Benefits of a Medicaid waiver?
Hi, everyone. The Medicaid Waiver saga continues for us. I’m still not sure I want to “go for it” because I don’t understand how or even if it will benefit us.
Will this wavier pay for my husband’s Medigap Insurance? Will it pay for his medications so he will no longer need Part D? We are supposed to open a Miller Trust and deposit $245 a month into it. I was told I can access that money but it has to be used for his needs. It would cover his Medigap and medications and that’s about it. What’s the sense in opening that trust account? Seems to me it’s like robbing Peter to pay Paul. What happens when the money in that account is used up each month? And, it’s our money. It’s not like Medicaid would match the funds.
I was also told he'd have to pay to pay a premium to Medicaid every month. At one point, the agent told me it could be as much as $1,000. WTH? What’s the sense of having Medicaid if you have to pay through the nose for it?
We don't need (or want) in-home Health Aides. With the exception of a new mattress for his hospital bed, we have all the DME that will fit in our house. Seriously, all I really want is to have his incontinence supplies paid for and maybe his meds.
I’m just totally in the dark with this Waiver thing. I have the feeling, without knowing what it will cover, that it’s not going to be worth the hassle of getting it. Thanks in advance for your help.
11 Answers
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My mom lives with me. She receives SSI of $750 a month. She receives traditional Medicaid, meaning I only pay the copay for her meds which is $3 each.
Her incontinence are paid for by Medicaid and shipped to me.
Her large shower chair, half in and half out of the tub, I bought used.
I bought a transport wheelchair for her to get around the house by herself, removing the foot pedals.
Medicaid purchased the portable commode next to her bed. She can stand and pivot well enough to use the bathroom on her own. Her supplies hang in a shoe rack behind her door in arm reach, baby wipes, pull ups, garbage bags for her can where all paper products go into, her deodorant, etc. so she can be as independent as possible.
Her health both mental and physical qualifies her to live in a nursing home. Her doctors completed paperwork to attest to this.
The medicaid waiver saves Medicaid the close to $50,000 a year from living in a nursing home to the $14,400 a year to live in our home.
I quit working when she had open heart surgery. Really didn't think 5 years later she would still be here.
Financially we live within our means so the $40 a day is paid to me as her caregiver. The daily rate depends on how much hands on the patient needs. I have certain restrictions regarding administering her meds but other than that, this is what the waiver does.
I have a 2 minute report to complete on line and they even give you a tablet to do this on. This is the state of Indiana.
Ideally, the waiver would, from Medicaid/Government funds, NOT our’s, pay for his Medigap, Part D and co-pay for meds. Incontinence supplies are around $100 a month. If those are all Medicaid would pay for, it’s hardly worth the $245 a month and whatever else we’d have to pay. However, thinking into the future, he will at some point have to go to a facility. Perhaps already having the trust in place would make this easier.
Thanks for your answer. I appreciate it a,
I’m in the beginning part of the process.
my prayers are with you as you decide what to do.
Talk your dad’s social worker and then she would make the change regarding incontinence supplies, and meds. He should be able to get them by Medicaid waiver.
That will pay for you MEDICARE Part B Premium, and most of your co- pays. Medications drop to $3.65-$8.35 a month.
If some of their RXs are not on the formulary, than there is probably a good medical reasons for that. Ask your doctor to explain why he is not on an older cheaper drug. (Allergies, only BP meds that does aggrivate neuropathy or Raynaud's,...)
This is an issue I have with how Drug plans are recommended. They go by the current list of RXs. Well only the most expensive plans cover my migraine pills, but I am allergic to the common drug, so I don't bother listing it, or list the one most companies cover. There are 2 or 3 Osteoporosis Rx out there. A few companies cover neither, but most cover one or the other. So if I put in drug A, it kicks out great plans because of the cost of this one drug, and Visa versa. My doctor thinks it is good to alternate every few years, so again, I run my search twice. Once with drug A, once with drug B. Print out the details, and know where the other pieces fall!
If it is a newer medication, contact the Manufacturer. The income limits for Prescription Assistance Programs are more generous than you might think.
It sounds like you never had Supplemental Insurance. THIS IS A NOTE FOR EVERYONE. There is a very narrow window of 3 months before and after, inclusive of month you qualify for MEDICARE, or if disabled, again when you hit retirement, to get Supplemental Health Insurance no matter your pre-existing conditions. Most people don't realize that if the wait, mild chronic conditions, or a serious illness long in remission ( in my case sudden onset Kidney Disease), means going thru underwriting. Most of the hundreds of programs won't take you. Those that do, charge the same premium as someone 991/2 or older. ( Actually a quick way to screen for premiums & plans is put your age in as 100.)
Is there anything your LO can still do? Write a business letter, fold clothes or see on buttons ( Vets are great at that). A hobby people might pay for. Many states have gone to work for Medicaid. I was told 3 years ago my premium would be $700 (56% of my income). But I work an hour a month for $10 and pay nothing! I am an independent contractor, report my income, but it is so small I don't have to pay taxes on it.
Lastly, if you don't go through Medicaid, you can hire help directly, rather than going through a Medicaid Approved Service, which usually costs double because of the paperwork and overhead! College Students, Retirees, and simple independent house cleaning company, may be much cheaper.
All things to weigh in on your decision.
Good luck!
I’m certainly not being “picky”. I’m just trying to understand so I can make an informed decision. And I am grateful for any help we receive from anywhere.
Thank you for for your response.