Declining a pension payment to qualify for PACE?

casole, I live in New Jersey and I recently looked into the PACE program for my husband as it’s a wonderful program where they will take him to all of his doctors’ appointments and they will take him to adult daycare where he will receive breakfast and lunch, etc. However, just like your mother’s case, my husband makes over the limit to qualify for the PACE program. I spoke to a caseworker at the facility that administers the program and I was told that his income was over the limit. The caseworker also told me that PACE is a Medicaid program and his income has to be within the Medicaid limit. The caseworker told me that since my husband’s income is over their limit, he can qualify for the PACE program if he does self payment of $6,000 a month.

Since PACE is a Medicaid program and your mother’s income must fall within their income limit, you should seek the advice of an elder law attorney who has experience with Medicaid and see if you can set up a QIT or Miller trust where the excess money over the Medicaid limit will be deposited into the trust and perhaps your mother will be able to qualify for PACE.

I don’t think anyone on LTC Medicaid or any other needs based program (like SSI or in your folks case PACE) can turn down anything that would provide an income or other resource(s) with a monetary value/ benefit.

so if you were named a heir to a recently deceased Sibling who left you 20K in their will, you cannot turn it down. 20K will be counted one way or the other as income and ineligible for any need based program with low income / assets limits. Your mom’s pension along the same lines, as it’s income required under her employers retirement program due to her.

If this was about getting eligible for LTC Medicaid to pay for a NH, then the suggestion on doing a Miller Trust can work as a way to get that excess income still go as the LTC Medcaid required income copay / Share of Cost to the NH. As the Miller $ plus their other income both go to the SOC. But this is enrollment at a PACE and PACE usually has no payment requirements for those on Medicare & Medicaid so I’m not sure if a Miller could even work to be a solution. You would need to precisely find out from the State as to this and then get an elder law atty to do the Miller would be my guess…. won’t be simple.,

Casole, A ? for you, I’m assuming folks own their home, & mom plans on staying at their home should your Dad - the at need spouse - predeceases her? Was it at all mentioned by whomever your mom spoke to at PACE that it falls under your States Medicaid Estate Recovery system, aka MERP? That if dad were to go onto Medicaid and become a dual PACE billing (dual as in on Medicare & Medicaid), that all the $ at the PACE paid by Medicaid will become a tally State is required to attempt to be reimbursed for? And it is done by placement of a lein on the property or a claim on the Estate. It could be a good bit of $$$ as Medicaid in PACE includes day care program costs PLUS any health care costs. It could be actually end up more $ supposedly owed to MERP via a PACE program than it would be if he was only on LTC Medicaid in a NH for only his custodial care costs at a NH.
Why? It’s because for LTC Medicaid it’s only NH daily room & board cost that comprises the tally, their health insurance paid costs are separate . But for PACE, it’s all day program various costs that Medicaid pays for plus all Medicaid as health insurance costs paid to the PACE as well. That’s how most States set it up for duals. They usually get an entirely new # for all PACE services and all care has to be done within PACE centers and network.

That whole lein repayment stuff is why PACE now has it where you do NOT have to be on Medicaid. It can be only Medicare and whatever premium it is for your State costs system. It was legally challenged by retirees who wanted PACE but not willing to go onto Medicaid to enroll.

For your suspicions that that’s a #s game afoot….. you are right!
PACE is paid by capitation rate by Medicare. MediCARE not Medicaid. PACE is set up on capitation rate similar as to how Medicare hospice benefit is set up on capitation payment rate. Medicare pays the hospice provider a fixed $ per enrolled on hospice individual… it’s abt $4,700 a month whether 2 days a week hospice visits or 4 days a week hospice visits. PACE similar as to how Medicare pays; a fixed amount for the month, whether Dad goes 3 X a week or 4 X a week & weekend in home visit as well.

PACE is full on guaranteed payment by Medicare and due to that you only need to be enrolled on Medicare and meet “need a NH level of care” criteria to enroll but will have to pay a premium for long term care portion of the PACE center and Medicare Part D drugs. For your case, 6K mo.

Administratively this format is a butt rash, so States have designed PACE to be for “duals” so all costs paid by either Medicare or Medicaid. Easy peasy billing & consistency in $ flow. And really PACE can find its # from existing “duals” in their community.

I don't see how a company would be able to holdback a payment oncevset up. Mom is entitled to that pension and it dies with her unless she has a beneficiary. Plus, since she is entitled to it, she may have to take advantage of it per Medicaid. When I started collecting SS, I was told what pensions were coming to me. Try for a Miller/QIT trust.

Update : I spoke with an elder atty and in Mass, Miller or qualified income trusts are not an option so no income can be redirected there.

She's probably not ready to give up her pcp at this point in any case. Anyway that's what I found out.