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I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid. We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
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V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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MediCARE is a federal entitlement. So if you go from your home in NY and are on Medicare and fall at Disneyworld in FL, your hospitalization costs will be paid by MediCARE. Medicare is portable. Now the FL hospital will be paid at whatever rates are locally not necessarily what the same service would be paid in NY. Medicare is national if the provider takes Medicare.
BUT MedicAID is a joint state & federal entitlement program; AND Medicaid is managed or administered by each state uniquely. You have to qualify for Medicaid under whatever terms your home state has for their program. You cannot be a resident in both states or qualify for Medicaid in two states. Only 1 can be your residence & that is the one who's Medicaid program you would be on.
If you own real property in state 2, that will likely disqualify you for Medicaid for state 1. All the states keep databases on real property ownership; finding out is just keystrokes to do; it will surface and there will be penalties or disqualification periods. Not pretty.
I would caution you on saying "she'll be wintering" as by & large folks who are snowbirds probably have the income & asset level that they should not ever qualify for Medicaid. Your not gonna get a lot of sympathy from Medicaid.
I agree with igloo572 above, first thing I thought when I read *wintering* was a *snowbird* who lives in her house up north but has a winter condo in Florida. She wouldn't qualify for Medicaid.
If this senior is saying with her grown children or other relatives in both States, you will need to check with each State's Medicaid to see what are their rules.
She is actually on Medicaid in CA living with Child 1. But will stay with child 2 from 12//14 Until 3/1/15 so child I can have respite. He Med I aid is secondary but were she to have a med iCal emergency is CA Medicaid billed like other Insurances, coverage while on vacation or In emergencies
I would suggest that Child 2 find a medical provider in her area who will accept mom's coverage before mom arrives. My husband is a physician (pediatrician) who has occasionally treated patients who are covered by Medicaid in a neighboring state. The problem is that the provider is required to file much paperwork with the neighboring state's program is order to even submit a claim. To be honest, it is usually not worth the cost of staff time considering the low compensation from Medicaid. Some doctors decline to see out of state Medicaid patients because of this.
Ritzy, you will have to check with California Medicaid to see what are the rules if a Senior is out-of-state visiting.... if there is coverage for someone visiting, check to see if there is a time limit for that Senior to be out-of-state.
Ritzy- Freqflyer & AK bring up important points. You really need to find out in advance clearly what coverage is & if any move could jeopardize her enrollment. For my mom - NH resident on Medicare, Medicaid & hospice in TX - if she were to go away from the NH for more than 2 days other than to the hospital, her Medicaid coverage would be suspended.
It's great that you are planning in advance of the respite visit to FL. I would start calling MD's in sisters's city in FL to see if any will accept new patients and what you need to do now to ensure that mom can be seen in advance. There are alot of snowbirds in FL, so there are MD's who do this, but I'd bet most limit care to bigger insurance coverage groups (BCBS, United) otherwise it's private pay at time of service.
If push comes to shove, mom can go to an ER and use Medicare to pay but there probably will be a co-pay for the non-reinbursed costs. For ER you kinda need to be on the watch if the ER doc's are in network for Medicare. Most ER doc's are independent contractors so they may or may not take whatever insurance you have. There was a really great series in the New York Times a couple of months ago on problems with out-of-network ER health care costs.
Medicaid, where I am in LA, has a pretty limited # of providers outside of those associated with a health science center type of medical complex. The vast majority of independent providers MD's do not take Medicaid at all ever for patient office visits. Like AK said the reimbursement rate is low, pitiful low. Some don't take Medicare either. You will be expected to prepay the anticipated cost of office visits. If you have not been paying any co-pays the costs will be staggering. I had an head & neck MRI done last Oct and we have good coverage through hubby with United and it was basically 5K; United paid their negotiated rate to provider and we had about $ 900 copay. If we paid cash in advance (like the day before in advance), it was discounted. Otherwise the $ 900 had to be paid before the procedure would be done - CC add's 3%; contract / monthly payment add 10%. They told me about 1/3 of the scheduled appointments have to cancel as they don't have the co-pay. Now the ACA / Obamacare will resolve a lot of this - thank goodness - but the costs are staggering. You don't want your sister to be put into a tough spot on this.
? for you - when you say "respite care", is mom on hospice? MediCARE has respite care as a hospice benefit to give the caregiver a break. So the elder goes to a respite facility for a short period of time which Medicare pays for.
Most state Medicaid programs end at the state line. Even private insurance companies have territory limits. She would still have Medicare, and they cover about 80% of costs. That's all she will have, sorry.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
Medicare is national if the provider takes Medicare.
BUT MedicAID is a joint state & federal entitlement program; AND Medicaid is managed or administered by each state uniquely. You have to qualify for Medicaid under whatever terms your home state has for their program. You cannot be a resident in both states or qualify for Medicaid in two states. Only 1 can be your residence & that is the one who's Medicaid program you would be on.
If you own real property in state 2, that will likely disqualify you for Medicaid for state 1. All the states keep databases on real property ownership; finding out is just keystrokes to do; it will surface and there will be penalties or disqualification periods. Not pretty.
I would caution you on saying "she'll be wintering" as by & large folks who are snowbirds probably have the income & asset level that they should not ever qualify for Medicaid. Your not gonna get a lot of sympathy from Medicaid.
If this senior is saying with her grown children or other relatives in both States, you will need to check with each State's Medicaid to see what are their rules.
Child 1. But will stay with child 2 from 12//14
Until 3/1/15 so child I can have respite. He Med
I aid is secondary but were she to have a med
iCal emergency is CA Medicaid billed like other
Insurances, coverage while on vacation or
In emergencies
It's great that you are planning in advance of the respite visit to FL. I would start calling MD's in sisters's city in FL to see if any will accept new patients and what you need to do now to ensure that mom can be seen in advance. There are alot of snowbirds in FL, so there are MD's who do this, but I'd bet most limit care to bigger insurance coverage groups (BCBS, United) otherwise it's private pay at time of service.
If push comes to shove, mom can go to an ER and use Medicare to pay but there probably will be a co-pay for the non-reinbursed costs. For ER you kinda need to be on the watch if the ER doc's are in network for Medicare. Most ER doc's are independent contractors so they may or may not take whatever insurance you have. There was a really great series in the New York Times a couple of months ago on problems with out-of-network ER health care costs.
Medicaid, where I am in LA, has a pretty limited # of providers outside of those associated with a health science center type of medical complex. The vast majority of independent providers MD's do not take Medicaid at all ever for patient office visits. Like AK said the reimbursement rate is low, pitiful low. Some don't take Medicare either. You will be expected to prepay the anticipated cost of office visits. If you have not been paying any co-pays the costs will be staggering. I had an head & neck MRI done last Oct and we have good coverage through hubby with United and it was basically 5K; United paid their negotiated rate to provider and we had about $ 900 copay. If we paid cash in advance (like the day before in advance), it was discounted. Otherwise the $ 900 had to be paid before the procedure would be done - CC add's 3%; contract / monthly payment add 10%. They told me about 1/3 of the scheduled appointments have to cancel as they don't have the co-pay. Now the ACA / Obamacare will resolve a lot of this - thank goodness - but the costs are staggering. You don't want your sister to be put into a tough spot on this.
? for you - when you say "respite care", is mom on hospice? MediCARE has respite care as a hospice benefit to give the caregiver a break. So the elder goes to a respite facility for a short period of time which Medicare pays for.