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FIVE THINGS TO KNOW ABOUT WHERE YOU RECEIVE LONG-TERM CARE AND HOW IT AFFECTS GOVERNMENT BENEFITS

1.  There Are Two Different Kinds of Places You Can Receive Long-Term Care.  You can receive long-term care in many different settings: a nursing home, assisted living, etc.  When you think about using government benefits to help pay for long-term care, all of these different kinds of care and facilities get divided into two different categories. 

The first category is nursing homes.  This includes a small number of specially licensed facilities that provide the most intense level of health care.  A nursing home may operate independently or in connection with assisted living facilities.  However, there is a clear distinction between being in the nursing home and other levels of care. 

The second category of long-term care includes everything that is not a nursing home.  This includes care provided in your own home, assisted living, CBRF facilities, group homes, and assisted living arrangements with enhanced or high levels of care that can mirror what would be provided in a nursing home.  No matter what type of care it is or how it is arranged, if it is not care provided in a nursing home, it is all lumped together and treated the same when it comes to government benefits.

With all of the options available and the many issues you need to think about, it is easy to get confused.  However, whether or not your can receive government benefits often depends upon this distinction.  When you talk with doctors, social workers, facility administrators and other health care workers, you need to make sure that you understand whether it will be nursing home care or not.

2.  Government Benefits Are Available for Nursing Home Care.  The government fully funds the Medicaid program that helps pay for nursing home care.  This Medicaid program is often called "Title 19". The program is very straightforward.  If you meet the eligibility requirements, you will receive help paying your nursing home bills.  The primary challenge is meeting those asset and income eligibility requirements.  However, the application process is relatively clear and nursing home bills get paid right away when you meet the requirements.

3.  If It Is Not Nursing Home Care, Then Government Benefits Are More Complicated.  Government benefits that help pay for any care that is not nursing home care (i.e., in-home care, assisted living, etc) comes from the Family Care program.  The application process involves an initial assessment of physical need by the Aging and Disability Resource Center, followed by a separate financial assessment of assets and income by an economic support caseworker. If someone passes through those steps, a separate care management organization will step in to handle the day-to-day issues regarding benefits and care. There are numerous agencies involved and it takes at least 45 to 60 days to get to the point where benefits are actually available.

4.  Many Facilities Do Not Take Family Care Benefits.  Assisted living and other facilities need to sign a contract with the government in order to receive Family Care benefits.  Many facilities choose not to have a contract.  That means that their residents cannot use the Family Care program to help pay the bills.  In some cases, a facility will only have a contract that covers a certain, specific level of care or facility.  Family Care benefits can be used to cover those particular bills, but anyone receiving other types of care or living in other parts of the same facility cannot get assistance from the Family Care program.  Choosing to stay in a facility that does not accept Family Care payments means that you must pay all of your own bills or be willing to move to a different facility when your money runs low.  If you think that you would ever need to rely upon the Family Care program to help with your bills, you need to be very clear whether the facility accepts Family Care benefits and what limits may be involved.

5.  You Can Get Help Sorting This Out.  The Aging and Disability Resource Center for each County has caseworkers that understand all of these issues.  They know which facilities are nursing homes, which facilities accept Family Care benefits and which facilities have only partial contracts with Family Care that may lead to confusion.  The Aging and Disability Resource Center also understands the limits of the different government programs and how the choices that you make could affect your ability to get government benefits down the road.  This information and assistance is provided free of charge.

A geriatric care manager can also provide vital information about the different facilities and how they work with the different programs for government benefits.  Geriatric care managers do charge a fee, but they can also provide more information and assistance.  You can get more information regarding the quality and suitability of different long-term care facilities.  They can also assist you with the process of selecting a facility and gaining admission to a facility in addition to answering questions about government benefits to help pay the bills.

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This is not legal advice or tax advice, pursuant to disclaimer.
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