As elder and adult family mediators, we keep learning about (not-so-new) legislation, court settlements, and resources that may pleasantly surprise many elders and their family members. Here are three that may benefit you, a loved one, or someone you support.
- Medicaid is Not a Single Program
Many, including myself, thought that Medicaid covers only nursing home care for low- and no-income individuals who financially qualify for the benefit. Not so.
In 1981 Congress approved legislation allowing states and the District of Columbia (DC) to offer alternatives to institutional care. Referred to as “home and community based care,” states and DC may provide a broad array of medical and non-medical services (excluding room and board) to both disabled and elderly persons that are not otherwise covered under Medicaid.
Depending on the jurisdiction, these might include:
- Respite relief for a caregiver;
- Home health aide;
- Assistive technology services;
- Modifications to the home that incorporate wider doors, ramps or roll-in showers for wheelchair-bound persons;
- Communication aids (such as speech amplifiers); and even
- Guide dogs.
Passage of this statute represented a first step toward recognizing that many individuals can be supported in their homes and communities, thereby preserving their independence and bonds to family and friends, at a cost usually less than institutional care. (For more state-by-state information, check www.medicaidwaiver.org.)
For years, patients in skilled nursing residences thought they had to show that their condition was improving to continue receiving Medicare support. In 2013, a settlement agreement reached in Jimmo v. Sebelius* stated that coverage of skilled nursing and skilled therapy services in skilled nursing facilities (SNF), home health (HH), and outpatient therapy (OPT) settings does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the “beneficiary’s need for skilled care.” Skilled care may be necessary to improve a patient’s current condition, to maintain the patient’s current condition, or to prevent or slow further deterioration of the patient’s condition.
The Jimmo case outcome represented a milestone in how Medicare covers chronic illness. Patients can now receive Medicare coverage for “maintenance” of their chronic illness without having to demonstrate “improvement” in their condition. (Centers for Medicare and Medicaid Services contains a Fact Sheet on the Jimmo settlement.)
Say you are getting older, eyesight dimming, and keeping up with your bills is more challenging. Daily Money Managers to the rescue! Daily Money Managers are trained, bonded, and certified professionals who will handle your bills and other financial matters on a personalized basis in your home. No longer must an adult child worry whether his or her parent is paying their bills on time or in full.
According to their professional standards, they help with bill paying and preparing budgets, among other services, to seniors and older adults, people with disabilities, busy professionals, high-net-worth individuals, small businesses, and others. Their mission is to support daily money management services in an ethical manner, to provide information and education to members and the public, and to develop a network of dedicated professionals. You can find more information on this resource at American Association of Daily Money Managers website. It provides a state-by-state listing of all qualified daily money managers.
*January 24, 2013 U. S. District Court for the District of Vermont.
Beyond Dispute Associates
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