WEBVTT
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All across America and around the world, this
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is Veterans Radio. This is Veterans Radio. Good
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day. I'm Jim Fossone. I'm the Officer of the
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Deck today here on Veterans Radio and thanks
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for joining us. We've got some interesting stories
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our podcasts there as well. We post new ones
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new interview, something you didn't know before
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by going to veteransradio .org. And before we
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get started, we want to thank our sponsors. First
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up, we want to thank Legal Help for Veterans.
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So wherever you are, you can find us, whether
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it's on your mobile phone or your computer or
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your laptop or tablet, but listen in to Veterans
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Radio Podcasts. We post something new every week.
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and you're going to find it informative. We want
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to welcome to Veterans Radio today Michael Guerrero
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who is going to try to explain to somebody like
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me and our veteran radio listeners that interplay
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between Medicaid and veteran benefits. Michael
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welcome to Veterans Radio. Well thank you so
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much for having me Jim. Well, you're an expert
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in this area. It's been something you've been
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involved in a long time. You're a certified Medicaid
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planner You are the founder and CEO of elder
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care resource planning. Could you explain what?
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Elder care resource planning is about Yeah, you
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bet. And so it's a first of all, it's a family
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-started business. So my mother my brother are
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co -founders on the business. It really is a
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Came together From that starting point, we are,
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in a few words, we're a national company that
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offers guidance and support for families going
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through long -term care crisis to enable them
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to access the valuable state Medicaid benefits.
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Those Medicaid benefits can pay for long -term
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care. Mostly they're about nursing homes. But
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these days are also about community -based services
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for long -term care like home care, assisted
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living, PACE programs. Well, and this is important
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because whether we like it or not, hopefully
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we all have this problem at some point where
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we get old enough and maybe work through some
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of our resources that we need to start thinking
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about either for ourselves or our parents or
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our brothers and sisters. Hey, what's the long
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term plan here? How are we going to manage this
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inevitable situation of long life and needing
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care? And in our world, as you know, we're involved
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with veterans and there's this interplay between
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the resources that may be available through Medicaid
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and resources that may be available through the
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Veterans Affairs federally. As you've gone about
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planning and explaining things to folks, why
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don't you tell us about some of the key differences
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of assisted living and memory care as they relate
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to both Medicaid and VA pensions. Okay, yeah.
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Assisted living and memory care and how Medicaid
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funds it and how VA pensions may help to offset
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those costs. Really important area here. As your
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listeners may know, the VA benefits, this pension,
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sometimes known as the aid and attendance, is
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a cash assistance program that provides essentially
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extra unrestricted funding for eligible veterans
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and their dependents to pay for, especially for
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those long -term care costs that come up in memory
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care or assisted living. What you need to know
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is that cash assistance can be used at any facility,
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anywhere where there's a qualified veteran who
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has qualified expenses. And that right there
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is an area that a lot of people get confused
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about what actually qualifies as an expense.
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How do I qualify for aid and attendance? It goes
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back in VA world to needing assistance with daily
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living, right? You can't do certain things in
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your daily living chores and you may qualify
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for aid and attendance. Why don't you talk a
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little bit about that? You wrote on it recently.
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Yeah, you're absolutely right. This is an area
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where VA benefits specifically aid and attendance
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is very similar to the long -term care Medicaid
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eligibility criteria as well. So, what we're
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looking at here is they're establishing what
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kind of care do you really need and how often,
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right? Is this a daily need? Do you need help
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getting up to go to the bathroom? They call these
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activities of daily living and they're very similar,
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although they use slightly different legal language,
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very similar requirements for VA aid and attendance
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and Medicaid's long -term care benefits. And
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they're specifically looking at the five activities
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of daily living. That's bathing, dressing, toileting,
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transferring, and eating. Not preparing food,
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but eating food safely, chewing it on your own.
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If you're having trouble with two or more of
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these, you're said to have a need for aid and
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attendance. Or conversely, if you're applying
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for long -term care Medicaid, you're said to
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have a need for long -term care Medicaid. The
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thing that gets many people tripped up, and you're
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probably thinking this question already, which
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is, well, my mom or my dad or my veteran is physically
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very capable of taking care of themselves, but
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they really can't be left alone because they're
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not all there. They have some cognitive decline.
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There's some dementia there. And that's actually,
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it cuts in a different way. So you can certainly
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qualify for long -term care benefits or in attendance
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if you are suffering from dementia or some sort
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of cognitive impairment that means you need supervision
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throughout the day as well. Michael, let's make
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this clear because these are two... I'm going
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to call them federal programs and you're going
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to correct me because they're not both federal
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programs but these are these are two different
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programs. Yeah. And you've got to go down both
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tracks at maybe at the same time and they have
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slightly different criteria and at the end how
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the money gets appropriated is different but
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let's back up because I made the first mistake
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by calling them two federal programs. They're
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not. Explain that. Okay, yeah, that's a confusing
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one because Medicaid it sounds like Medicare,
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which is national, right? but Medicaid is really
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an agreement between the federal government and
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each state government and they split the bill
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and and when the state pays for it, they also
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have some control over how the Medicaid programs
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are run within their states, so really As opposed
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to Medicare, Medicaid is really 50 different
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programs, but for shorthand or just for convenience
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sake, we kind of just refer to it as the Medicaid
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program. But each Medicaid program is really
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structurally different. They have some shared
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guidelines because the federal government establishes
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some rules. You kind of have to play within these
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lot, these fenced areas, these zones, but the
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states have lots of leeway. And you'll see that
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and compare states like California to Texas or
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Illinois to Florida. There's wide variations
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in how they administer the benefits and how they
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approve people for those benefits. So does this
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go then to for Medicaid where I live? Is that
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is that the state that kind of I got to work
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through and controls? Yes. Yeah. One of the common
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questions that comes up is, well, Do I have to
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live there? Because I really want to go, you
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know, live close to my children and my grandchildren,
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right? But they're, you know, now they're in
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Wisconsin and I'm still in Pennsylvania. So which
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state do I apply for? There is no minimum amount
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of time that you need to spend in a state in
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order to apply for your Medicaid long -term care
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benefits. So as soon as you are physically there,
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you're allowed to apply for it if your intent
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is, excuse me, if your intent is to stay. It's
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not like I can go visit for a vacation and come
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back. If your intent is to stay, you can apply
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on day one in that new state. You might need
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a residence, you might need a card, but those
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are details that don't actually, you can still
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use your old ID card. As long as you have a new
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place to stay, maybe it's your children's house
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in that new state. And the other track we're
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talking about, the VA aid and attendance for
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assistance with daily living problems, that's
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federal. Is that the same throughout the nation
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or does it change by state? Yeah, great question.
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And the beauty of that is that, I mean, you can
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say like, say you're living on close to a border
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between South Carolina and North Carolina. Well,
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you find a great facility across the border.
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and it doesn't matter for VA because the aid
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and attendance benefits are federal like you
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said and they don't care in which state you are
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located in as long as you're a qualified veteran
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and you have the qualified expenses. Now I mentioned
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that you've got different application programs,
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you have different slightly different qualification
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requirements. What do you bump into as an expert
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in this area as the biggest difference in qualifications
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or disjointed kind of criteria that you see?
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Yeah, that's a great question because there's
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a lot of different examples, but I'll stick to
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the most common things that come up. Many people
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often incorrectly assume that it's either VA
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or Medicaid. I can't get them both, right? And
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so they think, well, I want VA benefits. Now
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I have too much income. Now I can't qualify for
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Medicaid benefits. And the truth is, and for
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many of our clients as well, we're actually working
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with those VA benefits and we're making sure
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that they can meet the Medicaid requirements
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with their VA benefits in place. One of the things
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that traditionally, VA and Medicaid have an agreement.
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So if you are a long -term care Medicaid beneficiary
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and you're also receiving aid and attendance
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as a qualified veteran, and you are in a nursing
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home, under this agreement, it's a federal agreement,
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so it's applied to all the states, then your
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VA benefits are reduced, but for every dollar
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that they're reduced, the Medicaid program makes
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up the difference. So functionally, from your
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point of view as a payer, or you're paying your
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income share, you're not gonna see any change
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in your costs, or you're not gonna see an increase
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in deficit. But the Medicaid program agrees that
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they'll allow those aid and attendance beneficiaries
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or claimants to get $90 a month of unrestricted
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income from their Medicaid dollars in a nursing
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home. And that coordination makes some sense
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when you think about it, because the VA payment
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goes right to the individual veteran, whereas
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the Medicaid payment goes to the home. that,
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that's their ad or supporting, but you don't
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want to, you don't want to take dollar for dollar
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away and leave the veteran without money for
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incidentals. So that's what that $90 is sort
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of a month is about. Like, Hey, you're still
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going to get some pocket change to deal with
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incidentals. I guess that's the, would be the
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theory. Am I right? Yeah, that's right. They
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haven't updated those numbers quite as often
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as they should given inflation, but that $90
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is supposed to be some pocket change. on what
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Medicaid refers to as your personal needs allowance.
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Some states, each state has a different allowance
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per month for personal needs. And many states,
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even California, for instance, are below $90.
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So what it does is allows that Medicaid beneficiary
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with VA benefits to increase their personal needs
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allowance up to that $90. I bet one of the problems,
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cause you said at the beginning, the question
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is like a lot of people think, well, if I get
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one, I can't get the other. I bet that's a big
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problem. It's sort of this self selection. You
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root in your own minds. You rule it out. Do you
00:14:37.950 --> 00:14:40.250
bump into that a lot where somebody like three
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years later goes, you mean I could have done
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this three years ago? Yeah. Yeah. Um, absolutely.
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Um, I think that one of the. biggest ways in
00:14:50.320 --> 00:14:53.120
which we can actually add value for families
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is by helping them think if there's a couple,
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helping them think about the best approach. And
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this is often very tricky. But there is cases
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where we can really help the couple where one's
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a veteran and the other is not a veteran or the
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spouse of a veteran. And we can use a combination
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of VA benefits and Medicaid benefits to help
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with their long -term care costs such that they
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could have a quite comfortable situation with
00:15:29.320 --> 00:15:33.259
regards to long -term care. Obviously, your listeners
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should know, Jim, when it comes to long -term
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care, let's make sure that everyone has a shared
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understanding. This is an astronomical fees and
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costs that occur late in life when people's savings
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accounts are almost dwindled down to a very low
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level. So even if you've been a very good saver,
00:15:55.080 --> 00:15:58.919
many middle -class seniors are facing a crisis
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of how to pay for long -term care. Half a million
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dollars is... Yeah, I'm afraid to ask, what is
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the, I don't know, national average or something
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for long -term care on a picture... monthly annual
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basis, I'm afraid to ask, but what is the scary
00:16:16.610 --> 00:16:19.129
number? Oh, these numbers, I mean, they're varying
00:16:19.129 --> 00:16:21.830
quite a bit between home care and nursing home
00:16:21.830 --> 00:16:25.450
care. But let's give you an idea. The daily rate
00:16:25.450 --> 00:16:29.889
on average is about $400 a day for facilities
00:16:29.889 --> 00:16:33.529
if you're in a nursing home. That turns out to
00:16:33.529 --> 00:16:36.450
be almost $10 ,000 or about $10 ,000 a month.
00:16:37.350 --> 00:16:39.950
Now, there's quite a bit of variation. Like Alaska,
00:16:40.129 --> 00:16:43.490
you'll see rates that will build up to $50 ,000,
00:16:43.490 --> 00:16:47.289
$60 ,000 per month. because the facilities are
00:16:47.289 --> 00:16:51.269
so remote and limited and costly to run versus,
00:16:51.269 --> 00:16:55.029
you know, Texas, where you have rates between
00:16:55.029 --> 00:16:58.070
$6 ,000 and $8 ,000 on a monthly basis for a
00:16:58.070 --> 00:17:02.549
nursing home. But so, I mean, there is a temptation,
00:17:02.570 --> 00:17:04.950
I suppose, to shop around. But realistically,
00:17:05.210 --> 00:17:07.569
we're only going to go where we have family and
00:17:07.569 --> 00:17:10.829
support. Right. Yeah. And as you say, there's
00:17:10.829 --> 00:17:13.049
a point at which you've exhausted your private
00:17:13.049 --> 00:17:16.549
resources. You've probably your kids have probably
00:17:16.549 --> 00:17:21.930
exhausted what they can do for you. And. What
00:17:21.930 --> 00:17:26.410
percentage of your of your clients come to elder
00:17:26.410 --> 00:17:30.109
care resource planning ahead of time versus when
00:17:30.109 --> 00:17:36.849
the crisis hits? Yeah, I would say. 80, 20, maybe.
00:17:37.529 --> 00:17:40.549
Mostly we're talking to people who are in a crisis.
00:17:40.650 --> 00:17:43.609
And that's where we add the most value. Like
00:17:43.609 --> 00:17:48.529
it or not, we are planners. We're going to be
00:17:48.529 --> 00:17:51.930
right down there to the day. Look, we need to
00:17:51.930 --> 00:17:54.170
know these numbers on this date, and we need
00:17:54.170 --> 00:17:57.710
to do this and this. So it's a very tactical
00:17:57.710 --> 00:18:01.650
project management approach that we have. But
00:18:01.650 --> 00:18:06.890
we're facilitating eligibility Maybe weeks months
00:18:06.890 --> 00:18:10.089
ahead of time and by doing so we're more our
00:18:10.089 --> 00:18:12.049
fees Which are very reasonable compared to the
00:18:12.049 --> 00:18:15.490
market are being basically paid for by the benefits
00:18:15.490 --> 00:18:18.009
that we're helping them achieve Well, I appreciate
00:18:18.009 --> 00:18:20.130
you bringing up that there's a cost to this kind
00:18:20.130 --> 00:18:21.910
of planning. Do you want to give our veteran
00:18:21.910 --> 00:18:26.710
radio listeners? Michael Guerrero some idea of
00:18:26.710 --> 00:18:31.119
what this type of planning might cost Typical
00:18:31.119 --> 00:18:34.980
rates, there's law firms that specialize in this
00:18:34.980 --> 00:18:38.240
type of work or elder law firms and now charging
00:18:38.240 --> 00:18:43.980
anywhere between $10 ,000 and $20 ,000 for a
00:18:43.980 --> 00:18:46.680
complete case of helping families to go through
00:18:46.680 --> 00:18:48.960
the process of applying for nursing home benefits
00:18:48.960 --> 00:18:52.650
in the local states. Our fees start at $6 ,400
00:18:52.650 --> 00:18:55.549
for very low -resourced individuals and run up
00:18:55.549 --> 00:18:58.809
to $9 ,800 for the cases where we're helping
00:18:58.809 --> 00:19:01.029
spouses save hundreds of thousands of dollars.
00:19:01.829 --> 00:19:04.769
Yeah, and as you say, when you measure that against
00:19:04.769 --> 00:19:07.690
what it costs to be in one of those facilities
00:19:07.690 --> 00:19:11.940
on a monthly basis, you quickly see this is maybe
00:19:11.940 --> 00:19:15.039
not something I can do myself and shouldn't do
00:19:15.039 --> 00:19:18.000
myself if I want the best planning outcomes and
00:19:18.000 --> 00:19:20.559
particularly, and that's why we're talking to
00:19:20.559 --> 00:19:23.859
Michael Guerrero, if you're a veteran and you
00:19:23.859 --> 00:19:28.599
may qualify for certain benefits and you may
00:19:28.599 --> 00:19:32.460
need Medicaid, coordination is really the key,
00:19:32.599 --> 00:19:36.549
isn't it? Oh, absolutely. Yeah, these two programs,
00:19:36.549 --> 00:19:38.890
they don't fit nicely together like two Lego
00:19:38.890 --> 00:19:42.549
blocks. There is a lot of different conflicting
00:19:42.549 --> 00:19:46.769
requirements sometimes. Routinely, there's some
00:19:46.769 --> 00:19:50.130
states, for instance, where regardless of whether
00:19:50.130 --> 00:19:54.250
the veteran is qualified, eligible wartime veteran
00:19:54.250 --> 00:19:58.769
or not, you have to submit a claim before you
00:19:58.769 --> 00:20:03.720
can even file for Medicaid. So it's a ridiculous
00:20:03.720 --> 00:20:06.319
bureaucratic requirement, but it is just one
00:20:06.319 --> 00:20:07.880
of the things that we have to deal with. And
00:20:07.880 --> 00:20:10.599
we help the families to put into place as part
00:20:10.599 --> 00:20:14.539
of the process. I know in my business as a veteran
00:20:14.539 --> 00:20:18.019
disability lawyer, part of what we get compensated
00:20:18.019 --> 00:20:22.079
for is sort of not only the knowledge we bring
00:20:22.079 --> 00:20:24.829
to the table, like you're talking about. But
00:20:24.829 --> 00:20:27.269
there's a certain amount of stress relief you
00:20:27.269 --> 00:20:29.369
give to your clients when they go, OK, it's in
00:20:29.369 --> 00:20:30.690
the hands of somebody who knows what they're
00:20:30.690 --> 00:20:34.990
doing as compared to my poor daughter -in -law
00:20:34.990 --> 00:20:38.049
who's getting stuck with this task. I suspect
00:20:38.049 --> 00:20:40.910
you see that as well, that there's a certain
00:20:40.910 --> 00:20:44.029
amount of stress relief that results in engaging
00:20:44.029 --> 00:20:47.150
a planner who knows what they're doing. You bet,
00:20:47.309 --> 00:20:51.559
yeah. I mean, this is professional work. Just
00:20:51.559 --> 00:20:54.839
like I wouldn't want to fly a plane. I don't
00:20:54.839 --> 00:20:57.859
know how to do that. So I would bring in the
00:20:57.859 --> 00:21:00.619
professional to help me make sure to land that
00:21:00.619 --> 00:21:06.859
plane correctly. In any case, many people are
00:21:06.859 --> 00:21:13.210
unaware of the risks that they have. the financial
00:21:13.210 --> 00:21:17.150
risks, the medical risks that come up in these
00:21:17.150 --> 00:21:19.950
cases. And so we want to make sure that we steer
00:21:19.950 --> 00:21:22.089
them clear of that. Sometimes they're hidden,
00:21:22.109 --> 00:21:25.630
right? They're hidden beneath the surface, but
00:21:25.630 --> 00:21:29.470
we know they're there. And those risks are huge.
00:21:30.130 --> 00:21:32.769
One of the most common things is people submit
00:21:32.769 --> 00:21:37.829
the application and it turns out they are missing
00:21:37.829 --> 00:21:41.559
some information. the caseworker lets them know
00:21:41.559 --> 00:21:45.660
by sending them a form letter in the mail. And
00:21:45.660 --> 00:21:50.160
it gets there too late beyond their deadline.
00:21:50.200 --> 00:21:52.960
And then that application is simply thrown away.
00:21:53.019 --> 00:21:56.440
It's just denied. And it's really frustrating,
00:21:56.500 --> 00:21:58.720
but you have to see it from the caseworker's
00:21:58.720 --> 00:22:00.759
perspective. They're overwhelmed, and they're
00:22:00.759 --> 00:22:03.240
just doing their jobs. And so what we do is we
00:22:03.240 --> 00:22:06.140
make their lives easier as well by giving them
00:22:06.190 --> 00:22:08.710
all that information and easy to make decision
00:22:08.710 --> 00:22:11.410
ready to go. And I think any veterans who have
00:22:11.410 --> 00:22:13.710
worked through like the disability process or
00:22:13.710 --> 00:22:15.710
made application for aid and attendance would
00:22:15.710 --> 00:22:18.509
understand those issues that you have to package
00:22:18.509 --> 00:22:22.210
the information up in the way the government
00:22:22.210 --> 00:22:25.490
employee is looking for it. You got to make their
00:22:25.490 --> 00:22:28.029
life easier because they are overwhelmed and
00:22:28.029 --> 00:22:31.569
otherwise you. you risk and you almost encourage
00:22:31.569 --> 00:22:35.609
a denial of the claim. So as we come to the end
00:22:35.609 --> 00:22:39.029
here, Michael, can you if there's folks out there
00:22:39.029 --> 00:22:41.750
going, boy, I think I need to talk to a planner
00:22:41.750 --> 00:22:46.390
on this issue. Are there things that they should
00:22:46.390 --> 00:22:48.690
look for that you'd recommend? Hey, if you're
00:22:48.690 --> 00:22:51.430
going to talk to a planner, make sure they have
00:22:51.430 --> 00:22:54.769
this or these experiences or these certifications
00:22:54.769 --> 00:22:58.420
for those who've never maybe. thought about this
00:22:58.420 --> 00:23:01.359
issue, how should they go about finding somebody?
00:23:02.559 --> 00:23:06.339
Sure. Yeah. Well, we talk to a lot of different
00:23:06.339 --> 00:23:09.940
families every day. And I think in order to answer
00:23:09.940 --> 00:23:12.779
your question, I'll just sketch out like three.
00:23:13.079 --> 00:23:16.680
different types of services that are appropriate
00:23:16.680 --> 00:23:19.940
senior living or senior advisory services. So
00:23:19.940 --> 00:23:22.339
they kind of have a little bit more of a menu,
00:23:22.400 --> 00:23:25.339
right? Once you know what's on the menu, then
00:23:25.339 --> 00:23:27.220
you have an idea of what you want, what you don't
00:23:27.220 --> 00:23:30.640
want, or maybe actually maybe one of everything.
00:23:32.200 --> 00:23:37.609
So the menu really, if I can, Jim. I would say
00:23:37.609 --> 00:23:39.450
first and foremost, everyone should be aware
00:23:39.450 --> 00:23:44.809
of a fantastic trade association that runs, that
00:23:44.809 --> 00:23:48.069
assists with providing services for the professionals
00:23:48.069 --> 00:23:51.319
that work as what they call themselves as geriatric
00:23:51.319 --> 00:23:54.759
care managers. These are folks that work in this
00:23:54.759 --> 00:23:57.880
very difficult nexus between the medical side
00:23:57.880 --> 00:24:02.279
and managing care. And when it comes to providing
00:24:02.279 --> 00:24:06.460
long -term care with a variety of doctors and
00:24:06.460 --> 00:24:09.440
specialists and emergency rooms, you name it,
00:24:09.660 --> 00:24:12.480
these geriatric care managers can be extremely
00:24:12.480 --> 00:24:16.480
valuable as navigators, as medical translators,
00:24:16.480 --> 00:24:20.609
and they work on an hourly basis or on a project
00:24:20.609 --> 00:24:23.190
basis as well, providing assessments, making
00:24:23.190 --> 00:24:27.150
homes safer, and helping you interpret and understand
00:24:27.150 --> 00:24:29.930
what people are saying and how it's all working.
00:24:31.750 --> 00:24:34.809
In addition to that, you're going to run into
00:24:34.809 --> 00:24:38.730
lawyers that specialize in estate planning and
00:24:38.730 --> 00:24:41.869
making sure you're well prepared to, you know,
00:24:41.960 --> 00:24:45.119
for that final days and your wills, your trust,
00:24:45.279 --> 00:24:47.519
your adorable power of attorney, your medical
00:24:47.519 --> 00:24:49.980
advanced directive is in place. These are really
00:24:49.980 --> 00:24:51.720
important services that everyone really needs
00:24:51.720 --> 00:24:54.140
to think about, even if their estates are very
00:24:54.140 --> 00:24:58.140
modest. And then finally, Medicaid planners.
00:24:58.559 --> 00:25:01.880
So this is what we do. We work on that project
00:25:01.880 --> 00:25:06.200
basis. We work about how to unlock and make sure
00:25:06.200 --> 00:25:10.220
to make the most sensible plan to get from where
00:25:10.220 --> 00:25:13.380
you are to Medicaid eligible and unlock those
00:25:13.380 --> 00:25:17.160
benefits for you. I worked as a certified Medicaid
00:25:17.160 --> 00:25:19.880
planner as you started out saying that that is
00:25:19.880 --> 00:25:22.740
a designation that is very maybe perhaps little
00:25:22.740 --> 00:25:25.220
known. There are many people that are qualified
00:25:25.220 --> 00:25:27.640
out there that are not certified, but it is something
00:25:27.640 --> 00:25:30.480
that we use as a way to show to our clients,
00:25:31.339 --> 00:25:34.079
hey, look, we've done the testing, we do the
00:25:34.079 --> 00:25:37.380
ongoing education, and we make a commitment ethically
00:25:37.380 --> 00:25:41.480
to make sure that we are professionals working
00:25:41.480 --> 00:25:44.309
on behalf of the customers. That's where I was
00:25:44.309 --> 00:25:46.730
trying to get you to is that if I'm looking for
00:25:46.730 --> 00:25:49.170
somebody, I want somebody who didn't just say,
00:25:49.289 --> 00:25:51.029
hey, I can do this planning. I want somebody
00:25:51.029 --> 00:25:54.410
who is a certified Medicaid planner who's done
00:25:54.410 --> 00:25:57.890
all that testing has proven himself up. So yeah,
00:25:58.009 --> 00:25:59.990
that's exactly where I was trying to get to.
00:26:00.630 --> 00:26:08.400
If folks want to know more about Elder care resource
00:26:08.400 --> 00:26:11.900
planning. Where should they look? What's your
00:26:11.900 --> 00:26:14.900
website? How do they contact you guys? You bet.
00:26:15.299 --> 00:26:19.599
Yeah. So the website is, it's a long name, right?
00:26:20.700 --> 00:26:24.480
Eldercareresourceplanning .org. We maintain,
00:26:25.680 --> 00:26:29.099
it's kind of quaint in these days because there's
00:26:29.099 --> 00:26:32.400
so many different, you know, artificial intelligence
00:26:32.400 --> 00:26:35.039
out there, but we maintain a lot of information
00:26:35.039 --> 00:26:36.819
on our website. You don't even have to give us
00:26:36.819 --> 00:26:41.000
a call. You can learn a lot from our content,
00:26:41.099 --> 00:26:45.059
from our newsletters, and from our sibling websites
00:26:45.059 --> 00:26:48.420
as well that we maintain as well. I mean, I just
00:26:48.420 --> 00:26:50.920
looked up the information that we posted and
00:26:50.920 --> 00:26:54.779
it was updated last week. It's critical information.
00:26:54.900 --> 00:26:58.640
It changes all the time. So eldercareresourceplanning
00:26:58.640 --> 00:27:08.019
.org. The main line is 415 -854 -8653. And still
00:27:08.019 --> 00:27:14.660
remember the main line. But anyone interested
00:27:14.660 --> 00:27:17.740
just can reach us through the website. And I
00:27:17.740 --> 00:27:20.279
want to encourage veteran radio listeners, go
00:27:20.279 --> 00:27:22.420
look at the website. Even if you're not going
00:27:22.420 --> 00:27:26.160
to make the phone call, go to eldercareresourceplanning
00:27:26.160 --> 00:27:30.140
.org. to get educated, to read up on some of
00:27:30.140 --> 00:27:33.299
these topics. Maybe subscribe to the newsletter.
00:27:33.420 --> 00:27:36.259
I know I do. And I get information that, well,
00:27:36.259 --> 00:27:38.980
I didn't know that. Again, this isn't my area
00:27:38.980 --> 00:27:44.400
of specialty. So I really appreciated the newsletters
00:27:44.400 --> 00:27:46.599
that you put out, Michael. And I really appreciate
00:27:46.599 --> 00:27:48.880
the time you've given to Veterans Radio today.
00:27:49.839 --> 00:27:54.059
Yeah. Well, happy to serve. Veterans have done
00:27:54.059 --> 00:27:57.519
their part for our country and so I'm happy to
00:27:57.519 --> 00:28:02.539
do what we do is educate folks with authoritative
00:28:02.539 --> 00:28:06.539
and bankable information. And I want to thank
00:28:06.539 --> 00:28:08.759
everybody for listening to Veterans Radio today.
00:28:08.880 --> 00:28:12.180
I am Jim Fossone. It's been a pleasure to be
00:28:12.180 --> 00:28:14.880
your host. I'm a Veterans disability lawyer at
00:28:14.880 --> 00:28:17.440
Legal Help for Veterans and you can reach us
00:28:17.440 --> 00:28:23.710
at 800 -693 -4800. or legalhelpforveterans .com
00:28:23.710 --> 00:28:26.690
on the web. You can follow Veterans Radio on
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Facebook and listen to its podcasts and internet
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radio shows by visiting us at veteransradio .org.
00:28:34.549 --> 00:28:38.250
That's veteransradio .org. We again want to thank
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our national sponsors, the National Veterans
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Business Development Council, nvbdc .org. Legal
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Firm with a national practice before the VA can
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All across America and around the world, this
00:00:08.980 --> 00:00:15.140
is Veterans Radio. This is Veterans Radio. Good
00:00:15.140 --> 00:00:18.600
day. I'm Jim Fossone. I'm the Officer of the
00:00:18.600 --> 00:00:20.699
Deck today here on Veterans Radio and thanks
00:00:20.699 --> 00:00:23.460
for joining us. We've got some interesting stories
00:00:23.460 --> 00:00:25.640
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our podcasts there as well. We post new ones
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new interview, something you didn't know before
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00:00:49.219 --> 00:00:52.259
get started, we want to thank our sponsors. First
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up, we want to thank Legal Help for Veterans.
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Legal Help for Veterans fights for veterans'
00:01:00.240 --> 00:01:02.700
disability rights all across the nation. You
00:01:02.700 --> 00:01:09.219
can reach them at 800 -693 -4800 or on the web
00:01:09.219 --> 00:01:14.159
at legalhelpforveterans .com. We just want to
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So wherever you are, you can find us, whether
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it's on your mobile phone or your computer or
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Radio Podcasts. We post something new every week.
00:01:45.760 --> 00:01:49.560
and you're going to find it informative. We want
00:01:49.560 --> 00:01:53.000
to welcome to Veterans Radio today Michael Guerrero
00:01:53.000 --> 00:01:56.540
who is going to try to explain to somebody like
00:01:56.540 --> 00:01:59.840
me and our veteran radio listeners that interplay
00:01:59.840 --> 00:02:02.980
between Medicaid and veteran benefits. Michael
00:02:02.980 --> 00:02:06.140
welcome to Veterans Radio. Well thank you so
00:02:06.140 --> 00:02:08.439
much for having me Jim. Well, you're an expert
00:02:08.439 --> 00:02:10.199
in this area. It's been something you've been
00:02:10.199 --> 00:02:12.900
involved in a long time. You're a certified Medicaid
00:02:12.900 --> 00:02:17.560
planner You are the founder and CEO of elder
00:02:17.560 --> 00:02:21.219
care resource planning. Could you explain what?
00:02:21.520 --> 00:02:25.300
Elder care resource planning is about Yeah, you
00:02:25.300 --> 00:02:28.020
bet. And so it's a first of all, it's a family
00:02:28.020 --> 00:02:30.039
-started business. So my mother my brother are
00:02:30.039 --> 00:02:33.139
co -founders on the business. It really is a
00:02:33.139 --> 00:02:38.270
Came together From that starting point, we are,
00:02:38.270 --> 00:02:42.610
in a few words, we're a national company that
00:02:42.610 --> 00:02:46.229
offers guidance and support for families going
00:02:46.229 --> 00:02:49.550
through long -term care crisis to enable them
00:02:49.550 --> 00:02:53.969
to access the valuable state Medicaid benefits.
00:02:55.629 --> 00:02:57.610
Those Medicaid benefits can pay for long -term
00:02:57.610 --> 00:03:01.330
care. Mostly they're about nursing homes. But
00:03:01.330 --> 00:03:04.849
these days are also about community -based services
00:03:04.849 --> 00:03:07.389
for long -term care like home care, assisted
00:03:07.389 --> 00:03:10.930
living, PACE programs. Well, and this is important
00:03:10.930 --> 00:03:13.189
because whether we like it or not, hopefully
00:03:13.189 --> 00:03:15.430
we all have this problem at some point where
00:03:15.430 --> 00:03:18.490
we get old enough and maybe work through some
00:03:18.490 --> 00:03:21.210
of our resources that we need to start thinking
00:03:21.210 --> 00:03:24.189
about either for ourselves or our parents or
00:03:24.189 --> 00:03:27.550
our brothers and sisters. Hey, what's the long
00:03:27.550 --> 00:03:31.229
term plan here? How are we going to manage this
00:03:31.229 --> 00:03:35.289
inevitable situation of long life and needing
00:03:35.289 --> 00:03:40.729
care? And in our world, as you know, we're involved
00:03:40.729 --> 00:03:43.330
with veterans and there's this interplay between
00:03:43.330 --> 00:03:46.990
the resources that may be available through Medicaid
00:03:46.990 --> 00:03:51.949
and resources that may be available through the
00:03:51.949 --> 00:03:58.219
Veterans Affairs federally. As you've gone about
00:03:58.219 --> 00:04:00.860
planning and explaining things to folks, why
00:04:00.860 --> 00:04:03.599
don't you tell us about some of the key differences
00:04:03.599 --> 00:04:06.919
of assisted living and memory care as they relate
00:04:06.919 --> 00:04:11.219
to both Medicaid and VA pensions. Okay, yeah.
00:04:11.460 --> 00:04:16.240
Assisted living and memory care and how Medicaid
00:04:16.240 --> 00:04:20.319
funds it and how VA pensions may help to offset
00:04:20.319 --> 00:04:29.060
those costs. Really important area here. As your
00:04:29.060 --> 00:04:32.439
listeners may know, the VA benefits, this pension,
00:04:33.019 --> 00:04:36.240
sometimes known as the aid and attendance, is
00:04:36.240 --> 00:04:40.040
a cash assistance program that provides essentially
00:04:40.040 --> 00:04:44.959
extra unrestricted funding for eligible veterans
00:04:44.959 --> 00:04:48.399
and their dependents to pay for, especially for
00:04:48.399 --> 00:04:51.500
those long -term care costs that come up in memory
00:04:51.500 --> 00:04:55.220
care or assisted living. What you need to know
00:04:55.220 --> 00:04:59.959
is that cash assistance can be used at any facility,
00:05:00.800 --> 00:05:03.040
anywhere where there's a qualified veteran who
00:05:03.040 --> 00:05:06.279
has qualified expenses. And that right there
00:05:06.279 --> 00:05:08.879
is an area that a lot of people get confused
00:05:08.879 --> 00:05:11.579
about what actually qualifies as an expense.
00:05:11.720 --> 00:05:16.990
How do I qualify for aid and attendance? It goes
00:05:16.990 --> 00:05:22.949
back in VA world to needing assistance with daily
00:05:22.949 --> 00:05:28.509
living, right? You can't do certain things in
00:05:28.509 --> 00:05:32.310
your daily living chores and you may qualify
00:05:32.310 --> 00:05:34.449
for aid and attendance. Why don't you talk a
00:05:34.449 --> 00:05:36.230
little bit about that? You wrote on it recently.
00:05:37.490 --> 00:05:39.569
Yeah, you're absolutely right. This is an area
00:05:39.569 --> 00:05:43.110
where VA benefits specifically aid and attendance
00:05:43.110 --> 00:05:45.689
is very similar to the long -term care Medicaid
00:05:45.689 --> 00:05:48.829
eligibility criteria as well. So, what we're
00:05:48.829 --> 00:05:53.730
looking at here is they're establishing what
00:05:53.730 --> 00:05:58.389
kind of care do you really need and how often,
00:05:58.670 --> 00:06:00.870
right? Is this a daily need? Do you need help
00:06:00.870 --> 00:06:03.990
getting up to go to the bathroom? They call these
00:06:04.350 --> 00:06:07.329
activities of daily living and they're very similar,
00:06:07.569 --> 00:06:10.189
although they use slightly different legal language,
00:06:10.889 --> 00:06:13.350
very similar requirements for VA aid and attendance
00:06:13.350 --> 00:06:17.370
and Medicaid's long -term care benefits. And
00:06:17.370 --> 00:06:20.649
they're specifically looking at the five activities
00:06:20.649 --> 00:06:23.810
of daily living. That's bathing, dressing, toileting,
00:06:24.129 --> 00:06:26.790
transferring, and eating. Not preparing food,
00:06:26.910 --> 00:06:29.850
but eating food safely, chewing it on your own.
00:06:30.769 --> 00:06:32.949
If you're having trouble with two or more of
00:06:32.949 --> 00:06:34.970
these, you're said to have a need for aid and
00:06:34.970 --> 00:06:37.350
attendance. Or conversely, if you're applying
00:06:37.350 --> 00:06:39.170
for long -term care Medicaid, you're said to
00:06:39.170 --> 00:06:43.819
have a need for long -term care Medicaid. The
00:06:43.819 --> 00:06:46.420
thing that gets many people tripped up, and you're
00:06:46.420 --> 00:06:48.519
probably thinking this question already, which
00:06:48.519 --> 00:06:53.980
is, well, my mom or my dad or my veteran is physically
00:06:53.980 --> 00:06:56.560
very capable of taking care of themselves, but
00:06:56.560 --> 00:07:00.980
they really can't be left alone because they're
00:07:00.980 --> 00:07:04.279
not all there. They have some cognitive decline.
00:07:04.459 --> 00:07:07.189
There's some dementia there. And that's actually,
00:07:07.189 --> 00:07:09.709
it cuts in a different way. So you can certainly
00:07:09.709 --> 00:07:14.009
qualify for long -term care benefits or in attendance
00:07:14.009 --> 00:07:18.029
if you are suffering from dementia or some sort
00:07:18.029 --> 00:07:20.730
of cognitive impairment that means you need supervision
00:07:20.730 --> 00:07:24.149
throughout the day as well. Michael, let's make
00:07:24.149 --> 00:07:28.740
this clear because these are two... I'm going
00:07:28.740 --> 00:07:30.259
to call them federal programs and you're going
00:07:30.259 --> 00:07:31.899
to correct me because they're not both federal
00:07:31.899 --> 00:07:34.519
programs but these are these are two different
00:07:34.519 --> 00:07:38.420
programs. Yeah. And you've got to go down both
00:07:38.420 --> 00:07:42.939
tracks at maybe at the same time and they have
00:07:42.939 --> 00:07:45.540
slightly different criteria and at the end how
00:07:45.540 --> 00:07:48.060
the money gets appropriated is different but
00:07:48.060 --> 00:07:50.120
let's back up because I made the first mistake
00:07:50.120 --> 00:07:52.519
by calling them two federal programs. They're
00:07:52.519 --> 00:07:55.649
not. Explain that. Okay, yeah, that's a confusing
00:07:55.649 --> 00:07:57.870
one because Medicaid it sounds like Medicare,
00:07:58.069 --> 00:08:01.230
which is national, right? but Medicaid is really
00:08:01.230 --> 00:08:03.329
an agreement between the federal government and
00:08:03.329 --> 00:08:06.410
each state government and they split the bill
00:08:06.410 --> 00:08:09.610
and and when the state pays for it, they also
00:08:09.610 --> 00:08:13.850
have some control over how the Medicaid programs
00:08:13.850 --> 00:08:18.769
are run within their states, so really As opposed
00:08:18.769 --> 00:08:22.189
to Medicare, Medicaid is really 50 different
00:08:22.189 --> 00:08:25.269
programs, but for shorthand or just for convenience
00:08:25.269 --> 00:08:28.689
sake, we kind of just refer to it as the Medicaid
00:08:28.689 --> 00:08:31.709
program. But each Medicaid program is really
00:08:31.709 --> 00:08:35.389
structurally different. They have some shared
00:08:35.389 --> 00:08:37.950
guidelines because the federal government establishes
00:08:37.950 --> 00:08:40.429
some rules. You kind of have to play within these
00:08:40.429 --> 00:08:45.090
lot, these fenced areas, these zones, but the
00:08:45.090 --> 00:08:47.679
states have lots of leeway. And you'll see that
00:08:47.679 --> 00:08:51.559
and compare states like California to Texas or
00:08:51.559 --> 00:08:54.379
Illinois to Florida. There's wide variations
00:08:54.379 --> 00:08:56.820
in how they administer the benefits and how they
00:08:56.820 --> 00:09:00.879
approve people for those benefits. So does this
00:09:00.879 --> 00:09:05.919
go then to for Medicaid where I live? Is that
00:09:05.919 --> 00:09:08.519
is that the state that kind of I got to work
00:09:08.519 --> 00:09:11.820
through and controls? Yes. Yeah. One of the common
00:09:11.820 --> 00:09:15.269
questions that comes up is, well, Do I have to
00:09:15.269 --> 00:09:17.269
live there? Because I really want to go, you
00:09:17.269 --> 00:09:19.850
know, live close to my children and my grandchildren,
00:09:19.850 --> 00:09:22.509
right? But they're, you know, now they're in
00:09:22.509 --> 00:09:25.629
Wisconsin and I'm still in Pennsylvania. So which
00:09:25.629 --> 00:09:29.529
state do I apply for? There is no minimum amount
00:09:29.529 --> 00:09:32.370
of time that you need to spend in a state in
00:09:32.370 --> 00:09:35.029
order to apply for your Medicaid long -term care
00:09:35.029 --> 00:09:38.370
benefits. So as soon as you are physically there,
00:09:38.429 --> 00:09:40.750
you're allowed to apply for it if your intent
00:09:40.750 --> 00:09:44.370
is, excuse me, if your intent is to stay. It's
00:09:44.370 --> 00:09:48.690
not like I can go visit for a vacation and come
00:09:48.690 --> 00:09:51.570
back. If your intent is to stay, you can apply
00:09:51.570 --> 00:09:54.889
on day one in that new state. You might need
00:09:54.889 --> 00:09:58.590
a residence, you might need a card, but those
00:09:58.590 --> 00:10:00.950
are details that don't actually, you can still
00:10:00.950 --> 00:10:04.830
use your old ID card. As long as you have a new
00:10:04.830 --> 00:10:06.950
place to stay, maybe it's your children's house
00:10:06.950 --> 00:10:10.950
in that new state. And the other track we're
00:10:10.950 --> 00:10:14.570
talking about, the VA aid and attendance for
00:10:14.570 --> 00:10:17.970
assistance with daily living problems, that's
00:10:17.970 --> 00:10:20.190
federal. Is that the same throughout the nation
00:10:20.190 --> 00:10:23.309
or does it change by state? Yeah, great question.
00:10:23.809 --> 00:10:26.629
And the beauty of that is that, I mean, you can
00:10:26.629 --> 00:10:30.009
say like, say you're living on close to a border
00:10:30.009 --> 00:10:33.629
between South Carolina and North Carolina. Well,
00:10:33.750 --> 00:10:35.929
you find a great facility across the border.
00:10:36.360 --> 00:10:40.120
and it doesn't matter for VA because the aid
00:10:40.120 --> 00:10:42.379
and attendance benefits are federal like you
00:10:42.379 --> 00:10:46.679
said and they don't care in which state you are
00:10:46.679 --> 00:10:49.259
located in as long as you're a qualified veteran
00:10:49.259 --> 00:10:53.399
and you have the qualified expenses. Now I mentioned
00:10:53.399 --> 00:10:57.279
that you've got different application programs,
00:10:57.460 --> 00:11:02.480
you have different slightly different qualification
00:11:02.480 --> 00:11:07.809
requirements. What do you bump into as an expert
00:11:07.809 --> 00:11:13.889
in this area as the biggest difference in qualifications
00:11:13.889 --> 00:11:16.789
or disjointed kind of criteria that you see?
00:11:17.549 --> 00:11:20.370
Yeah, that's a great question because there's
00:11:20.370 --> 00:11:25.110
a lot of different examples, but I'll stick to
00:11:25.110 --> 00:11:28.769
the most common things that come up. Many people
00:11:28.769 --> 00:11:40.059
often incorrectly assume that it's either VA
00:11:40.059 --> 00:11:44.919
or Medicaid. I can't get them both, right? And
00:11:44.919 --> 00:11:48.320
so they think, well, I want VA benefits. Now
00:11:48.320 --> 00:11:51.100
I have too much income. Now I can't qualify for
00:11:51.100 --> 00:11:57.080
Medicaid benefits. And the truth is, and for
00:11:57.080 --> 00:11:59.559
many of our clients as well, we're actually working
00:11:59.559 --> 00:12:03.159
with those VA benefits and we're making sure
00:12:03.159 --> 00:12:06.879
that they can meet the Medicaid requirements
00:12:06.879 --> 00:12:10.659
with their VA benefits in place. One of the things
00:12:10.659 --> 00:12:15.460
that traditionally, VA and Medicaid have an agreement.
00:12:15.980 --> 00:12:22.639
So if you are a long -term care Medicaid beneficiary
00:12:22.639 --> 00:12:26.299
and you're also receiving aid and attendance
00:12:26.299 --> 00:12:30.299
as a qualified veteran, and you are in a nursing
00:12:30.299 --> 00:12:34.100
home, under this agreement, it's a federal agreement,
00:12:34.159 --> 00:12:37.120
so it's applied to all the states, then your
00:12:37.120 --> 00:12:39.580
VA benefits are reduced, but for every dollar
00:12:39.580 --> 00:12:42.659
that they're reduced, the Medicaid program makes
00:12:42.659 --> 00:12:45.539
up the difference. So functionally, from your
00:12:45.539 --> 00:12:49.480
point of view as a payer, or you're paying your
00:12:49.480 --> 00:12:52.799
income share, you're not gonna see any change
00:12:52.799 --> 00:12:56.899
in your costs, or you're not gonna see an increase
00:12:56.899 --> 00:13:03.159
in deficit. But the Medicaid program agrees that
00:13:03.159 --> 00:13:08.419
they'll allow those aid and attendance beneficiaries
00:13:08.419 --> 00:13:14.100
or claimants to get $90 a month of unrestricted
00:13:14.100 --> 00:13:16.820
income from their Medicaid dollars in a nursing
00:13:16.820 --> 00:13:19.220
home. And that coordination makes some sense
00:13:19.220 --> 00:13:22.179
when you think about it, because the VA payment
00:13:22.179 --> 00:13:25.700
goes right to the individual veteran, whereas
00:13:25.700 --> 00:13:30.040
the Medicaid payment goes to the home. that,
00:13:30.040 --> 00:13:33.419
that's their ad or supporting, but you don't
00:13:33.419 --> 00:13:35.639
want to, you don't want to take dollar for dollar
00:13:35.639 --> 00:13:38.820
away and leave the veteran without money for
00:13:38.820 --> 00:13:41.580
incidentals. So that's what that $90 is sort
00:13:41.580 --> 00:13:43.879
of a month is about. Like, Hey, you're still
00:13:43.879 --> 00:13:46.200
going to get some pocket change to deal with
00:13:46.200 --> 00:13:48.279
incidentals. I guess that's the, would be the
00:13:48.279 --> 00:13:51.090
theory. Am I right? Yeah, that's right. They
00:13:51.090 --> 00:13:54.669
haven't updated those numbers quite as often
00:13:54.669 --> 00:13:57.789
as they should given inflation, but that $90
00:13:57.789 --> 00:14:00.769
is supposed to be some pocket change. on what
00:14:00.769 --> 00:14:03.409
Medicaid refers to as your personal needs allowance.
00:14:04.429 --> 00:14:06.950
Some states, each state has a different allowance
00:14:06.950 --> 00:14:10.850
per month for personal needs. And many states,
00:14:11.429 --> 00:14:13.990
even California, for instance, are below $90.
00:14:14.330 --> 00:14:17.309
So what it does is allows that Medicaid beneficiary
00:14:17.309 --> 00:14:20.950
with VA benefits to increase their personal needs
00:14:20.950 --> 00:14:25.269
allowance up to that $90. I bet one of the problems,
00:14:25.350 --> 00:14:27.129
cause you said at the beginning, the question
00:14:27.129 --> 00:14:29.389
is like a lot of people think, well, if I get
00:14:29.389 --> 00:14:31.649
one, I can't get the other. I bet that's a big
00:14:31.649 --> 00:14:34.129
problem. It's sort of this self selection. You
00:14:34.129 --> 00:14:37.950
root in your own minds. You rule it out. Do you
00:14:37.950 --> 00:14:40.250
bump into that a lot where somebody like three
00:14:40.250 --> 00:14:41.809
years later goes, you mean I could have done
00:14:41.809 --> 00:14:46.950
this three years ago? Yeah. Yeah. Um, absolutely.
00:14:47.009 --> 00:14:50.320
Um, I think that one of the. biggest ways in
00:14:50.320 --> 00:14:53.120
which we can actually add value for families
00:14:53.120 --> 00:14:57.039
is by helping them think if there's a couple,
00:14:58.000 --> 00:15:01.360
helping them think about the best approach. And
00:15:01.360 --> 00:15:05.240
this is often very tricky. But there is cases
00:15:05.240 --> 00:15:09.440
where we can really help the couple where one's
00:15:09.440 --> 00:15:12.759
a veteran and the other is not a veteran or the
00:15:12.759 --> 00:15:17.080
spouse of a veteran. And we can use a combination
00:15:17.080 --> 00:15:21.139
of VA benefits and Medicaid benefits to help
00:15:21.139 --> 00:15:24.179
with their long -term care costs such that they
00:15:24.179 --> 00:15:29.320
could have a quite comfortable situation with
00:15:29.320 --> 00:15:33.259
regards to long -term care. Obviously, your listeners
00:15:33.259 --> 00:15:36.700
should know, Jim, when it comes to long -term
00:15:36.700 --> 00:15:38.860
care, let's make sure that everyone has a shared
00:15:38.860 --> 00:15:43.860
understanding. This is an astronomical fees and
00:15:43.860 --> 00:15:48.179
costs that occur late in life when people's savings
00:15:48.179 --> 00:15:51.120
accounts are almost dwindled down to a very low
00:15:51.120 --> 00:15:54.740
level. So even if you've been a very good saver,
00:15:55.080 --> 00:15:58.919
many middle -class seniors are facing a crisis
00:15:58.919 --> 00:16:02.039
of how to pay for long -term care. Half a million
00:16:02.039 --> 00:16:05.080
dollars is... Yeah, I'm afraid to ask, what is
00:16:05.080 --> 00:16:07.600
the, I don't know, national average or something
00:16:07.600 --> 00:16:13.049
for long -term care on a picture... monthly annual
00:16:13.049 --> 00:16:16.610
basis, I'm afraid to ask, but what is the scary
00:16:16.610 --> 00:16:19.129
number? Oh, these numbers, I mean, they're varying
00:16:19.129 --> 00:16:21.830
quite a bit between home care and nursing home
00:16:21.830 --> 00:16:25.450
care. But let's give you an idea. The daily rate
00:16:25.450 --> 00:16:29.889
on average is about $400 a day for facilities
00:16:29.889 --> 00:16:33.529
if you're in a nursing home. That turns out to
00:16:33.529 --> 00:16:36.450
be almost $10 ,000 or about $10 ,000 a month.
00:16:37.350 --> 00:16:39.950
Now, there's quite a bit of variation. Like Alaska,
00:16:40.129 --> 00:16:43.490
you'll see rates that will build up to $50 ,000,
00:16:43.490 --> 00:16:47.289
$60 ,000 per month. because the facilities are
00:16:47.289 --> 00:16:51.269
so remote and limited and costly to run versus,
00:16:51.269 --> 00:16:55.029
you know, Texas, where you have rates between
00:16:55.029 --> 00:16:58.070
$6 ,000 and $8 ,000 on a monthly basis for a
00:16:58.070 --> 00:17:02.549
nursing home. But so, I mean, there is a temptation,
00:17:02.570 --> 00:17:04.950
I suppose, to shop around. But realistically,
00:17:05.210 --> 00:17:07.569
we're only going to go where we have family and
00:17:07.569 --> 00:17:10.829
support. Right. Yeah. And as you say, there's
00:17:10.829 --> 00:17:13.049
a point at which you've exhausted your private
00:17:13.049 --> 00:17:16.549
resources. You've probably your kids have probably
00:17:16.549 --> 00:17:21.930
exhausted what they can do for you. And. What
00:17:21.930 --> 00:17:26.410
percentage of your of your clients come to elder
00:17:26.410 --> 00:17:30.109
care resource planning ahead of time versus when
00:17:30.109 --> 00:17:36.849
the crisis hits? Yeah, I would say. 80, 20, maybe.
00:17:37.529 --> 00:17:40.549
Mostly we're talking to people who are in a crisis.
00:17:40.650 --> 00:17:43.609
And that's where we add the most value. Like
00:17:43.609 --> 00:17:48.529
it or not, we are planners. We're going to be
00:17:48.529 --> 00:17:51.930
right down there to the day. Look, we need to
00:17:51.930 --> 00:17:54.170
know these numbers on this date, and we need
00:17:54.170 --> 00:17:57.710
to do this and this. So it's a very tactical
00:17:57.710 --> 00:18:01.650
project management approach that we have. But
00:18:01.650 --> 00:18:06.890
we're facilitating eligibility Maybe weeks months
00:18:06.890 --> 00:18:10.089
ahead of time and by doing so we're more our
00:18:10.089 --> 00:18:12.049
fees Which are very reasonable compared to the
00:18:12.049 --> 00:18:15.490
market are being basically paid for by the benefits
00:18:15.490 --> 00:18:18.009
that we're helping them achieve Well, I appreciate
00:18:18.009 --> 00:18:20.130
you bringing up that there's a cost to this kind
00:18:20.130 --> 00:18:21.910
of planning. Do you want to give our veteran
00:18:21.910 --> 00:18:26.710
radio listeners? Michael Guerrero some idea of
00:18:26.710 --> 00:18:31.119
what this type of planning might cost Typical
00:18:31.119 --> 00:18:34.980
rates, there's law firms that specialize in this
00:18:34.980 --> 00:18:38.240
type of work or elder law firms and now charging
00:18:38.240 --> 00:18:43.980
anywhere between $10 ,000 and $20 ,000 for a
00:18:43.980 --> 00:18:46.680
complete case of helping families to go through
00:18:46.680 --> 00:18:48.960
the process of applying for nursing home benefits
00:18:48.960 --> 00:18:52.650
in the local states. Our fees start at $6 ,400
00:18:52.650 --> 00:18:55.549
for very low -resourced individuals and run up
00:18:55.549 --> 00:18:58.809
to $9 ,800 for the cases where we're helping
00:18:58.809 --> 00:19:01.029
spouses save hundreds of thousands of dollars.
00:19:01.829 --> 00:19:04.769
Yeah, and as you say, when you measure that against
00:19:04.769 --> 00:19:07.690
what it costs to be in one of those facilities
00:19:07.690 --> 00:19:11.940
on a monthly basis, you quickly see this is maybe
00:19:11.940 --> 00:19:15.039
not something I can do myself and shouldn't do
00:19:15.039 --> 00:19:18.000
myself if I want the best planning outcomes and
00:19:18.000 --> 00:19:20.559
particularly, and that's why we're talking to
00:19:20.559 --> 00:19:23.859
Michael Guerrero, if you're a veteran and you
00:19:23.859 --> 00:19:28.599
may qualify for certain benefits and you may
00:19:28.599 --> 00:19:32.460
need Medicaid, coordination is really the key,
00:19:32.599 --> 00:19:36.549
isn't it? Oh, absolutely. Yeah, these two programs,
00:19:36.549 --> 00:19:38.890
they don't fit nicely together like two Lego
00:19:38.890 --> 00:19:42.549
blocks. There is a lot of different conflicting
00:19:42.549 --> 00:19:46.769
requirements sometimes. Routinely, there's some
00:19:46.769 --> 00:19:50.130
states, for instance, where regardless of whether
00:19:50.130 --> 00:19:54.250
the veteran is qualified, eligible wartime veteran
00:19:54.250 --> 00:19:58.769
or not, you have to submit a claim before you
00:19:58.769 --> 00:20:03.720
can even file for Medicaid. So it's a ridiculous
00:20:03.720 --> 00:20:06.319
bureaucratic requirement, but it is just one
00:20:06.319 --> 00:20:07.880
of the things that we have to deal with. And
00:20:07.880 --> 00:20:10.599
we help the families to put into place as part
00:20:10.599 --> 00:20:14.539
of the process. I know in my business as a veteran
00:20:14.539 --> 00:20:18.019
disability lawyer, part of what we get compensated
00:20:18.019 --> 00:20:22.079
for is sort of not only the knowledge we bring
00:20:22.079 --> 00:20:24.829
to the table, like you're talking about. But
00:20:24.829 --> 00:20:27.269
there's a certain amount of stress relief you
00:20:27.269 --> 00:20:29.369
give to your clients when they go, OK, it's in
00:20:29.369 --> 00:20:30.690
the hands of somebody who knows what they're
00:20:30.690 --> 00:20:34.990
doing as compared to my poor daughter -in -law
00:20:34.990 --> 00:20:38.049
who's getting stuck with this task. I suspect
00:20:38.049 --> 00:20:40.910
you see that as well, that there's a certain
00:20:40.910 --> 00:20:44.029
amount of stress relief that results in engaging
00:20:44.029 --> 00:20:47.150
a planner who knows what they're doing. You bet,
00:20:47.309 --> 00:20:51.559
yeah. I mean, this is professional work. Just
00:20:51.559 --> 00:20:54.839
like I wouldn't want to fly a plane. I don't
00:20:54.839 --> 00:20:57.859
know how to do that. So I would bring in the
00:20:57.859 --> 00:21:00.619
professional to help me make sure to land that
00:21:00.619 --> 00:21:06.859
plane correctly. In any case, many people are
00:21:06.859 --> 00:21:13.210
unaware of the risks that they have. the financial
00:21:13.210 --> 00:21:17.150
risks, the medical risks that come up in these
00:21:17.150 --> 00:21:19.950
cases. And so we want to make sure that we steer
00:21:19.950 --> 00:21:22.089
them clear of that. Sometimes they're hidden,
00:21:22.109 --> 00:21:25.630
right? They're hidden beneath the surface, but
00:21:25.630 --> 00:21:29.470
we know they're there. And those risks are huge.
00:21:30.130 --> 00:21:32.769
One of the most common things is people submit
00:21:32.769 --> 00:21:37.829
the application and it turns out they are missing
00:21:37.829 --> 00:21:41.559
some information. the caseworker lets them know
00:21:41.559 --> 00:21:45.660
by sending them a form letter in the mail. And
00:21:45.660 --> 00:21:50.160
it gets there too late beyond their deadline.
00:21:50.200 --> 00:21:52.960
And then that application is simply thrown away.
00:21:53.019 --> 00:21:56.440
It's just denied. And it's really frustrating,
00:21:56.500 --> 00:21:58.720
but you have to see it from the caseworker's
00:21:58.720 --> 00:22:00.759
perspective. They're overwhelmed, and they're
00:22:00.759 --> 00:22:03.240
just doing their jobs. And so what we do is we
00:22:03.240 --> 00:22:06.140
make their lives easier as well by giving them
00:22:06.190 --> 00:22:08.710
all that information and easy to make decision
00:22:08.710 --> 00:22:11.410
ready to go. And I think any veterans who have
00:22:11.410 --> 00:22:13.710
worked through like the disability process or
00:22:13.710 --> 00:22:15.710
made application for aid and attendance would
00:22:15.710 --> 00:22:18.509
understand those issues that you have to package
00:22:18.509 --> 00:22:22.210
the information up in the way the government
00:22:22.210 --> 00:22:25.490
employee is looking for it. You got to make their
00:22:25.490 --> 00:22:28.029
life easier because they are overwhelmed and
00:22:28.029 --> 00:22:31.569
otherwise you. you risk and you almost encourage
00:22:31.569 --> 00:22:35.609
a denial of the claim. So as we come to the end
00:22:35.609 --> 00:22:39.029
here, Michael, can you if there's folks out there
00:22:39.029 --> 00:22:41.750
going, boy, I think I need to talk to a planner
00:22:41.750 --> 00:22:46.390
on this issue. Are there things that they should
00:22:46.390 --> 00:22:48.690
look for that you'd recommend? Hey, if you're
00:22:48.690 --> 00:22:51.430
going to talk to a planner, make sure they have
00:22:51.430 --> 00:22:54.769
this or these experiences or these certifications
00:22:54.769 --> 00:22:58.420
for those who've never maybe. thought about this
00:22:58.420 --> 00:23:01.359
issue, how should they go about finding somebody?
00:23:02.559 --> 00:23:06.339
Sure. Yeah. Well, we talk to a lot of different
00:23:06.339 --> 00:23:09.940
families every day. And I think in order to answer
00:23:09.940 --> 00:23:12.779
your question, I'll just sketch out like three.
00:23:13.079 --> 00:23:16.680
different types of services that are appropriate
00:23:16.680 --> 00:23:19.940
senior living or senior advisory services. So
00:23:19.940 --> 00:23:22.339
they kind of have a little bit more of a menu,
00:23:22.400 --> 00:23:25.339
right? Once you know what's on the menu, then
00:23:25.339 --> 00:23:27.220
you have an idea of what you want, what you don't
00:23:27.220 --> 00:23:30.640
want, or maybe actually maybe one of everything.
00:23:32.200 --> 00:23:37.609
So the menu really, if I can, Jim. I would say
00:23:37.609 --> 00:23:39.450
first and foremost, everyone should be aware
00:23:39.450 --> 00:23:44.809
of a fantastic trade association that runs, that
00:23:44.809 --> 00:23:48.069
assists with providing services for the professionals
00:23:48.069 --> 00:23:51.319
that work as what they call themselves as geriatric
00:23:51.319 --> 00:23:54.759
care managers. These are folks that work in this
00:23:54.759 --> 00:23:57.880
very difficult nexus between the medical side
00:23:57.880 --> 00:24:02.279
and managing care. And when it comes to providing
00:24:02.279 --> 00:24:06.460
long -term care with a variety of doctors and
00:24:06.460 --> 00:24:09.440
specialists and emergency rooms, you name it,
00:24:09.660 --> 00:24:12.480
these geriatric care managers can be extremely
00:24:12.480 --> 00:24:16.480
valuable as navigators, as medical translators,
00:24:16.480 --> 00:24:20.609
and they work on an hourly basis or on a project
00:24:20.609 --> 00:24:23.190
basis as well, providing assessments, making
00:24:23.190 --> 00:24:27.150
homes safer, and helping you interpret and understand
00:24:27.150 --> 00:24:29.930
what people are saying and how it's all working.
00:24:31.750 --> 00:24:34.809
In addition to that, you're going to run into
00:24:34.809 --> 00:24:38.730
lawyers that specialize in estate planning and
00:24:38.730 --> 00:24:41.869
making sure you're well prepared to, you know,
00:24:41.960 --> 00:24:45.119
for that final days and your wills, your trust,
00:24:45.279 --> 00:24:47.519
your adorable power of attorney, your medical
00:24:47.519 --> 00:24:49.980
advanced directive is in place. These are really
00:24:49.980 --> 00:24:51.720
important services that everyone really needs
00:24:51.720 --> 00:24:54.140
to think about, even if their estates are very
00:24:54.140 --> 00:24:58.140
modest. And then finally, Medicaid planners.
00:24:58.559 --> 00:25:01.880
So this is what we do. We work on that project
00:25:01.880 --> 00:25:06.200
basis. We work about how to unlock and make sure
00:25:06.200 --> 00:25:10.220
to make the most sensible plan to get from where
00:25:10.220 --> 00:25:13.380
you are to Medicaid eligible and unlock those
00:25:13.380 --> 00:25:17.160
benefits for you. I worked as a certified Medicaid
00:25:17.160 --> 00:25:19.880
planner as you started out saying that that is
00:25:19.880 --> 00:25:22.740
a designation that is very maybe perhaps little
00:25:22.740 --> 00:25:25.220
known. There are many people that are qualified
00:25:25.220 --> 00:25:27.640
out there that are not certified, but it is something
00:25:27.640 --> 00:25:30.480
that we use as a way to show to our clients,
00:25:31.339 --> 00:25:34.079
hey, look, we've done the testing, we do the
00:25:34.079 --> 00:25:37.380
ongoing education, and we make a commitment ethically
00:25:37.380 --> 00:25:41.480
to make sure that we are professionals working
00:25:41.480 --> 00:25:44.309
on behalf of the customers. That's where I was
00:25:44.309 --> 00:25:46.730
trying to get you to is that if I'm looking for
00:25:46.730 --> 00:25:49.170
somebody, I want somebody who didn't just say,
00:25:49.289 --> 00:25:51.029
hey, I can do this planning. I want somebody
00:25:51.029 --> 00:25:54.410
who is a certified Medicaid planner who's done
00:25:54.410 --> 00:25:57.890
all that testing has proven himself up. So yeah,
00:25:58.009 --> 00:25:59.990
that's exactly where I was trying to get to.
00:26:00.630 --> 00:26:08.400
If folks want to know more about Elder care resource
00:26:08.400 --> 00:26:11.900
planning. Where should they look? What's your
00:26:11.900 --> 00:26:14.900
website? How do they contact you guys? You bet.
00:26:15.299 --> 00:26:19.599
Yeah. So the website is, it's a long name, right?
00:26:20.700 --> 00:26:24.480
Eldercareresourceplanning .org. We maintain,
00:26:25.680 --> 00:26:29.099
it's kind of quaint in these days because there's
00:26:29.099 --> 00:26:32.400
so many different, you know, artificial intelligence
00:26:32.400 --> 00:26:35.039
out there, but we maintain a lot of information
00:26:35.039 --> 00:26:36.819
on our website. You don't even have to give us
00:26:36.819 --> 00:26:41.000
a call. You can learn a lot from our content,
00:26:41.099 --> 00:26:45.059
from our newsletters, and from our sibling websites
00:26:45.059 --> 00:26:48.420
as well that we maintain as well. I mean, I just
00:26:48.420 --> 00:26:50.920
looked up the information that we posted and
00:26:50.920 --> 00:26:54.779
it was updated last week. It's critical information.
00:26:54.900 --> 00:26:58.640
It changes all the time. So eldercareresourceplanning
00:26:58.640 --> 00:27:08.019
.org. The main line is 415 -854 -8653. And still
00:27:08.019 --> 00:27:14.660
remember the main line. But anyone interested
00:27:14.660 --> 00:27:17.740
just can reach us through the website. And I
00:27:17.740 --> 00:27:20.279
want to encourage veteran radio listeners, go
00:27:20.279 --> 00:27:22.420
look at the website. Even if you're not going
00:27:22.420 --> 00:27:26.160
to make the phone call, go to eldercareresourceplanning
00:27:26.160 --> 00:27:30.140
.org. to get educated, to read up on some of
00:27:30.140 --> 00:27:33.299
these topics. Maybe subscribe to the newsletter.
00:27:33.420 --> 00:27:36.259
I know I do. And I get information that, well,
00:27:36.259 --> 00:27:38.980
I didn't know that. Again, this isn't my area
00:27:38.980 --> 00:27:44.400
of specialty. So I really appreciated the newsletters
00:27:44.400 --> 00:27:46.599
that you put out, Michael. And I really appreciate
00:27:46.599 --> 00:27:48.880
the time you've given to Veterans Radio today.
00:27:49.839 --> 00:27:54.059
Yeah. Well, happy to serve. Veterans have done
00:27:54.059 --> 00:27:57.519
their part for our country and so I'm happy to
00:27:57.519 --> 00:28:02.539
do what we do is educate folks with authoritative
00:28:02.539 --> 00:28:06.539
and bankable information. And I want to thank
00:28:06.539 --> 00:28:08.759
everybody for listening to Veterans Radio today.
00:28:08.880 --> 00:28:12.180
I am Jim Fossone. It's been a pleasure to be
00:28:12.180 --> 00:28:14.880
your host. I'm a Veterans disability lawyer at
00:28:14.880 --> 00:28:17.440
Legal Help for Veterans and you can reach us
00:28:17.440 --> 00:28:23.710
at 800 -693 -4800. or legalhelpforveterans .com
00:28:23.710 --> 00:28:26.690
on the web. You can follow Veterans Radio on
00:28:26.690 --> 00:28:29.710
Facebook and listen to its podcasts and internet
00:28:29.710 --> 00:28:34.309
radio shows by visiting us at veteransradio .org.
00:28:34.549 --> 00:28:38.250
That's veteransradio .org. We again want to thank
00:28:38.250 --> 00:28:41.349
our national sponsors, the National Veterans
00:28:41.349 --> 00:28:46.789
Business Development Council, nvbdc .org. Legal
00:28:46.789 --> 00:28:50.180
Help for Veterans. A Veterans Disability Law
00:28:50.180 --> 00:28:55.279
Firm with a national practice before the VA can
00:28:55.279 --> 00:28:58.940
help you on your claims and your appeals. It
00:28:58.940 --> 00:29:02.279
can be reached at legalhelpforveterans .com or
00:29:02.279 --> 00:29:07.779
1 -800 -693 -4800. We also want to thank our
00:29:07.779 --> 00:29:12.779
local sponsors. This would include the Charles
00:29:12.779 --> 00:29:16.619
S. Kettles chapter of the Vietnam Veterans of
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America. That's chapter 310. VFW Graf O 'Hara
00:29:21.359 --> 00:29:25.519
post 423. The American Legion Erwin Preskin post
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46 in Ann Arbor as well. The VA Ann Arbor Health
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Care System and certainly the National Vietnam
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