<p>My grandmother lives in an assisted living home that accepts Medicaid. It is a very nice place, and she only waited a few months to get in. Not in the ritziest neighborhood, but decent. She gets a lot of services and it is an awesome deal for the little she pays. She turns over her small pension, and Medicaid pays it all. I hope the ACA won’t change this for her. She had no assets at all.</p>
<p>I meant, state-run may boil down to VA, mental and some etc. Bad edit.</p>
<p>I got curious because a few years ago I visited several elder care facilities for a work related project and one administrator of a very nice facility specifically told me they were private pay only. Now, it may be that if you spend everything you have they can’t kick you out. I have no idea. But she was very clear that they do not accept Medicaid or Medicare. Just checks. Anyway, this article makes it sound as though government-run nursing homes do still exist in some parts of the country. Actually, in the piece they sound a little sorry to see them go private. Now, that surprised me.</p>
<p>[County-owned</a> nursing home going private: Lake County’s Winchester House seeks private management - Chicago Tribune](<a href=“Lake County-run nursing homes becoming a luxury”>Lake County-run nursing homes becoming a luxury)</p>
<p>State run probably also covers those that are city and county owned. They are dwindling but still exist. This is quite a tangent, though. Now back to ACA…</p>
<p>When my mother was researching assisted living in our area, she found that the upscale ones had long lists, and even if they did accept Medicaid, some required that you still had to write a check for a specific period of time (perhaps two years?), and then they would accept Medicaid. I guess they decided that people might run out of money eventually. But she was still able to find decent ones, if not upscale, that were still accepting people in a reasonable amount of time. I really don’t see why people should be entitled to fancy, upscale retirement homes anyways, if they aren’t paying for it. The one she found was more than adequate, it is very nice. </p>
<p>Does anyone know if the ACA will change anything about how Medicaid funds assisted living, or if it doesn’t even address it? I would hate for Grandma to get booted out of there, as she won’t even set foot in me or my parent’s house!</p>
<p>If you don’t want to deal with Medicaid or be a burden on your kids, and you are not too old, I would urge everyone to consider LTC insurance. The best time to buy it is in your late 50’s when you can still get through underwriting, and the cost of the policy has not gone through the roof. It is a labor-intensive task because the insurance is difficult to understand and there are many moving parts which you need to comprehend. </p>
<p>It took me over 3 months, dealing with 3 different brokers and 5 insurance companies before I made a decision. The medical underwriting was nasty but somehow my wife and I got through it.</p>
<p>^Exactly. This is the most legit way to give both your spouse and your children peace of mind, because if you think health insurance premiums under ACA are hefty, just wait til you see the bills for LTC 
The underwriting is a bear and the premiums eye-opening though :)</p>
<p>At any rate, the ACA-related question to my mind is whether the instruments of look back and recovery written into the laws around Medicaid and the movement toward recovery in several states can be applied to medical costs.</p>
<p>So lets say your not in a home, not even retired, but due to an illness, are no longer earning much and use Medicaid because you can’t get on the exchange based on your income. If you own two homes (lets say a family cottage) and two cars, can Medicaid legally come after you for the medical bills you wrack up? Could that illness event, even if not fatal, trigger liens against property you intended to leave your children?</p>
<p>I think its a good question. I’m not planning to go on Medicaid in ten years or anything, but if you’re self-employed and have assets and are currently paying $1200 a month out of pocket for health insurance, and your income is tied to your health and ability to generate revenue, then the scenario is not really so abstract :)</p>
<p>GP, thanks for the advice. What should you do if you reach your late 50s and then can’t get through underwriting for LTC insurance? </p>
<p>Ten years or fifteen years from now, long term care is going to be a disaster. Many people will need it and not be able to pay for it.</p>
<p>kmcmom13,</p>
<p>I assume you are talking about being under the age of 62 and too sick to continue generating income?</p>
<p>In this situation you need to have long term disability insurance. I’ve been paying for mine since I was 26. I hope to never use it, but in the event I need it, it will cover 60% of my current income until I can start collecting social security and withdraw from my retirement accounts. Long term disability insurance is not expensive and will provide income stream should the need arise.</p>
<p>I also wanted to comment on Medicaid recovery.</p>
<p>My distant relatives (a couple) died several years ago within a short period of time. The only asset they had was an inexpensive house they bought from proceeds of a settlement. The settlement was result of an work place accident (explosion) at the place where the husband worked. </p>
<p>Both husband and wife worked, but never really made much and in their old age partially relied on government programs. They came in US when they were both in their early 40s. I do not understand how it happened (since they both worked), but at their retirement age they had Medicaid, and not Medicare.</p>
<p>Anyway, the husband died of a throat cancer and was in a nursing home only the last couple of weeks of his life for hospice. The wife died of leukemia and never was in the nursing home (her daughter was able to take care of her in her last days).</p>
<p>While both of them were alive, they were able to keep their house. However, when they died, after a period of time, the state came after their house. </p>
<p>I don’t know how ACA changes this scenario in my state.</p>
<p>^Lerkin, I have LTD insurance, so I understand what you’re saying. But there are many temporary situations where a business proprietor may not qualify for LTD but will have reduced earnings due to illness, or the illness of a spouse, etc. After all, LTD is long term 
And, at 60% of one’s earnings, it’s difficult to say what their actual earning level might be on the spectrum of % of PL.</p>
<p>So my question stands, if a person were to need medicaid under expanded medicaid because their income level for whatever reason fell to less than 138% of the poverty level YET they had assets, eg. paid home(s), then is it possible for the existing recovery legislation to “recover” against that person’s assets.</p>
<p>My company pays for 60% LTD and allows the employees to bump it up to 70% or more by paying an additional amount.</p>
<p>kmcmom13,</p>
<p>For individuals over 55, the states are required to recover medicaid. So the “best time” to be on Medicaid is between the age of 26 and 54. </p>
<p>Their might be a legislative fix in the future, but I doubt it. I also doubt that states themselves are able to fix it, since it is a federal requirement.</p>
<p>Also, I hear you regarding 60% (although it is more like 75% since you are not going to be paying payroll taxes on it). And I completely sympathize with those who are self-employed. It is a much riskier endeavor than to work for somebody else.</p>
<p>States that seek to recover ALL costs, possibly including “capitation charges” include:</p>
<p>AL, AZ, CA, DE, FL, HI, IL, IN, IA, KY, ME, MD, MN, MT, NE, NH, NJ, NY, ND, OH, OK, OR, RI, TN, UT, VA.</p>
<p><a href=“http://assets.aarp.org/rgcenter/il/2005_06_recovery.pdf[/url]”>http://assets.aarp.org/rgcenter/il/2005_06_recovery.pdf</a></p>
<p>In these states if you were enrolled in Medicaid after the age of 55, but never used it, the states can in theory still go after your estate (capitation charges).</p>
<p>HHS says “required,” but, imo, it works out to “required to have some policy.” That doesn;t say their are teeth in it. Because you can see how different states handle this- or only halfheartedly, at best. Now, perhaps that’s because some significant % of recipients, up to now, did thing as they were supposed to.</p>
<p>Federal statement, but, like many other things, then states decide how to proceed.</p>
<p>There was an asset test for Medicaid up to now. It changed with ACA.</p>
<p>I know several friends whose parents got LTC insurance some time ago. They got very good policies at the time, but they are but a drop in the bucket for what the costs are now and what they do cover is not the deal breaker. You think college is expensiver? Well, the better nursing/assisted care faciilites make even the most expensive colleges bargains price wise.</p>
<p>Flossy what is the change with ACA for Medicaid? it was/is a five year look back and about $30K in assets, I believe, Is it a state by state change or national?</p>
<p>Income only with no asset test is my understanding. Maybe, I’m wrong. I hope so because I don’t think a lot of people know what they are signing themselves up for and that’s very sad IMHO.</p>
<p>Changes in eligibility criteria do not change “recovery” requirement.</p>