home 5 years ago and qualified for Medicaid.  I can do the same thing for my mother when she goes into the nursing home next month.”
   Long-term care Medicaid policy is constantly changing and there are major changes expected within the near future in Louisiana that will dramatically impact the ability to qualify.  It will be necessary to stay abreast of the changes in policy and be aware of the policy in place at the time of application.
   
   Example:  When Mrs. J went into the nursing home 5 years ago, she was immediately eligible for Medicaid because she had donated all her assets to her children 3 ½ years before admittance to the nursing home and application for Medicaid.  This action conformed to the 36- month look back period and penalty period that began at the time of donation that was in effect at the time of application.  The Deficit Reduction Act signed by President Bush on February 8, 2006 increases the look back period to 60 months and delays the penalty period start until application for Medicaid is made. Louisiana is expected to adopt this policy.  When the policy is adopted, a donation 3 ½ years ago will result in a penalty period beginning at the time of application and ineligibility for a significant period of time could result.  Guidance from Senior Financial Protection in the current Medicaid policy could have prevented this fiasco.