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Aging Wisely Florida Medicaid Archives - Aging Wisely

Can I Take My Loved One Out of the Nursing Home?


Our experts help with your frequently asked eldercare questions. With the holidays coming up this is an especially timely topic: handling holiday (and other) visits when your loved one lives in a nursing home.

holiday visits from a nursing home

Can I take my loved one out of his/her nursing home for an outing or holiday visit?

Yes, residents of nursing homes can definitely leave the nursing home for outings and visits with family. Of course, the nursing home is regulated tightly and residents are considered to be under medical care while there, so it is necessary to follow certain procedures.

You should talk to your loved one’s nursing staff about outings, to ensure the person’s safety and well-being. The staff can also prepare you for what might be needed during the trip, such as equipment and care needs. If you have not personally taken care of your loved one alone in some time, it is important to understand their needs before planning a nursing home outing.

Typically, you will need to “sign out” a nursing home resident and talk to the care staff about the plan and timing of the visit. It is important to let them know the intended length of the visit and keep in touch if anything changes, so they can plan accordingly. There are also financial implications for overnight/longer visits.

Florida Medicaid Rules for Holding Nursing Home Beds

In addition to whether or not you can leave a nursing home and what type of visits are advisable, costs are an important factor to consider. If a resident leaves a nursing home overnight, they (or some payment source such as Medicaid) would need to continue to pay the cost to hold their spot. For a private pay resident, monthly payment would simply be as usual and then the bed would be held (for longer stays away from the nursing home–even hospital stays, the resident/family would have to determine if they wish to pay to hold the bed).

This is known as a “bed hold” in Medicaid terminology and the policies vary by state. For what is known as “therapeutic leave”, Medicaid in Florida pays the nursing facility to reserve a resident’s bed a maximum of 16 days per fiscal year (July 1-June 30). Therapeutic leave means the resident leaves the facility to go to a family-type setting (not another nursing home or hospital). Each night away counts as one day.

However, the nursing home must have at least 95% of its Medicaid-eligible beds filled in order to bill the state for bed hold days (presumably, if not, there would be sufficient open beds for the person to return). If a resident exceeds the yearly allowed days, the resident or family could also pay privately to hold the bed. If they do not wish to do so, the nursing home may discharge the person but must readmit them in the 1st available Medicaid semi-private bed (of course, it does not have to be the same room as before).

The nursing home should provide this policy in writing, at admission and again when you go on any therapeutic leave. For a complete list of Medicaid bed hold policies by state click here (check with your state to see if the policies have changed since this was updated).

Medicare Skilled Nursing Coverage and Leaving the Nursing Home

Medicare only covers short-term skilled nursing care, so this isn’t an issue for most nursing home residents. However, if you are in a skilled nursing facility receiving treatment under Medicare and wish to leave to visit loved ones for the holidays, can you?

Despite what you are sometimes told, Medicare does not necessarily consider a family visit to mean you don’t need skilled care. You can be gone during the day (attending an outing, but back by midnight that day) and the facility can still bill Medicare for the day. If you stay away overnight, the facility typically can’t bill Medicare for that day. You can talk to the facility about their bed hold policy, and you may be able to privately pay to hold the bed if you wish.

Remember, however, that missing out on therapy services, in particular, may slow your recovery process and you may benefit less from your time in the skilled nursing facility. It is best to discuss your needs and scheduling of any visits with your care team.

The Logistics of a Nursing Home Outing

We have many clients who we arrange regular outings for, often with the help of a nursing assistant. We would never want our clients to feel that the nursing home is like a prison, but we also want to make arrangements to make any visit safe and comfortable.

Talk with care staff about the details beforehand and consider whether some assistance might be needed. You can arrange special transportation or an aide to go along with the person, to assist with transferring, going to the bathroom and other needs that may arise.

Our senior caregivers have shared tips and information about traveling with someone with dementia and they offer senior concierge services to plan events/outings and escort the person (even on long-distance trips to visit family).

We can also help with creative ideas for making the holidays special for your loved one residing in a nursing home or assisted living. Contact us for ideas or help with nursing home visits, concierge services, patient advocacy and more.

Also, don’t forget to check out our Senior Gift Guide!

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What is Medicare Going to Cost Me in 2016? Medicare FAQs


Our Medicare advocates are here to help you understand Medicare as we’re in the midst of the Medicare 2016 open enrollment decision making. Today, we’ll answer some FAQs about Medicare, such as “What is Medicare going to cost me in 2016?” and “What is Medicare going to cover in 2016?” and “Will I be subject to a big Medicare Part B increase?”. We also help you find a broad range of information, such as “What is Medicare?” and “What is Medicaid?” and when you need to sign up and take certain steps.

What is Medicare going to cost me in 2016?

All of the numbers are not out yet, but sign up for our newsletter to get all the details as soon as they come out! We do know what Medicare Part D’s maximum deductible will increase from $320 to $360. Of course, this is only the maximum limit placed on the plans. Your drug plan may have no deductible at all and can range up to $360 (however, a Kaiser Family Foundation issue brief revealed that 2/3 of all Part D plans will have deductibles and a growing share will have the maximum deductible in 2016).

Part D plan premiums vary widely (as do the associated costs for covered medications) so it is important to analyze the best plan for your current situation during open enrollment. For 2016, the chart below details the income-adjusted premiums for Part D. In other words, if you are looking at a particular Part D plan and your income is more than $85,000 (or $170,000 for joint filers)–based on your 2014 return–you will need to add the extra cost to this premium to get your true monthly cost.

what is medicare part D premium for 2016

The average Part D premium is projected to increase by 13% from 2015 to 2016 ($36.68 to $41.46). Even if a number of beneficiaries switch/are reassigned to lower-premium plans, the average increase is likely to be the largest since 2009 (Kaiser Family Foundation).

Most of the other Medicare costs will likely stay similar to 2015. However, a big area of concern for some Medicare recipients is the potential 52% hike in their Medicare B premium if they are not protected by the “hold harmless” rule.

What is Medicare “hold harmless” and will I be subject to a large Part B premium increase in 2016?

Social Security benefits will not get a COLA (Cost of Living Adjustment) next year, which means that most Social Security recipients who are also Medicare beneficiaries will not see an increase in their Part B premium ($104.90–stable since 2013) under Medicare’s “hold harmless” provision. But this “hold harmless” rule doesn’t apply to about 30% of beneficiaries: those who are not yet receiving Social Security, new Medicare beneficiaries, individuals earning more than $85,000 a year (or $170,000 for joint filers), and Medicare/Medicaid “dual eligibles” (though for dual eligibles, the burden will fall mostly to the state Medicaid programs).

Unless Congress or the administration make some modifications, these Medicare beneficiaries will generally be facing a Medicare B premium of $159.30, with higher income retirees paying as much as $509.80/month.  The Part B deductible for these beneficiaries would rise to $223 next year (from $147 in 2015). This is due to the fact that premiums must cover cost increases within the Medicare program, and since about 70% of people are protected by the hold harmless rule this puts a large share of cost on the remainder.

What is Medicare open enrollment, when is it and what to I need to do?

Medicare open enrollment is your chance to switch Medicare D plans for 2016 (and switch to/from Medicare Advantage). Read more about Medicare open enrollment 2016 and what you need to do during this period (October 15th-December 7th). If you need help with this process or initial Medicare enrollment, our Medicare advocates can assist with our Medicare Analysis Package.

Find out more about Medicare and Medicaid at:

Aging Wisely’s Medicare Fact Sheet (2015 version), includes all the basic facts about Medicare and key dates get your Medicare 2016 handbook, compare plans, find out what Medicare covers and more

Medicare Interactive answers questions about Medicare rights and benefits, run by the Medicare Rights Center.

What is Medicare? What is Medicaid? Who Pays? by EasyLiving’s senior care experts, with links to fact sheets about Medicare’s coverage of home health care and other resources

Contact our healthcare advocates  for any questions about Medicare, Medicaid, other benefits and your health needs. We do not sell insurance or any products, so our opinions are based on our experiences helping many families and our analysis of what’s best for you!

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Long Term Care Insurance, Medicaid, Planning…What You Need to Know


long term care, Medicaid planning

Do you and your family have a plan in place for what you would do if you need ongoing care when diagnosed with a chronic illness? Do you have the legal documents needed to handle your affairs? Do you understand Medicaid, Medicare and long-term care insurance? Do you have an understanding of the costs and options for long-term care? Do you know what’s involved with paying privately for care options versus your choices under Medicaid?

Long term care can be defined as the range of services or support that a person receives to meet their personal care needs, which may include medical, social services and various support services. One of the keys to long-term care preparation is to start planning early!

Linda Chamberlain, Medicaid planning attorney

This Aging Wisely educational series brings you expert advice from Linda Chamberlain, Board Certified Elder Law Attorney and founder of Aging Wisely and EasyLiving home care. Linda has been practicing elder law in Clearwater since 1991, and has achieved Martindale Hubbell’s highest rating as an AV® Preeminent™ Attorney. She specializes in Medicaid planning, Medicaid applications, and long-term care issues.

Make plans to join us for the first class in this series on October 27th from 1:00-2:30 pm.

What you should do before you get sick:

If you are nearing retirement age, it is crucial to start planning now. While specific decisions depend upon your unique personal circumstances, there are a number of steps that everyone can take, regardless of their circumstances. This is the time to ask questions about expected potential long-term care costs and options, to understand Medicare versus Medicaid and what is covered. This is prime time to gain control over your choices in the future, should you need assistance.

Click here to get the Aging Wisely educational series long term care flier. We invite you to share this great resource with anyone you know who might be interested!

Call us at 727-447-5845 for any questions about long-term care issues, to RSVP or to get information about future events. Sign up for our newsletter for all the latest educational events and news.

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The Role of the Assessment in Accessing Public Benefits


florida medicaid

Paying for long-term care services is a top financial concern for a majority of consumers today (research from the nonprofit LIFE foundation and LIMRA). Families often struggle to navigate the various long-term care options, while trying to match these choices up with their budget or access financial help. Although states, including Florida, have worked to make accessing long-term care easier for individuals and families, the public benefits system remains confusing for families, especially in times of turmoil.

For all these reasons and more, families should consider getting a geriatric care management assessment when eldercare issues begin to arise. The earlier in the process a family accesses this help, the more opportunity there is to play an active role in choices and save valuable time and money.

How does the geriatric care management assessment help specifically with paying for long-term care?

  • It gives you, your family and the professionals helping you a better picture of the situation (and your preferences) to pursue the right options and save time pursuing unrealistic options.
  • It helps define the costs associated with those options and the resources you have to cover costs and needs (including non-financial resources like assistance from friends, families, non-profit groups, etc.) and possibly creates a budget (and alternative budgets for comparison).
  • It explains the related public benefits you might need to access and the steps to take. Timing and details can be very important to the eligibility process, so understanding those before you get started gives you the best chance to avoid problems. It also makes recommendations for planning professionals and resources, so you have the opportunity to plan ahead.
  • It  takes all the puzzle pieces of a fractured system and puts them together. Geriatric care managers created the profession for this reason. Many of them helped clients in specific settings or with a specific concern, but there was really no one for the family to rely on to bring things together and offer continuity. For most people, long-term care is a journey during which they access different types of care, make various transitions (if not in actual place they receive care, then in the types of services accessed) and have varying needs. The medical, financial, familial and personal situation evolves and often requires multiple resources at any given time to cover the needs. A specific service or provider may conduct an assessment but it tends to only be focused on one aspect or perspective of that long-term care journey.

We have been working on our upcoming presentation for the Florida Conference on Aging, which further details how the assessment can play a valuable role for both families and practitioners, especially as it relates to Florida’s Statewide Medicaid Managed Care Program. Under this program, Floridians now receive Medicaid-covered long-term care services from private, managed care companies. This adds another layer of decision making for individuals and families, furthering the need for the assessment. The independent assessment can also provide valuable information to the care providers involved and help families make more informed choices, which saves time and difficulties for everyone involved.

For those of you who might be attending the 2014 Florida Conference on Aging, we hope to see you at our session! Our workshop, conducted by Senior Care Consultant Susan Talbott, is tentatively scheduled as follows:

Public-Private Partnership: Why an Independent Level of Care Assessment Benefits Providers and Clients

Wednesday, August 6, 2014

8:30 AM – 9:30 AM

You can find the conference information on the Florida Conference on Aging website.

For help with Florida Medicaid and other long-term care needs or to inquire about a geriatric care assessment, give us a call at 727-447-5845 anytime!


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Florida Medicaid: The Big Switch to Managed Care


Florida Medicaid advocacy

Medicaid reform legislation that was proposed in Florida in 2011 was designed to move management of Medicaid benefits to private, for-profit managed care companies. In the time since, there have been many meetings and debates, various changes, pilot programs and challenges to overcome in getting this concept implemented. However, the time is now here…and Florida Medicaid recipients will soon be receiving letters asking them to enroll in a particular plan (if they have not already). The state is rolling these changes out on different dates in the various counties. The roll out date for Pinellas, Pasco and Hillsborough counties is February 1, 2014.

What does this mean for Florida seniors?

If you are receiving Medicaid benefits or you have applied, this change affects you…and means you will have some decisions to make. If you care for an aging parent in Florida and/or serve as a decision maker (for example as guardian, P.O.A., healthcare surrogate) for a Florida elder or other person receiving Medicaid benefits , you should understand these changes so that you can assist and understand what choices need to be made. Essentially, all Medicaid beneficiaries will now be receiving benefits through a managed care company. So, they will have to choose which plan they wish to enroll in to manage their benefits. If a senior does not make a choice, Florida will choose a plan for that person. Enrollment is mandatory. The plan will oversee your benefits and care plan for determining how much/which benefits and services you receive. Once enrolled in a plan, a representative will meet with you and develop a care plan (you are entitled to have an advocate with you at this meeting and to have input in developing your care plan). If you have problems with your plan or the care being provided, there are specific processes for complaints and changes (the consumer guide below provides information on this; it is important to note that you have limited time frames for making changes and filing complaints).

What do I need to do?

You will have some decisions to make and it is very important to clearly understand these decisions and how they may affect your care. There have also been numerous program glitches that could cause issues for you. If you work with an Aging Wisely care manager currently, your care manager can help you through this process and provide resources to help at various stages. Our team has been studying the changes and getting training from some of the top experts, so we can be best prepared to help you. As always, we also work collaboratively with expert providers so we can refer you for help in specific areas.

Consumers can get some excellent information on these Florida Medicaid changes on the website Foundation for LTC Solutions. This group of Florida elder advocates has created resources like a decision tree and guide for the enrollment decisions. If you want to understand more about the program and decisions involved (as well as some of the pitfalls and important tips), you can download their Florida Medicaid Managed Care Consumer Guide. The guide is divided up in to sections based on your situation (answer a couple simple questions to be guided in to the correct section), so that while there is a lot of information you should only need to review the section that is applicable to your (or your loved one’s) situation.

Because Medicaid benefits will now be managed by the specific plan in which you enroll, the decisions can have a big impact on the care you receive. For example, if you are currently receiving home health benefits or care at assisted living, you may have to switch providers or move if your new plan is not contracted with these providers. We want to draw your attention to the importance of this major change, while not panicking you. Advocates have worked hard to spot the difficulties with the process and fight for protections. There are some safeguards built in and options if you encounter problems. Having a good care team is essential for each elder… you need strong advocates and resources to help (whether dealing with issues related to Medicaid managed care or just eldercare in general).

If you are working with Aging Wisely, your care manager will be reaching out to you about these changes as they apply to you and offering assistance. The resources above offer great insight for Medicaid recipients and their loved ones/decision makers to get an overview and answers to key questions.

If we can help with any questions or resources about Florida Medicaid, Medicare or other patient advocacy issues, please contact us at 727-447-5845.

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