Who Pays For Senior Living Communities In California?}

Submitted by: Lori Solomon

Planning

Planning for senior living can be complex due to its unpredictability. Some people will never require this care, while others will need care over the course of a number of years. Some will be able to live at home independently, while others may do so, but require home care. Many choose to move to an active or assisted living senior community, while others will have no choice, due to their health conditions and/or finances requiring them to move to a skilled nursing home.

Families and the senior, when possible, should meet to prepare for senior living in advance, to ensure that the seniors wishes will be met. The adult children or other concerned family member, a trusted friend, or elder law attorney will likely be involved in the decision making process.

State/Federal Programs

Public programs pay for some senior living facilities, specifically skilled nursing facilities. These usually have eligibility requirements tied to the seniors age, income and assets that must be met before they can receive services.

Medicare provides limited care after a qualifying acute hospitalization. Medi-Cal (Californias Medicaid program) pays for nursing home care for people who qualify, and In-Home Supportive Services (IHSS) provides some home care for others.

Medicare for Skilled Nursing Facilities (SNFs)

As defined in Title XVIII of the Social Security Act, Medicare (“Health Insurance for the Aged and Disabled”) is a Federal health insurance program for aged (65+), entitled to Social Security and certain disabled individuals who have received such services for at least 24 months. (e.g., persons with end-stage renal disease (ESRD) who require dialysis or a kidney transplant, regardless of income). Medicare provides for a short term nursing facility stay covered under Medicare Part A (Hospital Insurance). It does not cover long-term custodial care in a nursing home.

SNF care under Part A is covered only if it follows within 30 days of an acute hospitalization of three or more days, and is certified as medically necessary. Medicare does generally not pay for long-term care in a nursing facility, and the number of SNF days provided for is limited to 100 days, with a co-payment required for days 21 to 100.

Medicaid – (called Medi-Cal in California)

Medi-Cal – for Skilled Nursing Facilities

Medi-Cal is a joint Federal-State government program that provides health care services to public assistance recipients and to others who cannot afford to pay for these services themselves. Eligibility rules are complicated and differ based on many criteria including marital status, current living arrangement and state of residence.

In California, a single individual can have no more than $2,000 in countable resources, but there are special rules for couples designed to prevent impoverishment of one spouse when the other spouse goes to a nursing home. In either case, one can keep their home and vehicle, when applying for Medi-Cal, and it will not be included as a resource on their application.

The spouse remaining at home can keep all of the couple’s income up to a specified amount per month, as well as a predetermined $ amount in assets. The spouse may also obtain additional income through a “fair hearing,” or by court order. The spouse in the nursing home is allowed to have up to $2,000 and will keep $35 each month for their personal needs. Any remaining income goes to pay their share of cost to the nursing home. The income and asset limits change each year.

Social Security

Social Security is a retirement pension due individuals who have worked and paid into the system for a specified period of time. It is based on income earned over time and is independent of the persons overall financial situation.

Supplemental Security Income (SSI) for Residential Care Facilities SSI is a supplement paid to individuals who have low income and few resources, over age 65 or are blind or have a disability. The Social Security Administration manages the SSI program. (A person receiving SSI automatically receives Medi-cal). Resources counted in determining qualification include real estate, bank accounts, cash, stock and bonds. Individuals are able to get SSI, if their resources are worth no more than $2,000. Exempt are the home one resides in and the land it is on, a vehicle, burial plot, up to $1500 in burial funds and life insurance policies with a face value of $1500 or less.

The government will make up the difference between a recipient’s Social Security benefits and the SSI subsidy limit. For a Social Security recipient eligible for SSI benefits, retirement communities occasionally accept the SSI subsidy rate for a shared room (usually for residents who do not requires assistance) and return to the resident approximately $100 for living expenses.

In-Home Supportive Services (IHSS) – IHSS provides home care for the blind, disabled, or seniors who are eligible and cannot live safely at home alone. Services include domestic help, meal preparation, and non-medical personal care. People who are eligible for Medi-Cal or other state or federal cash assistance programs may qualify for this assistance. For specific eligibility information, contact the county Department of Social Services.

Long-Term Care Insurance

Insurance products may be able to help pay for care. Some will create an income stream to help pay for care regardless of whether the individual is remaining at home or residing in a care facility. Others are more limited and will only pay for specific services in carefully defined facilities after the insured has met certain eligibility criteria and conditions.

People who are too elderly or who already have a health condition are unlikely to qualify for this kind of coverage. Others may not be able to afford the premiums for this insurance and would quickly qualify for Medi-Cal if they need long-term care. Still others may not be able to continue paying premiums as time goes on.

When applying for a long-term care insurance policy, you choose the amount of the daily benefit, the number of years that benefits would be paid, and the number of days or months before the company will begin paying benefits after qualification.

The premium is based on those choices and age of the insured. Premiums can range from hundreds of dollars annually if you buy at age 50 to several thousand dollars annually if you buy at age 75. Policies can cover care at home, in nursing homes, assisted living facilities, and adult day care or they may pay only for home care or for nursing homes.

Private Funds

The senior or family on behalf of the senior most typically pays out of their own income and resources. In some cases, they sell their current residence, financing their senior living with the proceeds from the sale. Other than eligibility for SSI, independent retirement living and assisted living facilities are paid for out of pocket with private funds. Oftentimes families are able and willing to provide financial support to supplement their elderly loved ones. Families have no mandated responsibility to finance senior housing for their elders. There are some states which accept Medicaid for assisted living facilities, but this does not yet apply to Californias Medi-Cal system. In addition, at the skilled nursing facility level, about one-third of long-term care is paid for with private funds.

Copyright 2005-2006 Accent on Seniors Inc. All rights reserved.

About the Author:

accentonseniors.com

Lori Solomon, Founder and President of ACCENT ON SENIORS, a California State licensed, FREE referral placement and information service, brings over 25 years of experience serving industries involved with the senior community in California.

Source:

isnare.com

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