Find Programs That Pay Family Caregivers

Giving Caregivers a Helping Hand

Anyone who has worked in the eldercare space for long can tell you the most common question they hear. "Can I get paid for caring for my loved one?" This is a complicated question and there is not a single answer for everyone. Today we are happy to announce that we have made answering this question a little bit easier with the launch of our Paid Caregiver Program Locator.

Nationwide there are over 100 programs that can pay family members or friends for the caregiving efforts they provide to their loved ones. However finding these programs and understanding their complex eligibility requirements is a major challenge, especially for time-constrained caregivers. Now caregivers can search our comprehensive database of programs by answering a few simple questions describing their situation and quickly discover if they are any programs available to them.

The need to pay caregivers can best be illustrated by statistics which clearly show what a major burden our caregivers carry both economic and otherwise. In the US today, there are approximately 35 million individuals providing unpaid care for aging family and friends. They provide an average of 25 hours / week of care for an average of 4 years. Over half of them work full-time in addition to caregiving and 60% of those individuals, not surprisingly, say their caregiving responsibilities have impacted their work.

Lastly, 84% of caregivers say they require more information about caregiving topics. Since we know their number one question is about financial assistance programs, we hope Paid Caregiver Program Locator can reduce that last statistic.

View PayingForSeniorCare.com's new Paid Caregiving Program Locator.

Using Medicaid to Pay for Assisted Living

We received a call recently from a family looking to help their mother move into assisted living.

Photo by Abbeyfield Kent

Their mother was increasingly unable to care for herself in the large house where she lived alone. Her income was well below the 300% of federal poverty level set by the Social Security Administration and, unfortunately, she had little savings. They wanted to know how they could use Medicaid to pay for the cost of assisted living care. This family’s inquiry was very common, so we wanted to share the answer, in a general way, as a blog post.

Medicaid’s Long Term Benefits

The states and the Center for Medicaid Services (CMS) have been responding to popular demand for this form of long term care and, over the last decade, we have seen a significant improvement in the program rules and waivers with regards to their assisted living benefits.

The long term care benefits from Medicaid generally consist of nursing home care, not assisted living. (For more about how Medicaid is structured see this simple explanation.) While nursing homes provide a more comprehensive and sophisticated level of care, many people who are well enough prefer the independence and higher activity levels of assisted living communities. When someone who is Medicaid qualified, medically and financially, and yet prefers to live in assisted living instead of a nursing home, they can turn to the states’ Medicaid Waivers.

State Programs Vary

While there’s a federal administration for Medicaid oversight and regulations, the states are left to implement their own versions of the low income health insurance program. In our research, we found that 44 states now offer some help for individuals to pay at least some of their assisted living costs via Medicaid programs and waivers.

Often these state Medicaid programs use different names and ways to refer to their assisted living benefits. Sometimes these programs will be called care homes, supported living communities or adult foster care, among other names.

And it is not just the names that differ—the benefits do as well. Sometimes, the state programs will reimburse only for the actual care and skilled nursing services provided by the communities. Often, the cost of the room and food is excluded from being paid by the states, but at least a few states have waivers that include the full cost of the assisted living as long as it is at one of their approved facilities.

In order to learn more about the particular benefits available in your state’s Medicaid program and its associated waivers, we refer you to our partner’s website for a “State-by-State Guide to Medicaid’s Assisted Living Benefits.”

Affordable Alternatives

While Medicaid is one of the most well known and largest programs for long term care benefits in the US, it is still not designed to address the growing demand for receiving care in assisted living. It might not be the best source of funding for your family. Because Medicaid is often restricted to only paying for the care services, the rates paid out might not be sufficient to cover all of an elder’s expenses.

It might be best to start with an assisted living community search to find the most affordable community for your family. Assisted living rates will vary widely, even within the same city. A free search service could help families locate communities that fit their budget.

Help Qualifying for Medicaid Long Term Care

Diversity of Medicaid Planning Assistance Options Can Confound Applicants

For those seeking long term care assistance from Medicaid, determining eligibility is challenging and the application process is daunting. Couple this with the fact the person completing the application paperwork is very often doing so on behalf of a loved one for whom they are concurrently providing care. This combination of challenges can make the process of obtaining Medicaid assistance almost insurmountable.

Fortunately, Medicaid planning assistance is available. Unfortunately, there is such a diversity of individuals and professionals who refer to themselves as Medicaid Planners that one more challenge exists for caregivers: determine which form of Medicaid planning assistance is right for your situation. Some planners provide services free of charge and others are fee-based. Some are public employees; others are employed by for-profit organizations. Some will refuse to provide assistance if the applicant's income or assets are too high and others will refuse if they're too low. To say it is confounding is an understatement.

It is not an exaggeration to say one needs assistance to determine the type of Medicaid planning assistance one needs. Here we provide that assistance—to direct persons seeking Medicaid planning assistance to the appropriate resource for their needs.

Getting Started

Photo by Nathan Pfau

Our organization has identified seven different categories of professionals who provide assistance helping families with the Medicaid application process. Start by considering which one of these groups best describes your financial situation:

 

Group 1

1. Applicant's monthly income is less than $2,000 or $3,000 if married.
2. Applicant's total financial assets, not including their home, are valued at less than $2,000

Group 2

1. Applicant's monthly income is between $2,000 - $3,500. If married, joint income is greater than $3,000 but less than approximately $4,500.
2. Applicant's total financial assets, not including their home, are valued between $2,000 and $50,000. If married, combined assets are valued at less than approximately $115,000.

Group 3

1. Applicant's monthly income is greater than $3,500 or, if married, joint income is greater than $4,500.
2. Applicant's total financial assets, not including their home, are valued at more than $50,000 or if married, combined assets are valued at less than $115,000.

Group 1

Applicants in Group 1, very likely, already meet their state's financial eligibility requirements for Medicaid long term care services. This means they will require no assistance qualifying or simply administrative assistance managing the Medicaid application paperwork. There are multiple sources from which they might gain help at no cost.

• Area Agencies on Aging - there are a network of over 500 local area agencies on aging throughout the country. These agencies employ Case Managers / Benefits Counselors who help applicants to understand the Medicaid application process, gather the necessary documents and fill out the paperwork. Typically, each agency has responsibility for multiple counties.
• County Medicaid Offices - Each county has an office responsible for managing Medicaid. Administrators may be available to help with the Medicaid application or they may refer you to the local area agency on aging.
• SHIPs Counselors - These are volunteers who provide free counseling, usually over the phone, on Medicare and Medicaid benefits. They are perhaps better used to answer specific questions one might encounter while filling out the application, rather than guiding you through a Medicaid application process step by step.

 

Group 2

Applicants in Group 2 may already meet their state's Medicaid eligibility requirements, or they may qualify through a Medicaid Spend Down program or their assets and incomes may require some minor financial re-structuring in order to meet Medicaid limits. Because their status is uncertain, they may compromise their opportunity to qualify for Medicaid by seeking assistance from a state employed individual. Therefore, the prudent approach is to seek outside (non-public) assistance, even though they may have to spend money out of pocket to do so. It is worth mentioning that for most individuals the money they spend out-of-pocket on professional assistance is money they would have otherwise have been required to spend on care through a Spend Down program. There are multiple avenues of assistance available; each with pros & cons.

• Geriatric Care Managers - Care managers are professionals hired to manage all aspects of caring for an aging loved one (except providing hands-on care). As such, most are familiar with Medicaid and the planning and application process. Care managers typically bill by the hour and could provide as much or as little assistance as is required for any applicant. Using a Care Manager for Medicaid application assistance is best suited for those families who also require care management assistance.
• Eldercare Financial Planners - Financial planners specializing in eldercare can also be proficient in Medicaid planning. These professionals are best suited for those with broader financial planning goals which include but are not limited to qualifying for Medicaid.
• Fee-Based Medicaid Planners - These are dedicated professionals who specialize in helping families gain approval for Medicaid long term care and nothing else. They bill a flat fee for their services and can be very efficient in their processes. These are best suited for families whose sole goal is to gain Medicaid approval.

Group 3

Applicants in Group 3 have both incomes and financial assets that are higher than Medicaid's limits. These individuals may not be able to afford their cost of care, especially on a long term basis, but they still do not qualify for Medicaid assistance. These candidates are typically hoping to prevent becoming impoverished in order to gain Medicaid benefits.

• Elder Law Attorneys - Using a lawyer for Medicaid planning is probably the most expensive option but the expense is justified when a variety of complicated scenarios exists. For example, when the applicants are significantly over the limit and they have considerable assets they wish to protect or when a special needs trust is being set up for a family member. Another example is with married couples where only one spouse requires Medicaid and the other wishes to continue living independently.
• Eldercare Financial Planners - Financial planners specializing in eldercare are also a good option especially when the financial planning needs extend beyond simply planning for Medicaid as is likely the case for families in Group 3 with higher net worths.
• Commission-Based Medicaid Planners - Planners who work on commission are mentioned with a word of caution. These individuals make commissions from the sale of Medicaid compliant annuities and trusts and will usually only work with those with higher countable assets. They do not charge their clients. As such, their primary motivation is to sell financial products not to gain their client's access to Medicaid services. Their interests are not aligned with those of their clients. That said, they can still provide a valuable service but potential candidates must proactively look after their own interests.

Do you or your organization provide Medicaid planning services? Do you agree with our assessment? Have we missed any types of assistance providers? We welcome your comments.

What can I do if I have too much income or resources to qualify for Medicaid?

Financial products to help qualify for Medicaid

Medicaid, the Federal program for the care of the disabled and elderly poor, has strict eligibility requirements: the individual applying for Medicaid must have very low income and little assets. The exact numbers and rules will vary in each state. (To learn more about using Medicaid to pay for eldercare in general, see our article on it.)

In some cases, though, an individual who exceeds the income and asset limits by a relatively small amount may be able to qualify by using financial products to ‘lower’ their income by putting the excess money in an account that limits its use to only certain expenditures. This has created a market for products and services to help people who need assistance to become eligible.

 

Too Many Resources or Savings

If you are over the asset limits for Medicaid, you can’t just give away the excess as Medicaid examines past financial transactions for up to 60 months preceding application.  

 

Photo by

John Patrick Robichaud

To help meet the assets limits, Irrevocable Funeral Trusts are an option for some individuals who have less than $15,000 over the eligibility limits. It is important to note that these trusts must be irrevocable. 

Some might wonder why use an Irrevocable Funeral Trust to pay for a funeral. Beyond helping to qualify the individual in need of care for Medicaid, these products also have some other benefits. Instead of pre-paying a funeral home, there is no need to select and plan in detail for a funeral in advance. Also, an irrevocable funeral trust can include the travel expenses for family members who come to the funeral. However, despite these advantages, an irrevocable funeral trust is not for everyone. Learn more about irrevocable funeral trusts in our full article on them. 

Medicaid Qualifying Annuities are specially designed annuities that help couples where one spouse requires care and the other does not. In these cases, Medicaid rules would otherwise force the well spouse to spend  most of their joint assets on the long term care of the other spouse, leaving him or her with limited resources on which to live. In order to avoid this situation, Medicaid state rules allow the couple to create an annuity from the couple’s assets and name the well spouse as a beneficiary. Find out more about how a Medicaid planner can help create a qualifying annuity.

 

Too Much Income

Similarly, an individual can be disqualified for Medicaid due to an income that is too high. However, here again, some products have come in existence to help address the situation for certain individuals and couples. 

Qualifying Income Trusts, Qualified Income Trusts, or Miller Trusts help individuals overcome the income cap. In some of states, known as ‘Income cap states,’ there is a cap, or maximum on the amount of monthly income someone can have. While this amount will vary in each state, in 2014, $2,163 per month is the highest state income cap and, in some states, it is less. Income over the Medicaid limits is secured in a trust to ensure it’s used on the care and medical needs of the individual. 

‘Medically needy states,’ without an income cap, look at the income of the individual and require that it be spent down by needed medical and long term care expenses before qualifying the individual. Find out which Medicaid financial criteria apply in your state.

Additionally, nonprofit organizations operate Pooled Income Trusts. These jointly managed trusts have lower administrative costs by pooling together many qualifying individual trusts within the state. These are often used in the case of disabled persons, but elderly can also qualify if all transfers take place before the age of 65. Special Needs Trusts have a similar application, but are not pooled and managed by a nonprofit.

 

Get Help

For both income and asset qualifying products, Federal rules are complex and state rules also matter and vary widely. For example, sometimes one might encounter products known as a ‘Medicaid Qualifying Trusts,’ which are, in fact, no longer compliant for Medicaid. 

Find out more on our site and seek the services of a professional Medicaid planner and/or elder law attorney when you are ready.

Getting Paid for Caring for an Elderly Loved One with Medicaid

Update Sept. 2015 - Our organization has released a Paid Caregiver Program Locator which allows families to search for programs that can be used to pay them as caregivers.  Start here. 


There are a variety of ways to help bridge the financial gap when caring for an elderly loved one. One of the most attractive approaches is to be paid as a family caregiver. For many families, this option offers two distinct advantages: receiving a new source of income while also ensuring the quality of care that your loved one receives.

In this post, we explain how Medicaid can provide this type of funding. If you are interested in the other, non-Medicaid based programs to get paid for care giving, please see this blog post (“Five Ways to Pay Family Members as Caregivers”).

Photo by the Abbeyfield Kent Society.

Overview

Medicaid, a federal program that is administered by the states, operates a series of programs referred to generally as ‘Cash & Counseling.’ The National Resource Center for Participant-Directed Services oversees the states’ Cash and Counseling programs. Other names include as Consumer Direction, Participant Direction and Self Directed Care. Most states have these programs under their own Medicaid waiver programs. They exist with a variety of names, such as Colorado HCBS Waiver for the Elderly, Blind, and Disabled and the New Jersey Personal Preference Program. See the full list here.

Program Description

At their most basic level, these programs provide cash to the participant and allow them the choice as to how best to spend it on their care. Participants can select their own home care agency, which may be someone from their own family. This means that the adult children and, in some cases, the spouse of the recipient could be hired as a caregiver.

When an individual is already enrolled in Medicaid or eligible, the agency will begin with a visit to the home of the senior to understand their needs. They will also contact the recipient’s caregivers and doctors. Once the agency has made a decision how much care is needed, a specific funding benefit is made based on the need and the regional cost of care. The benefit amount can change as the recipient’s needs change.

Most programs consider the situation where the care recipient needs a ‘surrogate’ to help them make care provider decisions. In these situations to avoid conflicts of interest, the care decision maker should be different from the individual who is employed as a caregiver.

Because the caregiver will actually become an employee of the senior, in some states, a third party organization might be required in order to make sure that payroll taxes are filed if those payments are above a minimum level where taxes are due.

Eligibility

• The care recipient must be enrolled in a Medicaid consumer directed waiver. Sometimes Medicaid waivers are oversubscribed and individuals will be placed on a waiting list.  

• In most states, individuals must be 65 and/or disabled. Participants with Alzheimer’s, who require nursing, or who require assistance with the activities of daily living are medically eligible.  
• Participants must be a resident in one of the states where these programs are available. See our list of the state programs for detailed information on your state program.

Understandably, getting paid to provide the care that many family members are already providing is an attractive option for families. However, the programs can be complicated. For people who are considering applying to Medicaid for the first time, a Medicaid planning professional can help. 

Learn More

Individuals wishing to learn more about how these programs can be accessed for your situation should visit our website for the full article on the Cash and Counseling programs and to find out more the program in their state.

New Products Help with Eldercare Financial Planning

As the ‘Age Wave’ Approaches, Private Business Steps in with Eldercare Financial Products

With Baby Boomers nearing retirement age and with many of their parents already needing aging care, private businesses are creating a series of new financial products to help families pay for care and aging related products. Over the past ten years, the market has seen the emergence of a variety of products serving the aging market that can be grouped into three categories. First, there are products that help families to convert assets to pay for care. Second are the loans specifically designed to meet the needs of families facing a paying-for-care challenge and the third is the financial products that help families to meet Medicaid's ever-changing, eligibility requirements.

Asset Conversions

Many families have significant financial resources tied up as assets that, in this non-liquid state, cannot be used to pay for care. Usually, the asset is their home. Reverse mortgages have been available since the 1960s. However, it was not until the late 80s when the government stepped in with regulation and consumer protections, that reverse mortgages gained in popularity. Today, there are what can best be described as private reverse mortgages that allow homeowners to receive a portion of their homes' value in cash without the same upfront costs as a reverse mortgage.

EquityKey and Rex Agreements are two examples that allow homeowners to receive cash immediately by selling a percentage of their home's future appreciation.  This clever idea enables participants to both receive cash, while continuing to hold 100% of their home's existing value. These products are best suited for persons who wish to age in their homes and might need to make home modifications to do so. Learn more from the EquityKey article and the Rex Agreements article on our website.

NestCare is another option, while still in development, this product is a more consumer friendly version of a reverse mortgage except the home is actually being sold in one month, one percent increments.  Even after 100 months, or over 8 years—a complete sale—the homeowner maintains the right to live in their home indefinitely.

Like homes, life insurance is another "asset" that can now be used for pay for care while the policyholder is still alive.  Life settlements involve selling the death benefit of a life insurance policy for a portion of the benefit amount.  This concept, which is also referred to as viatical settlements, began in the 1980s. However, the newer financial products associated with life settlements are designed specifically to pay for care and do so in a manner that allows the policyholder to become eligible for Medicaid should the funds from their life insurance settlement become exhausted. These Medicaid life settlements are being pioneered by an organization called LifeCare Funding. The concept is looked on so favorably that the state of Texas passed a law that requires Medicaid applicants with life insurance to be informed of the option. Several other states are expected to follow suit with their own versions of the law. Learn more about converting a life insurance policy to help pay for long term care on our website.

Eldercare Loans

Loans intended specifically for eldercare became a reality several years ago.  However, the best model for them is still being fashioned given the challenges associated with lending money to someone in failing health. The current version of eldercare loans are made on a short term basis when the borrower is expecting an alternative source of funding to become available.  It is quite common for the need for eldercare to come unexpectedly and families may wish to borrow money for assisted living, for example, while waiting for a home to sell.  Another very common scenario is when one is waiting for veterans' pension benefits.  Elderly veterans and their spouses can receive several thousand dollars per month for care but the application process can take 6 - 18 months.  Once approved, the benefits are retroactive to the date of application, resulting in a lump sum payment. Eldercare loans are given knowing a lump sum payment is forthcoming and the loan can be repaid from that lump sum. Lear more about eldercare loans on our website.

Annuities and Trusts

The third category of financial product specifically intended to help families afford eldercare involves annuities and trusts that enable families to qualify for Medicaid or veteran's pensions.  Both Medicaid and veterans' pensions provide significant financial assistance for care but both programs have strict financial eligibility requirements that take into consideration both the applicant's (and their spouse's) monthly income and their financial assets.  Pooled income trusts, a financial product sometimes managed by non-profit organizations, provide a way to lower one's monthly income in order to meet Medicaid or the VA monthly income requirements. Irrevocable funeral trusts enable a way to pre-pay for one's funeral expenses while at the same time lowering one's overall assets to meet Medicaid and VA asset limits. Medicaid and VA planning annuities achieve this same purpose; they convert assets that would otherwise disqualify the applicant into income that can be used for ongoing care. Often a Medicaid planner can best advise families on how to best make use of these products. Learn more about how a Medicaid Planning works in this article on our site.

Given the already high and ever increasing cost of eldercare and the massive number of Americans expected to require care over the next 20 years, we expect to see the amount of private financial products addressing this market to continue to grow.

Comments

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The Case for Adult Daycare Extends Beyond Costs

Adult Daycare provides a low cost alternative to nursing home care while maintaining the senior’s health and connection to home.

Somewhere between 25 - 35 percent of seniors will require nursing home level of care at some point during their retirement. Nursing home care costs approximately $77,000 per year. Most Americans cannot afford $77,000 per year in care costs even if they sell their homes and everything in them. This means Medicaid (the federal government entitlement program) will continue to fund the majority of nursing home care.

Photo by Univ. of the Fraser Valley. A happy participant at the Pleasantview Care Facility.

The Baby Boom Generation are starting to retire and many will require nursing home level care over the next 20 - 30 years. Even though there is a declining percentage of seniors in Medicaid funded nursing homes, we face a looming care funding crisis. The demand for elder care is expected to triple by 2050.

Enter adult day care. Full-time adult day care, 5 days / week for a year costs approximately $18,000. This is less than one quarter of the cost of nursing home care. If there were such a thing as 24 hr adult day care, it would still be less expensive than nursing home care by 10%.  Approximately, two-thirds of nursing homes are private, for-profit companies. The opposite is true with adult day care: just over one-quarter are private, for-profit organizations.

Photo by Univ. of the Fraser Valley. One girl twirls around a senior in a wheelchair
 as part of the final dance at the Pleasantview Care Facility.

While the American Elder Care Research Organization focuses most of our research on costs and financial options, we believe that the reasons to consider an adult daycare program as an alternative care go beyond just the economic. Surveys show that over 90 percent of Americans want to grow old living at home, even if they require long term care. Adult day care allows them to do so. If not in their own homes, then in the homes of family members. The staff to patient ratios in adult day care and nursing homes are surprisingly similar; about 1 to 6 in both.  Adult day care also provides recreational activities and social interactions, both of which improve health outcomes and can further reduce the need for care.


For help discovering financial assistance and adult daycare programs near you or to read about state Medicaid policies visit our page on Adult Daycare.

5 Ways to Pay Family Members as Caregivers

Update Sept. 2015 - Our organization has released a Paid Caregiver Program Locator which allows families to search for programs that can be used to pay them as caregivers.  Start here.

Without question, the most common question our organization is asked is: "Can I get paid to provide care for my parents (or spouse)?"  On own website, we maintain a list of programs that offer that option to family caregivers, but as some new options have become available, we thought a blog post overview of all five different ways family members can be paid as caregivers of their elderly loved ones was in order. 

1) Medicaid Waivers

This is the most common and well known option.  Many states have Medicaid Waivers that allow participants to receive care at home instead of in a nursing home.  Some of these waivers allow for self-direction of care services.  This means the participant is free to select their care providers.  They can "hire" their adult children, other relatives or a few states, their spouses to provide them with personal care.  Relatives are paid the Medicaid hourly rate for home care.  Medicaid Waivers have enrollment caps, so only a limited number of individuals can participate through this option.

The exclusion of spouses in many states from being paid has led to an unintended consequence of some divorces.  While there are rules prohibiting spouses from being paid, there are no rules that prohibit former spouses.

See our website for a state by state guide of the Medicaid programs. 

2) Medicaid Personal Care Services (PCS)

Approximately 50 percent of states allow for personal care services in their Medicaid State Plans.  As with Medicaid Waivers, some of these programs allow for consumer direction of personal care providers enabling participants to hire friends and family members to provide them with personal care. 

These PCS programs differ from Medicaid Waivers in two key ways.  First, typically Medicaid Waivers have less restrictive financial eligibility requirements than PCS programs.  It is not uncommon for the monthly income limit for a Waiver to be approximately $2,130, while Medicaid PCS programs might be closer to $800 - $1,000 / month.  Second, because these programs are offered through the Medicaid State Plans, they are entitlements, unlike Medicaid Waivers which are not. 

3) State Based Non-Medicaid Programs

There are also non-Medicaid consumer directed care programs.  Unfortunately, a much fewer number of states offer these programs.  During our most recent survey, we found 12 states offer consumer direction in their non-Medicaid assistance programs for the elderly. 

4) Veterans Directed Home and Community Based Services

The 4th option is for veterans and their spouses only.  Similar to Medicaid Home and Community Based Services Waivers, there are Veterans Directed Home and Community Based Services.  Under these programs veterans, especially those living in rural areas, are given the flexibility to select what cares services they require and whom shall provide them.  Family members and friends can be hired to provide personal care.

5) Medicaid Life Settlements

Also referred to as Life Care Funding Plans, this is the newest way family members can receive payment for caregiving.  The approach is for holders of life insurance policies who require ongoing care and are considering Medicaid as a long term solution. 

Medicaid counts life insurance policies as assets and generally persons with these policies cannot qualify.  A Medicaid Life Settlement allows the individual to convert their life insurance policy into a dollar amount of care services.  That money is put into an account and used to pay for care for the policyholder.  It can be used for any type of care such as home care, assisted living or to make home modifications that help seniors maintain their independence (walk-in tubs, wheelchair ramps, stairglides etc.). 

It can also be used to pay family members for the care they provide.  For example, a spouse with Alzheimer's may require 24 hour supervision.  They might go to adult day care for 8 hours on weekdays and be looked after by their spouse for the remaining time.  The spouse could be paid the hourly Medicaid rate for the caregiving. 

The account that holds the money is a Medicaid qualified spend down, so when the funds are exhausted the individual is in a very strong position to qualify for Medicaid.

To learn more about each of this option and discover other sources of funding please explore our website.