Thursday, July 17, 2014

Medicaid 'Surprises' You May Encounter

Your parent has been approved for Medicaid.  Now what?  He or she will receive care in the home, assisted living, adult family home or nursing home.  Chances are, though, you'll encounter some surprises.  Here are a few:

1.  Your parent could get a roommate.  In most states, the Medicaid program is obligated to provide a shared room if available.  That isn't always possible, though.   In Washington State, many adult family rooms have only private rooms, so when a resident converts to Medicaid funding, he or she gets to stay put.  If your parent happens to be assigned to a shared room and a private room is available, it's sometimes possible for you (the family) to pay the difference between the shared rate and the private rate.

2.  Medicaid covers the basics.  The emphasis is on the basics.  The good news: Medicaid will cover physician services, prescription drug and home health services and also Medicare copays.  Supplies like incontinence products and toilet paper are covered.  Other things aren't paid for in most states such as dental care and transportation to medical appointments, except in limited instances. Many adult family homes, assisted living and nursing homes do have "in-home" physicians who come in on a routine basis to see the residents. Some facilities also have podiatrists coming in, and mobile laboratories for blood draws.

3.  Mom gets an allowance.  Remember when you received one as a child?  Your parent on Medicaid will get a similar monthly personal needs allowance. In Washington State, it's $62.70 for an assisted living or adult family home resident, and $57.28 for a nursing home resident.  Not very much and certainly not enough to cover going out to lunch, buying new clothes or springing for birthday gifts for the grandchildren.  That's where you come in.  You can pay for outings and buy gift cards, clothing or other items.  But you can't legally give your parent large sums of cash, as to put them over the asset limit for Medicaid.  That's $2000 in many states, including Washington.

Note:  Medicaid coverage varies from state to state.  Check out your state's website by googling Medicaid (your state).  Washington State's Medicaid website is found at

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