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Ask an advisor: Will Medicaid rescue my ailing mother?

Updated: Jul 25, 2023

Ask an advisor: Will Medicaid rescue my ailing mother? By Nathan Place January 13, 2023 4:53 PM

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In the United States, long-term care is expensive and not covered by Medicare.Pexels/Andrea Piacquadio Welcome back to "Ask an Advisor," the advice column where financial professionals answer questi

ons from real people. The topic can be anything in the world of finance, from retirement to taxes to wealth management — or even advice on advising. This week's question comes from a retiree in New York City who's concerned about not just her own retirement, but her parents' as well. Her 90-year-old father has been taking care of her 87-year-old mother, who has chronic health problems, at home in their Manhattan apartment. This arrangement worked for a few years, but recently it's become clear her needs require more professional help — and neither Medicare nor their insurance will cover it. Sadly, this is a common problem. American seniors spend an enormous amount of money on healthcare. According to one recent study by the Center for Retirement Research, the median U.S. retiree s

pends about 25% of their Social Security on medical expenses. Medicare helps cover some expenses, but not long-term care — the kind that this retiree's mother needs. Could Medicaid, Medicare's sister program for low-income Americans, be the answer? Here's what this New York retiree wrote: Dear advisors, My parents are both elderly and recently began to need care at home. In particular, my mother suffers from severe physical and mental ailments, and needs help bathing and dressing every day. Her Medicare Advantage plan will only cover up to 30 days of this, and we're running out of time. On the other hand, Medicaid covers some home care, and I am wondering whether my mother qualifies even though my father probably does not. She receives a very minimal Social Security check ($1,065 per month), and that is her only income. My father receives a larger Social Security check ($2,200 per month) as well as a small pension ($374 per month) and also has a small IRA containing about $40,000. Is it possible that my mother could be covered by Medicaid? And if not, where else can we turn for coverage? Thanks for your help. Sincerely, Wondering on the West Side

Medicaid is probably a ‘no’ George Jameson, CFP, financial advisor at Blackbridge Financial in Charlotte, North Carolina It sounds like your mother meets the health criteria and income level, but unfortunately, it's based on "annual household income." A household of two in New York must have an annual household income (before taxes) that is below $24,353. This includes both spouses' income. If it were just your mom living in the house, she would qualify because the limit for a single occupant household is $18,075.

But there are other resources to look into. Most states have in-home assistance programs for low-income seniors who are not eligible for Medicaid. Some of these programs provide cash assistance; others provide care services and respite. The common thread amongst all of these programs is that they help seniors remain living at home or help families to care for seniors in their homes.

Get help navigating the bureaucracy Mary Johnson, Social Security and Medicare policy analyst at the Senior Citizens League in Alexandria, Virginia A major issue in helping your mom qualify for Medicaid may rest on marital status — whether your mom and dad are married and living together, versus their individual incomes alone. Most states have requirements that may require "spending down" to qualify for Medicaid, but there may also be some spousal impoverishment protections that allow the spouse to remain in the family home and to retain some small amount of savings. State law will determine ho

w your mother's income will be counted. Fortunately, there are many sources for help and information. For general income eligibility, you can look on the website for New York State Medicaid. The Medicare Rights Center is an excellent resource for learning about programs that could potentially help your parents if their incomes and resources are low enough. Free one-on-one counseling about Medicare and Medicaid is available through your State Health Insurance Assistance Program from trained benefit counselors. Thanks for your question. This is one of the most difficult challenges facing retirees today.

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