Sunday, March 13, 2005


“Show me the money …” is unquestionably the major determinant for availability of health care in the US. MS because it is traditionally a disease of middle age catches a person or family usually right in the economic middle. If you are independently wealthy or if you are below a designated poverty level you will have more access to long term care options than someone stuck in the middle will.


Bottom line you have to get out of the middle. A lucky year in the stock market or your lottery ticket could rocket you into the independently wealthy category. 


The best alternative of them all would be a LTC (Long Term Care) insurance policy. However, as you are already diagnosed with MS, I suspect this is improbable.


More than likely you will have to turn to Medicaid and ‘spend down’. Every State is different regarding Medicaid guidelines. You need to sit down with an Attorney and/or Financial Planner specializing in Elder Care Law and develop a Medicaid asset protection plan.


Do not confuse Medicaid and Medicare. Medicare is medical insurance and will be discussed in a following summation post under insurance. Medicaid is medical assistance and that's what this post is about.


Medicaid application and approval is based on a ‘look back’ period of your family financial assets. Our mistake was waiting too long to try to maximize asset protection. Need was upon us faster than planning anticipated.


The catch is you never know when you are going to NEED Medicaid. Asset protection on the other hand is based on the years PRIOR to your application. Unless you are psychic, NOW is the best time. GO vist an Elder Care Attorney in YOUR State and talk  .... Or buy a subscription to the Psychic Hotline and ... believe! 


Will you really ever need medical assistance?


Let’s look at Patti’s costs specifically for a 24/7 care facility. If a million dollars in out of pocket cash over the next 15 years is nothing to you than just ignore this. If not then read on ...


Daily costs

$ 191 (24/7 attended & custodial care) room & meals

     15 RX

$ 206 


$206 a day extended out is $75,190 a year. Minus what Patti receives from Social Security that leaves a balance due of $61,150.  I cannot raise a daughter, pay a mortgage and keep our home PLUS come up with an extra $61,150 out of pocket cash to pay for 24/7 care. We had no choice but to turn to Medicaid for help.


Additionally Patti and I knew that too much of her care was dependent on assumptions of my immortality and invincibility. It was time to ‘lock up’ her future care. With fading mental and physical health she wanted to at least participate in the decision making process.


Our paperwork and application process took almost 5 months to complete through approval; the picture demonstrates the size of the paperwork involved.  


I referenced ‘spend down’. Again each State is different, but in general it is economically catastrophic. In a nutshell you liquidate family assets to 'spend down' on medical expenses until you are below poverty levels to become eligibile for Medicaid.


The dreams and financial plans of a life time disappear. But then again MS has already begun to erode them anyway. I discovered that dreams built on a foundation of money wipe away as easily as images on an Etch-a-Sketch screen. There are moments when I wonder if I'm not in the middle of some Old Testament kind of lesson about something. Frankly it all still leaves me reeling at times.


More importantly, the PLUS is that Patti is secure, safe, and has 24/7 carefor the rest of her life. Some days I have to keep reminding myself of that positive outcome. And when you add it up, it is an extraordinary safety net. MS is not an acute killer. At 49, Patti could easily live to 65 and beyond. At just 2005 costs (not including inflation) that will be a million dollars in out of pocket care giving costs over the next 15 years. And as we all get older, as Patti progress, and care giving becomes even more physically demanding what other tolls would it take on others? We knew we had to move in this direction sooner than later.


Caregivingly Yours, Patrick Leer

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