Navigating Medicare and Medicaid

If you’re caring for someone over the age of 65, chances are that you know something about Medicare, the health insurance program that covers nearly all older Americans. But there’s another really important program that you need to know about: MediCAID.

Medicaid is important because it’s the safety net when everything falls apart. When your frail mother has been caring for your dad at home alone for five years and she can’t do it any longer. When 24 hour a day home care is too expensive, and still not enough to keep your dad safe. And, then when his nursing home care quickly depletes their savings.

Maybe you’ve only heard about Medicaid as a program that provides health insurance under Obamacare. Well, for much longer than we’ve had Obamacare, Medicaid has been paying for nursing home care and in-home care for people who are very frail or disabled and whose income and assets are low or have been depleted by the costs of care.

Read: 5 Common Misconceptions About Medicaid

Currently, there are over 8 million Medicare beneficiaries who are also eligible for the full Medicaid benefit package, which includes varying degrees of LTC (long-term care) and coverage of their Medicare Part B premium, as well as deductibles and coinsurance. There are also another 4 million or so Medicare beneficiaries whose income is too high for the full Medicaid benefit package but who get some help from Medicaid paying Medicare out of pocket costs.

If you’re a caregiver for one of these 12 million folks, you don’t need me to tell you how confusing this all can be. For those of you who aren’t, think about how hard you’re already working to manage Medicare and now imagine layering another completely different program on top of that. It’s a full-time job in addition to all your other full-time jobs.

What’s especially confusing is that Medicare is basically one program that’s the same for everyone in the country, but Medicaid is different in every state. Each state has different rules about who qualifies for Medicaid and the available benefits, and some states are more generous than others. So, for example, one state will practically guarantee home-based services and supports for in-need older adults with monthly incomes as high as about $2500, while another state sets the income threshold much lower AND has a long waiting list for services.

A big issue is that, even if you qualify for both programs, they are rarely coordinated with each other. Family caregivers are faced with navigating two different sets of program rules and requirements, on top of coordinating all the other services their loved one needs and uses. Usually, for example, doctors, who are paid by Medicare, have no idea about the Medicaid long-term care services someone might be receiving at home to help with such things as bathing, dressing, or eating. These providers don’t talk to each other, in part, because the programs aren’t coordinated.

The good news is a few states are very organized. They’ve worked hard in collaboration with federal government staff to create a “one stop shop” where you can choose for both Medicare and Medicaid. These programs often assign the participants a care manager or case worker who helps coordinate everything. For example, Minnesota offers the Minnesota Senior Health Options program that “combines separate health programs and support systems into one health care package.”

The bad news is that a lot of states are still struggling to make the programs work better together and some states haven’t really tried. On the bright side there are a lot of philanthropies, experts and policymakers working to fix this. But they need our help. The solutions they develop MUST REFLECT your experience and SOLVE YOUR problems.

To that end, a wonderful foundation, Arnold Ventures, wants to hear directly from you about your current care experiences with the many services you might be arranging and managing. Services such as medications, medical equipment, physician services and in-home care and behavioral health services. They’re hosting a series of focus groups where I will be leading an hour-long confidential conversation about the care you provide and how well you are supported.

Arnold Ventures, together with my team, will use this input to recommend solutions to policymakers. If you are interested in participating, please go to this page and share your contact information so we can send you more information.

In the meantime, if you’re taking care of someone who is enrolled in both Medicare and Medicaid, here are some tips for getting the best support you can.

The “PACE” Program. The Program for All-Inclusive Care for the Elderly (PACE) is a great program that many states offer through which very frail older adults who live in the community and are enrolled in both Medicare and Medicaid can get services bundled into one package and delivered through adult day services. The program is widely seen as the gold standard for care coordination and integration. Unfortunately, not all states offer PACE but there may be one in your area. To check, you can consult google or go to the PACEFinder resources on the National PACE Association website.

Area Agencies on Aging (AAA). Some states contract with AAAs to help manage access to Medicaid resources. It’s worth checking out. Call your local AAA – which you can find here – to see what kind of information and support they provide.

State Health Insurance Assistance Programs. These programs are funded federally but available locally to help you navigate Medicare. It’s free — You can find out more here.

Daughterhood Circles. Don’t forget to check out whether there’s a Daughterhood Circle operating in your area or your state. Many meet virtually so you can join even if you’re not in the same neighborhood. The listing is on our website here. If you’d like to start a Circle and become a Circle leader, get in touch with us here.

Daughterhood in a Time of COVID: Our History and Our Future

As the first nursing home and assisted living facility residents get their COVID-19 vaccines, I feel like I’m seeing a little light at the end of the tunnel. I’ve been quiet on the blog this year because I’ve felt speechless – empty of any information, advice or even reassurance I could provide the millions of caregivers doing a hard job during the most difficult of times. I felt helpless as I watched the deaths mount and read story after story of isolation and disconnection.

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The Burden of “Self-Care”

Every time I turn on my computer, I see some story or advice about the importance of self-care, especially for women.

We read about how Arianna Huffington is on us to get more sleep, which has the effect of keeping me up all night worrying about the bad things that will happen to me if I don’t. Or this doozy from Christiane Northrup where she advises caregivers to be sure to eat a balanced diet, get exercise and “indulge” themselves.

Let’s be real for a moment. The job of taking care of aging parents can be a total life destroyer. It takes your money, your time, your ability to work, your friends, your relationships, your ability to do the things you love, or even to take a rest.

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‘Daughterhood Circles’ offer family caregivers a way to connect

(Article Reposted with permission from Memorywell.com)

Think of it as a mom’s group for a different and less joyful chapter of life.

One woman struggles to understand why her mom won’t leave her room. Another woman, whose mother now lives with her, wonders on really bad days how this became her life. A third is determined to remember her stepmother from a different time, before the disease that recently took her life made her so angry.

It’s a Tuesday evening at a tapas and wine bar in Marietta, Georgia, a suburb outside Atlanta, and seven women have gathered to honor one another.

“Here’s to caregivers,” says the organizer, as they raise and clink their glasses.

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It’s Not Your Fault

The emails come into our inbox. “Please help,” is usually how they start.

What so often follows is the same story with only slightly different details. A 90-something parent, living on social security, has fallen, gone to the hospital and now needs rehabilitation to get up and walking again. And Medicare – the health insurance program that covers nearly all older adults – would pay for the skilled rehab care but for one thing. The hospital never admitted the parent as an “inpatient”, despite a multiple night stay. Instead the parent was admitted under “observation,” which doesn’t count as an inpatient hospitalization. And without three nights of inpatient care, Medicare won’t pay for the subsequent skilled facility services.

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When Your Parents Won’t Listen

We asked daughterhood readers recently about the most stressful part of caregiving. Many responded that their biggest struggle is conflict with their parents. When their mother or father disagrees with or ignores safety or health-related directions. Things like not staying off the ladder to refusing to see a doctor.

It’s so hard to sit by and watch when our parents seem to need help but refuse to get it. We feel the full weight of responsibility for what happens to them but, at the same time, we have no control over their choices.

But we try. Women especially are taught that if they just try harder, get smarter, skinnier, dress better and be nicer, they’ll be okay. So it makes sense that this do-more mentality pervades our caregiving too. But this is a mean trap. We are — maybe not entirely consciously — judging our self-worth by whether we can stay in the ring without getting taken out by the realities of aging: mortality, frailty, disease and an upside down, seriously messed up healthcare system. Realities we shouldn’t even pretend to be able to influence.

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Caregiver’s Holiday Survival Guide

Let’s face it. Caregivers don’t get to participate much in the holidays. While everyone else is planning trips and parties, shopping for gifts or decorating the house, caregivers are still muscling through their daily grind.

If you’re taking care of a parent or loved one, you know what I mean. It’s hard to avoid feeling especially deprived this time of year. Whether you’re sitting in the ER again, dealing with frustrating dementia behaviors, or worrying about your mom’s depression, the misery of it is all just magnified this time of year. One of the hallmarks of caregiving is that it leaves you feeling like you’re missing out. Missing out on fun everyone else is having, missing out on your old life – before you were a caregiver. Of course, Holidays make this feeling even worse.

The simple fact is, whatever makes us sad, makes us sadder in December. Everything hard is harder. We feel the passage of time more acutely and our losses more profoundly. If your family member has dementia, it’s extra painful. This time of year is, after all, loaded with memories.

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It’s All About Connection: Caregivers Survival Guide

Other than death of a loved one, few things are more disorienting than making the shift from being cared for by your parents to caring for them.

This transition is made even more challenging because it usually comes as such a surprise. And it’s not just the biologically wired blind spot we have against our parents’ vulnerability. It’s the utter shock that, when it happens, there’s no place to turn for help. It’s like trying to climb a rock face without any toeholds or crevices where you can grab on, and then scaling it without a net.

The problem with our aging care system is that even though there’s a lot of information out there to help, the situations most caregivers confront are so incredibly complex, unique, and specific (such as, why won’t rehab providers accept my Dad?) that they can’t find exactly what they need. Or they want the exact right answer to a very complex question that doesn’t have right answers.

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Making Medicare Choices for Your Parents

“My dad doesn’t have Medicare!” A friend said to me recently.

“What?” I responded. This seemed unlikely. Pretty much everyone over age 65 has some form of Medicare and my friend’s dad is at least 90 years old.

Then he explained, “Dad has something called ‘Blue Cross advantage.’”

I explained that his dad does have Medicare but it’s a particular form of Medicare that private health plans (like BlueCross BlueShield) offer. It’s called “Medicare Advantage.”

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4 Sanity-Preserving Truths Your Good Friends Want You to Know

Do you realize that 70 percent of the human food supply depends on a bunch of women dancing?

This is my interpretation of what my beekeeper friend, Nicole, taught me about how honey bees do their job. It inspired the most important advice I’ll ever give about Daughterhood —  and explains a big initiative we’re launching to help you.

Let me explain how these dots connect.

First, we all know that if bees don’t help boy and girl flowers share pollen with each other, they can’t make the vegetables, nuts, fruits, berries, and wheat that we eat, or the plant food that cows and chickens eat before they become burgers and nuggets.

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