How To Qualify For Medicaid to Pay For Long Term Care in Washington State.

Hi friends, my name is Jim Freeman, founder of Silverbridge Senior Transitions, a certified senior transition specialist. We provide immediate resources, guidance, and solutions to seniors and their families in the process of changing life circumstances in Pierce, King, Kitap, and other counties around Puet Sound. You know what this means for Sam families who are facing an immediate crisis. Maybe they're in a nursing facility or maybe they're in the hospital. They're going to get an immediate plan to to leave that hospital and and uh the resources and the skilled professionals to help them do that. I'm a managing broker with Coldwell Banker Park Real Estate. In the case where a discharging patient owns a home and needs to sell to pay for long-term care, we provide transition loans to pay expenses before their home sells. We work closely with all of our vetted categories of network professionals to address any need of the senior whether they remain at home or move to a higher level of care. And so today I'm very happy to be joined by one of those vetted experienced professionals really a key a key uh resource for you know any senior in changing life circumstances. Not everybody uh will need uh Medicaid to pay for long-term care, but some will. And in my experience, having done this with dozens and even maybe hundreds of seniors, uh we should all plan for it. And so today I want to introduce uh three of my close friends, Carolyn and Ian Horler. Uh their company is called uh to homeless specialties consulting and they have an associate Bert Reynolds. No, not that Bert Reynolds, but Bert Reynolds who is uh also an expert in the in the Medicaid field. And I want them to explain who they are, what they do. But before they begin, uh, uh, Ian in particular was the director of, uh, unit with the Washington, state of Washington government who was in charge of approving people for their applications for Medicaid for long-term care insurance. Uh Carolyn was uh she calls herself a policy wonk. Uh but she was also an expert in uh in dispersing or approving applications for SNAP uh which is a you know food benefit program for seniors and other people. Bert, what exactly did you do in that in that uh constellation

for long-term care services? And um of course I approved or um denied applications for long-term care services, but I was the administrative hearing specialist, which meant I was the representative for the department and a representative for the clients up until the hearing. So I actually picked apart the cases and made sure that they met the Washington State Administrative Code um for approval or not approval. and I helped walk families through the process for um administrative hearings.

Okay. And Ian, do you want to give a brief description of what you did?

I got into the business uh and was in the welfare or uh assisted programs for 40 years. In the last 17 of them with the state of Washington, I was working as the subject matter expert for region three, which goes from Pierce County all the way down to Clark County all the way out to the coast and included the entire peninsula. and I answered questions for attorneys, for guardians, uh for um anybody who had questions about their case, family members, their representatives, and I helped resolve them before they ever got to BERT with an administrative hearing. I made sure that things were done correctly, just like Bert did, and tried to avoid uh the issues that a lot of times happen because a worker missed something. And that's what I I did. And when I retired, I decided that no one was replacing me. And as a result, I opened this business up so that we could continue doing this for people because there's a tremendous need. Uh I have lots of clients we've already dealt with and their issues are that they don't know how to uh apply for long for long-term care, Medicaid, and they don't know what the requirements are. Well, I heard from a friend who said that he knew somebody who said something And so there's so much misinformation and that's why we got into this to prevent the misinformation and help people transition into Medicaid long-term care.

Okay, good. All right, Carolyn, how about you? What uh what what what did you do and what's your particular expertise?

I spent most of my career in Washington state in uh food stamps in SNAP, but when I started it was called food stamps. Uh first as a case worker approving and denying benefits and that sort of thing. And then I got picked up by our quality control team. I was a manager with them and uh training our reviewers on the latest uh federal requirements, um going to conferences, giving presentations, uh being on calls with the federal uh representatives, that sort of thing. Then I went on a uh developmental job assignment for about two and a half years working as an internal auditor which was absolutely fascinating. And then after that ended because it was only a a short time you know just two and a half years then I joined the uh SNAP policy team and I was a policy manager with them. I viewed that as more of a support role because people needed to have the information. They needed to have clear instructions. I needed to make sure that they knew how to do their jobs. So, mine was a support role.

Okay.

We retired.

All right. Well, so uh you know si at Silverbridge uh and and my vast staff of people that I work with not um you know what what I find is exactly that when I when I first encounter a senior's a senior couple or senior individual or their families uh they you know they they don't really even know where to start. They don't even know what the right questions are. Uh there are a few people who plan ahead you know and have the resources to do that but it's not very often uh and uh this you know very often you know uh a home or other assets are what they have to pay for long-term care. Some people may have a lot of home equity. They may have some investments. Not not very many. Uh but most people, most families or individuals, it's really their home equity that that they're going to have to liquidate to pay for long-term care. And uh uh Ian, what in particular, you know, do you know about that? If somebody has, let's say, a couple hundred,000 uh of equity that we can that we can liqufy to use for their long-term care. What's the problem with assuming that you have a lot of money that you're going to be able to pay pay for private pay for long term?

Well, part of the problem is a lot of the facilities now are asking for two or three years private pay and they run anywhere from $8 to $15,000 a month. So even if you have equity in your house, $300,000 at, you know, $10,000 a month, it doesn't take very long for that to go through. So, we help people look at the long term of how they're going to transition from that period where they can private pay to where they actually have to have Medicaid, long-term care, and things they can and cannot do to protect themselves cuz we have people who make mistakes and the department is not very forgiving of those mistakes when when you apply for Medicaid. Um, for instance, putting the house into a a trust sounds reasonable so that your children can get the house without going through probate, but for Medicaid, it creates a whole host of problems which can be avoided. Or deciding that you want to give your grandchildren each $50,000 for their for their education. Great thing to do, but not when you're doing Medicaid because there's a five-year look back by the department and they're going to look at why did you give this money away? And the assumption is it's to become eligible for Medicaid or to avoid a state recovery. And that's up to the individual or their family to prove to the department that that was not done for either of those reasons. So that's where we come in. We help people plan for the future. There are some who are going to go on Medicaid right away because they just all they're living on is uh is on their social security and a small retirement. those folks. We help get them onto Medicaid as quickly as possible. We help people go through the computerized application process so that they can have a way of getting into the system right away rather than doing paper, which I always discourage. And then what the process itself is going to be with talking to a financial worker on the phone and then later on it's going to be talking to a social service specialist who's going to do an assessment of that person in person and those kind of things and we go over the kind of questions they ask because what they're looking at is what help does that person need and what level of help do they need? Do they need help in home? Do they need hope? Uh help to go into an adult family home or assisted living or into memory care, long-term uh the uh skilled nursing facility. And we help the family know the kind of questions and how to answer them because a lot of times for inh home, the question would be, uh do you need help getting out of bed? And and oh no, no, the the daughter says, oh, I I help them. Yes, they work 5 days a week and they're only there on Saturday and Sunday, but they want to look helpful. And that's the wrong answer to give because it reduces the number of hours that would be available for them to be in the home and have somebody helping them. So, that's what we do generally as a business is we help people fill out the forms to understand what they're asking about, what to look for. There's a five-year look back. the department uses uh a u an automated verification system which they call ABS and what that does is give them a print out of all the banking information in the in the area on their bank accounts and it's looking for anything that's unusual over the last 5 years paying a mortgage or paying rent that's standard it's not going to click out but if there's suddenly a $5,000 payment that's jumps out then they're going asked the client, "What was that $5,000 for?" And it could be, "Well, I had um a leak in the roof and I had to have it fixed." Well, now you're going to have to go back to that month and if you have the receipts, which most of us don't keep, you can go to the bank.

Oh, why would we? Yeah.

Exactly.

Yeah.

You go you go to the bank and you get that month and you can see Charlie's roofing company, $5,000. So, it explains it and the department will accept that.

All right. Well, so you you uh you in your job as as a senior official uh you did that and uh and and BERT was mopup when people uh made mistakes and they had to go for a public hearing. Uh what can you can you explain that process a little bit, Bert, and maybe why you don't want to do that?

Really, it wasn't mop up. It's um basically so as the administrative hearing specialist, I was like a lead worker over the financial services. So the people the bene the public benefit specialist. So if they had questions about cases, I answered those questions. I was kind of like the front line for answering questions for that and helping get cases approved or not approved. And so when they got to hearing was the last straw. Hearing was always it it was always at the time that you know either the worker didn't have the information, they didn't have the time, um wires got crossed. So, it's not really necessarily mop-up, but it was really more about making sure that everybody learned from that case because at the end of the day, whatever went on with that case was translated to the public benefit specialist so that we could make sure that the individuals that were being served were either receiving benefits that they were eligible for or were not receiving benefits. So, um yeah, a lot of help with that. I've worked with attorneys and guardians and um understanding, you know, there's a lot of times that cases come in and they have an authorized representative, they have a power of attorney, uh they have all this. And that was where mine was mostly gathering that and making sure that the case was correct as far as application review, those processes. That's what mine was. It doesn't not necessarily mop up. It was trying to help before they got to the hearing and then once they got to the hearing, making sure that everybody could learn from those cases and making sure that people were eligible to receive benefits if they were eligible. Um, that's where my piece came in.

Okay. Well, so uh who who can help a senior uh fill out forms?

Both of us. All

any of usbody.

Any of us.

Yeah, any of you. But, uh, how about people, you know, outside of your organization. Can Can people help?

Anyone can fill out the application for the client, whether it's a family member or a friend, any kind of relative, they can do that. It it's not a problem because there's a section there who, you know, who helped you fill out this form and you put your name in. And a lot of times uh I also put make sure if they're a DPOI durable power of attorney or power of attorney or uh have an authorized representative form filled out that that's put on the application. So that's who the department will contact first to set up the information because the financial worker does a the interview over the phone and they if if the family member that you're dealing with has advanced dementia or or Alzheimer's, they're probably not the best one to talk to about the case itself. Um I always used to tell people um most of the time they're in Egypt because they're in denial uh of the things going on around them and they want things to be normal. So they'll answer questions as if it's normal. Everything's normal, right?

But the people, you know, friendly people, caring people who are around the subject, you know, are not likely to be experts in uh the the rules and regulations and the approval process for for that particular type of aid. Uh so that, you know, leads me back to you. uh you know if I if I were trying to help somebody and I have in the past uh tried tried to help them fill out forms I'd want to know your phone number and have it on my hot dial because you know frankly you know I having done this with as you say dozens and maybe hundreds of seniors uh it's still always a mystery to me and the fact is that the the rules change all the time don't they?

they frequently change uh as changes come from uh from the federal office and then into the state office. So yes, the Washington administrative code changes. Um there's others that are automatically done which is the u the benefits levels are adjusted usually yearly. So those happen uh the amount that the spouse in the home can keep for themselves changes almost yearly. uh depending on what's going on. And so it continues to go up. The house to be exempt has to be under $1.3 million. It used to be a whole lot le less than that, but with inflation in the state of Washington, we know that the cost of housing has gone up. So that has changed. And people think that they're ineligible. Well, I I have a, you know, a 2024 Mercedes parked out in the driveway. Well, if it's your only car, it's not a problem because one vehicle is exempt. And people don't know that and they think they they feel like I I've got to I got to spend everything down in order to become eligible because they heard, well, it's $2,000. Well, that's true. It's $2,000 for the person in the facility or receiving services. But the spouse in the home depending on where the spouse other where their spouse is. It's $70 odd,000 that they can save for themselves plus 2,000 for their spouse. And if they're in an SNIF, then it's even higher. You can go up skil nursing skil nursing facility. It can go up to 150 just over $150,000.

All right. Well, so I I have another question though. Uh Medicaid isn't the only assistance available for seniors. Uh and this is kind of directed towards Carolyn. Uh can can uh Medicaid recipients receive SNAP benefits also? Or what about what about Medicare? What about VA aid and attendance benefits? uh how does how does one uh you know make their way through this maze of of uh agency help uh and how how to apply for all that?

Yeah, in many cases the person or the family will be eligible say the husband and wife still living at home um who needs some help but they're still able to you know prepare their own meals and things like that. They would still qualify potentially for for SNAP benefits. Um there's when you get into an older population, there's a number of other factors that come into play. Um but still there's every possibility that that they will. If one spouse is in a facility, the other spouse is still at home, that spouse may qualify independently as well. Uh but not if they're in a facility, not if half their meals are provided. And since usually three meals a day, it essentially means that you have to provide two of your of your meals. That doesn't happen in a facility. Uh so it is always possible. Uh Medicare and the VA aid and attendance can also play into some of this. Medicare uh not so much for the the long-term care part of the benefits, but just in the uh making sure that people have applied for it and that they have the uh the income that they're entitled to receive from it. Some people are very slow to apply for Medicare.

Yeah. Well, and it it seems to me that, you know, those are all government benefits. There's also long-term care insurance. Uh there's, you know, some people have retirement uh pensions, government p pensions or railroad pensions, all kinds of things. And the maze is extremely complicated. It it, you know, I myself, even though I have experience with it, would not want to approach any of that without, you know, some form of expert advice. And uh Ian and Carolyn and Bert, you all advise attorneys, don't you? who yeah who who who are paid to to provide estate plans uh for people and you know attorneys are human beings. We're all human beings. You know we we all make mistakes. Uh and that's why having a a community a real community of professionals who who are in this business have some knowledge uh specialized knowledge in one category or another but are but know each other and are willing to work together in the best manner possible to provide the best solution and answer for somebody in a crisis in particular. That's that's really important. Um so uh we're going to we're going toh cut this off here. We could probably go on for a couple of days, I'm sure, exploring all these programs, but I just want people to know that uh, you know, this is a team game. It's not there's no there's no one individual who can provide everything that's needed for people in a crisis or even doing your your estate planning properly. Uh, we're going to put contact information for Tacoma specialties consultants uh in in the text of this video that we'll have. We'll make it available to a lot of people uh and uh so so we will have your contact information but what what do you do to educate people into either individuals or groups or uh or companies or hospitals? What you know what services do you provide for training?

You want to talk? Well, we have uh several training opportunities that we've already created and several of them are approved for uh continuing legal education and we're working on making sure that the others meet the same requirements. Uh and they can go into everything from an overview that explains the uh the general process and what to expect down to those who might need it such as attorneys offer very very specific aspects of it. This is what uh constitutes a resource. This is income that may be counted. this is something that may not be counted. All of the little pieces in there, uh we can do a two-day training on on all of that for people. So, we range in everything from an hour as an overview of one particular section uh to a a very detailed two-day training.

May I add something else uh in here that kind of goes back to something we were talking about earlier?

Sure.

When we're talking about Ian and Bert's role in all of this and they were talking about administrative hearings, those come into play when the department takes an action against a client and the client says, "Hey, wait a minute. I don't agree with that or even wonders if was that action even right?" So, that's when they get involved to say, "Yeah, let's take a look and see if that action was right." because it's written into every single letter that goes out to the client that you have the right to request a hearing on anything that the department does if you don't agree with it. And it might even be that uh you're qualified for a certain number of hours of assistance and that's too low. It's an action that's against the person. So yes, you have the right to request that hearing. That's where they get involved.

Okay, cool.

And B is one of the best. She's got what is it, Bird? Like a 98% success rate on yours.

Yes. About a 98% success rate.

Yep.

Yeah.

Because all the problems are handled ahead of time. Mhm. And I also mention for what Carolyn was talking about our trainings, we have done them for facilities and assisted the general public and have and when people consult with us, we have a little handout to kind of help walk them through some of that. So, um, we have a a broad arrangement of services that can be provided to everybody from the general public to the loved one to the client to the attorneys to the guardians and so forth.

So, like you said, a community,

right? A community. So, uh, you know, at the end of our discussion here, uh, I see either one, two, three, four people on this recording and, uh, all of us, all four of us and other people that work with us spend quite a lot of time on the front end, uh, interviewing seniors or their families, trying to help them, trying to understand who they are, what their special needs are, and how we can help. Uh, and how many, uh, Ian, how many people every year apply for Medicaid for long-term care insurance?

In the region that I work, there's 29,000 clients currently on.

29,000? Yeah.

29,000. And I would say on an average month, it's around a,000 a month,

right,

who apply. Not all get on, but a thousand apply.

So we don't have enough waking hours ourselves to spend uh the time uh communicating with getting to know people helping them out as much as we would want to. So, I'm going to make an appeal to anybody uh watching this that uh if if if you have some capacity either time or some some past expertise and you're interested in helping seniors through these uh through these crises or even talking to people about planning in advance, 5 years in advance or more, uh you know, I' I'd welcome all of you that have that uh that yearn and that capacity to somehow contact us, email us or you know, drop a online our websites and uh you know let's let's see if we can put a community together of people who are just interested in helping people just by listening and and by talking to people and understanding who they are as human beings and really what's going on with their life. That's so important. And there there there aren't enough social workers. There's not enough money in the systems or not enough money anywhere to do that. So it's it's going to take uh a community of people who really care about each other to get involved with each other at least to the extent of uh receiving you know requests for information or uh you you know talking about a problem they have or some challenge they have. So I would encourage you all that to do that. Hope you will and uh we'll we'll as as frail human beings that we are we'll try to organize that in some way that uh might be helpful to everybody. All right. Well, any last words, uh, Bert?

Not that I can think of.

Okay. Ian,

to steal a first lady's phrase about it takes a village to help a child. It takes a city to help the elderly get the services they need.

All right, Carolyn.

It's complicated. There's just no easy answers on any of this. And it truly does take all of us to be able to help. You might refer people to us because you find out their need. We might refer people to you because we're talking to them. They we find out that they need the kind of assistance that you can offer. So, it's very much both ways on all of this,

right?

With anybody that we work with.

Okay. Well, uh great talking to you. Uh we'll we'll put this we'll make this available for people. Uh we'll have your contact information available. And uh folks, if you're listening and watching, uh hope to talk to you soon.