Site icon John R. Frazier J.D., LL.M., MBA

Medicaid Planning for Assisted Living versus Nursing Home Care

Attorney Joe Pippen Interviews Attorney John Frazier

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Radio Interview Transcript for: Medicaid Planning for Assisted Living versus Nursing Home Care 

Attorney Joe Pippen:    All right, let’s go to attorney John Frazier on the line. John is our Elder Law attorney who handles Medicaid planning, VA, and other Elder law issues for the firm. Good morning, John.

Attorney John Frazier:   Hey Joe, how are you doing today?

Attorney Joe Pippen:     I’m doing good, and you?

Attorney John Frazier:   Doing great.

Attorney Joe Pippen:     So what’s the topic, what’s the Medicaid tip of the day?

Attorney John Frazier:   Today I was going to talk about (Medicaid Planning for Assisted Living versus Nursing Home Care) the difference between Medicaid planning for a resident of a nursing facility as opposed to an assisted living facility. There are some very important differences, there are also some significant similarities.

About 90% of my clients are long-term residents of a nursing facility; about 10% are assisted living residents. The major similarities are that the criteria for qualification are pretty much exactly the same. The asset restructuring strategies to obtain Medicaid are pretty much exactly the same, but there are some very, very significant differences, and this is the reason why so many of my clients are residents of nursing facilities rather than assisted living facilities.

I think the biggest difference and problem with assisted living Medicaid in Florida is that we’ve got a very significant waiting list for assisted living Medicaid. It could take a year or two years, sometimes, for a person’s name to come up on the waiting list.

The procedure is that, when you’re looking to apply for Medicaid in an assisted living facility, you have to call the Area Agency on Aging as a very first step and have the person’s name put on the waiting list to complete a form called a 701S screening form.

If the person does not get a score of a five on the screening form, let’s say they get a score of a three. They’re probably going to be put on an indefinite waiting list. However, if they get a score of a five on this screening form, then the waiting list will probably only be 30 to 60 days for assisted living Medicaid.

This is where it’s very important to speak with an elder law attorney about this waiting list process because if you just call in without legal guidance, most of the time you’re going to get a score of less than a five. However, if you speak with an elder law attorney who’s skilled in working with this process, it greatly increases the chances of getting a score of a five and reducing the waiting list.

Another significant difference is that the state of Florida pays quite a bit more for Medicaid in a nursing facility. The average cost of care is about $9,500 a month in a nursing facility; I’ve seen some facilities charging $17,000 a month in the Tampa Bay area. Assisted living facilities only charge between $2,000, and I would say $7,000 a month on average, so they’re a lot less expensive.

The other thing about assisted living Medicaid, a difference, is that the average reimbursement from the Florida Medicaid program is only about $1,000 to $1,400 a month in excess of the person’s monthly income. Therefore, if you take the example of a person having $1,000 a month in social security, Medicaid would cover the entire cost of the bill at any nursing facility in the state of Florida, if the person were on Medicaid.

However, for an assisted living facility, the government’s only going to pay between $1,000 and $1,400 a month, so that’s another very significant difference and accounts for the reasons why so many of my clients are residents of nursing facilities rather than assisted living facilities. That’s a basic overview of the two.

Attorney Joe Pippen:     John, there are some other places that just have names like “memory care”, they don’t tag themselves as assisted living or nursing homes. So, how would a facility that called itself memory care division or unit, how would they generally be classified? A nursing home?

Attorney John Frazier:   No, generally speaking, that’s assisted living. And that’s a perfect example of the confusion that many of my clients have when they call us. I’ll have clients call me and say, for example, “My husband’s been in memory care and we need to apply for Medicaid.” And I tell them, “Memory care typically means assisted living, which means waiting list.”

I’ve had several clients insist that they’re in a nursing facility, and then I’ll ask them how much they’re paying per month: “$6,000 a month”. And right there, that tells you it’s an assisted living facility because the average cost of care in a nursing facility is $9,500 a month.

This is a critical issue to determine right at the beginning because if you apply for Medicaid and you haven’t gone through that waiting list process, the case is going to be denied. So it’s critically important to know whether it’s a skilled nursing facility or assisted living facility.

The state of Florida has different licenses for each of these. We can determine, in each county throughout the state of Florida, from the Agency for Healthcare Administration, what the classification is. But if a person says “memory care”, it has always been assisted living.

Now, if they say lockdown unit, that typically means a skilled nursing facility, but memory care is almost always an assisted living facility, meaning a waiting list. So it can be very, very confusing.

Attorney Joe Pippen:     Is there a difference between a nursing home facility and a skilled nursing home facility?

Attorney John Frazier:   No, they are the same. And this is another thing that can be very confusing. If a person is discharged from a hospital and sent to rehab, that’s a nursing facility. That’s another way to determine the difference between the two because rehab only occurs, and it’s up to 100 days under the Medicare reimbursement, only in a nursing facility, meaning that we can apply for Medicaid right away and not worry about the waiting list issue.

But these terms can be very, very confusing for the public. A skilled elder law attorney is going to know the difference, but the public is generally not. It can be very, very confusing.

Attorney Joe Pippen:     All right, John, someone out there listening would like more information and would like to learn how to protect their assets and maximize government benefits. How would they contact you? Please give your information.

Attorney John Frazier:   The office number is (727) 586-3306, extension 104. My cell phone is (727) 748-5374. And my email address is john@attypip.com.

Attorney Joe Pippen:     All right, for you listening out there, you don’t have to spend down all of your assets. They can be protected to a large degree. You can maximize government benefits. You need a skilled Medicaid attorney, elder law VA attorney to assist you. Mr. Frazier works with our firm, he’s had thousands of these cases. So whether you use John or someone else, you can really save a lot of money and protect yourself and maximize government benefits. John, thank you so much for being on the show this morning.

Attorney John Frazier:   Thank you and have a great Sunday.

Attorney Joe Pippen:     All right, you too.

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