But while his family, and his physician, agree on the need for more advanced care, his health insurers do not.
Medicare does not generally cover long-term nursing home care. Medicaid does, but only when it deems those services “medically necessary” — and that determination is made by insurance agents, not by the patient’s doctors. The state of New Jersey, where my parents live, recently switched to a managed care system for its elderly Medicaid recipients. Instead of paying directly for the care that this patient population needs, the state pays a fixed per-person amount to a string of private companies, who in turn manage the needs of patients like my father. On paper, these companies cover the full range of required offerings: nursing homes, assisted-living facilities and a suite of in-home support services. In practice, they do what most insurance companies seem to do: obfuscate and evade and force you to beg.
When I told my father’s care coordinator what his doctor said, she was unequivocal. “He is not even close to qualifying,” she said. “He’s only 78, and he can still walk and wash and dress himself without assistance.”
I countered that he had “bathroom issues” and that he frequently refused to shower.
“Refusing to do something is not the same as being physically incapable of doing it,” she said.
About four million Americans already live with dementia. Medicare doesn’t cover long-term care. Medicaid does, but it’s super tricky, and most don’t get even close to what the docs say they need in terms of support: https://t.co/HmKOvHdSmS
— Jeneen Interlandi (@JInterlandi) December 1, 2019