I am thinking ahead here. Does anyone here know if Medicaid pays for home care for people with dementia? I know that under right financial circumstances, it will pay for nursing home. But NH is very expensive. Wouldn't it be a good justification to tell them that it is less expensive for them to pay for home care than NH. Does anyone know?
If you tell us where you live, someone here might be able to do some research for you.
Like some states Medicaid waivers will pay for AL, but most states do not at all OR the waiver is very very narrowly defined. Which translates into just a very small # of beds on AL waiver for those facilities that participate. This is why you often hear "the AL requires 2 years of private pay before Medicaid". For the AL, 2 yrs has high probability that Medicaid bed elder will die, move, or need a higher level of care within the 2 yrs, so it's a safe bet that bed will be open in 2 years. The AL contracts will be worded so that terms can change if waiver changes.
What seems to be the trend now for waivers is for community based day programs & moving away from 1-on-1 in the home caregiving by a state paid provider or an AL waiver. It's more cost effective to provide services this way. Like what PACE or some variation on PACE is. Program of All inclusive Care for the Elderly. PACE is paid by combo of Medicare & Medicaid & does a private public partnership through your state - usually with existing experienced community clinics type of providers - to run a center paid by the M&Ms through CMS. Where I am in New Orleans, it's Catholic Charities & there's one by us at The Benson Center. Elders are evaluated for care and if eligible they go to PACE 2 - 4 days a wk & get Basic health care, medication management, activities, meals and transportation provided through the center. Center has MDs, PAs, RNs, all sorts of other nursing staff, PT/OT, too. At no cost to individual, as everybody is a "dual" so on both M&Ms. But all other caregiving time & needs outside of PACE will for the most part need to be provided by family or elder /family pays for. The one by us does not have a copay, so I imagine elder has SS$ to pay for additional caregiver time if need be or family does for free. If something happens like a fall, TIA, then PaCE staffer will get reassement done and then they transition into another Medicaid program - like a NH - if need be.
If you are hoping that Medicaid will pay for 24/7 at home care, well not likely to happen. You'd have to be living in area where cost of care is beyond extraordinarily high, like Alaska or NYC, plus elder would have to document in detail health care need for such 24/7 care.
For my mom, her last yr on NH Medicaid, state reimbursement was $160 day - $4,800mo. Pretty low cost for room & board & 24/7 nursing oversight. I think nationwide R&B reimbursement $ 175 a day. It would be hard to have skilled caregivers accept a $ 7 hr wage before taxes, fica. Not even minimum wage for most places.
My point in this is that depending on a waiver to solve how to keep mom / dad at home will not work for the long run. If your elder does not really have the $ for PP for 2 -3 years, then you need to look at doing what you can now to get them eligible to show "at need" both financially & medically for skilled nursing care in a NH that takes Medicaid.
Medicaid costs are crushing state budgets & states are having to do whatever to narrow eligibility & provide mandated services more cost efficient.
This is gonna be interesting..... if it means elder has to see a doc who takes "duals" in order to get orders for admission into a Medicaid participating NH / skilled nursing care facility OR other Medicaid paid programs, folks are going to need to find a new MD. A lot of docs do not take Medicaid at all. A lot of Medicare Advantage plans do not enroll those on Medicaid. If TX can do this and show deceased costs, other states will follow. Not pretty.