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What is the Alabama Medicaid income threshold? Hi, I just stumble across this forum, so I can only pray I've posted in the proper section.

We are looking for agencies in GA that could help an AL Medicare patient in a GA nursing home. Mostly likely income is too much for Medicaid (and would have to qualify in AL, not GA). In less 15 days, they must leave because can't afford the $152 per day.

At a loss on where to place him. Because they actually reside in Alabama, the LPN providing "social services" at the nursing facility is unable to offer any advice or assistance.

We could send him back to AL, but his wife isn't able to care for him alone. Seems that we could move them to GA somehow, but I am at a loss. There is no room in our home or we could take them in. There are skilled facilities in AL, but Medicare still requires $152 per day, so I don't know what that would solve -- UNLESS they can get Medicaid.

I read that Medicare pays for certain home health services if a doctor orders it. I would think we would have to get him back to his actual home and somehow be seen by his primary physician to even consider this. Does anyone know if any "treating" physician can order home health?

He is pretty much immobile (bed ridden). Along with multiple health issues, the biggest problem is that he is an extremely large man and we are unable to lift or move him. He is unable to get up to use the restroom (he has a cath), so using the restroom requires cleaning ... it currently takes 4 nurses to turn and clean him.

This is breaking my heart and I don't know where to turn. It is sad that they have worked all of their lives in GA, and moved to AL several years ago when they lost their home to do a series of unfortunate events.

They currently live in a trailer in AL (valued at around $50K). Although I've read there might be ways around it, no one is opposed to selling the trailer and putting it toward the care. However, even if it were to sell at over $5K per month that pretty much would deplete that fairly quickly. Between the two of them their income is about $3k per month - which apparently is too much to qualify for Medicaid; and the majority of it goes toward medications.

I've seen the posts about the book on Medicaid secrets, but frankly I don't have time to read a book. I have to take action now ...

Not sure this is enough info to warrant advice, but I'm willing to continue to conversation. Bottom line l(1) looking for agencies that cross state lines (2) wondering if it would be best to try and get him back to AL and pursue options there (which totally takes family support out of the loop (3) looking for any other options or advice that anyone could take the time to share with me

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Thank you all so much for your responses. Unfortunately, he unexpectedly passed away on Thursday and we buried him today. This has truly been a trying time for our family. I'm sure I'll be posting again and subscribing to this forum, as we will now be caring for my mother-in-law. I certainly want to make sure we are better prepared.
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Now MedicAID is a joint federal & state program. Administered by each state uniquely but within an overall federal guideline. So what GA has for requirements may differ from AL. The states in general require that they have to be a resident of the state in order to qualify for Medicaid. The application will require all sorts of documents - like his awards letters from SS and retirement; his health insurance details; his bank statements, insurance policies, etc. And all of these will need to show residency in GA. It will a lot to deal with. Can it be done, yes, but will be somebody's almost full time job to deal with for the next couple of months.

He can get onto GA Medicaid once he becomes a resident of the state and meets whatever the specific financial & medical are for GA. Now 1 big thing will be their homestead - as it is in AL (& I'm assuming that it;s in their names and they have a homestead on it so there is no way around this not being found out) will be a non-exempt asset for GA Medicaid. Until AL gets sold & the land it is on too, they will not qualify for GA Medicaid. Also since it is "real property" whatever it gets sold for will be easily verified and all the proceeds from the sale may have to be used for his spend-down. Now the sticky part in this is that I bet that some of the $ from the sale could be your MIL's allowed under Medicaid community spouse separate assets. Really you would need an experienced elder law attorney to decipher and work all this out as the whole CS situation is very very different that widow or widower Medicaid which is pretty straight forward for $ limits.

Now if they sell it, then where does MIL go? If she doesn't too need a NH, she can qualify for any of the community spouse allowances under Medicaid. She will need to become an GA resident to get any of the CRSA / MMNA (Community Spouse Resource Allowance or Minimum Monthly Maintenance Allowance - think of this as like alimony for the NH set).

Really the easier situation is to get him back to AL and go through AL Medicaid program. It sounds like he just cannot be taken care of at home (anyone's home) he needs a facility.

Could he possibly qualify for hospice? If he could that could be an avenue to get care accross state lines. He would need to go with a hospice group that is in both GA and in AL. The bigger ones like VITAS or Compassus are nationwide. Hospice is 100% MediCARE benefit. If he could get hospice now in GA and then they help you co-ordinate a transfer to another NH in AL that the hospice group already has a relationship with. It needs to be a NH that accepts Medicaid, as he is going to then go into the AL NH as "Medicaid Pending". Now for hospice, there will be 2 MD needed to sign off on this: the hospice MD so that one would be with Vitas or Compassus AND either his personal MD or the medical director of the NH. I would really look to see if he can clear hospice as this could solve some of the problems plus get a care plan going for now in GA and then for AL later.
Really hospice could totally be a way to manage a lot of this and with Medicare paying for a good part of this.

I bet he meets the criteria for Medicaid (financial & medical) as MIL is a community spouse so his actual required co-pay is going to be within the amount allowed.

Also about CS stuff, most Medicaid NH are 80/90% are widow or widower applications. For them its like no more that 2K in non-exempt assets & 2K in monthly income. Exact amount varies by state (like for my mom in TX it was no more than $ 2,094.00 in monthly income when I applied for her). But for CS it's different and often the NH will overlook this and the spouse is just too distracted in dealing with their about to go into the NH spouse to correctly & adamantly deal with the CS situation. You need to be on top of this because MIL will need to make sure that she is getting some of his required co-pay (the SOC - share of cost) of his months income to the NH under Medicaid. MIL is NOT herself required to become impoverished only FIL is. She can continue to live in the trailer (and the trailer will totally be an EXEMPT asset and will stay that way as long as mom keeps it as she is the CS) and she needs every penny to be able to do this.

To me your gut feeling on what is really needed is realistic. The sooner he can get back to AL & into a facility there the simpler all this will be for all.

About Medicaid & non residents, it can happen but seems to be for special circumstances. My MIL & her entire NH after Hurricane Katrina moved to Texas. TX Medicaid accepted all those on LA Medicaid. But after about 6 months, any of the ones who still had a home in LA were told that they either had to sell the LA property as it would be non-exempt for TX; or they could move back to LA or start to private pay. Since Medicaid is state run, they kinda have to do this. Good luck in all this; it just flat isn't simple.
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MrsJ - my guess is that there are 2 different situations going on; each very different. This may be long so get a drink….

1. It sounds like right now he is on MediCARE. MediCARE is a federal entitlement which just about everybody qualifies for and you sign up for it once you turn 65 and is totally portable. So if you are a resident of Louisiana and go to Disneyworld and fall and go to the hospital in Orlando, Medicare will pay for hospitalization costs. Reimbursement will be federally paid and at whatever rate it's set for that region. Medicare is "portable".

Medicare will only pay for a set # of days based on the procedure code. For most elderly if they fall and break a hip & have surgery to repair, then when after their more than 3 day stay @ the hospital, they get discharged to a facility for "rehab". Usually if they are elderly the rehab is a a facility that is a NH with rehab ability (as opposed to a rehab unit that is trauma or post chemo oriented which get younger patients). Now the hospitalization is paid by Medicare & the rehab is also BUT only for a # of days. In general they automatically get 21 days rehab with Medicaid paying 100%. Then when they hit day 22. in order for Medicare to pay the maximum 100 days of rehab, they need to be "progressing". For the hip break, they need to be participating in OT & PT and it's making a difference, their "progressing". For most elderly they don't, so family either has to decide to keep them in the facility but going to the NH only sector or taking them home. But if Medicare will find them progressing, then Medicare will pay only a % of the stay and family or if they have a good insurance policy will pay the balance. For you all the amount is $ 152 day.

My suggestion is to speak with the social worker to see where he is in his "progress". Sometimes it may help to speak with the PT or OT as some of this has a degree of flexibility of interpretation. Now the NH likes Medicare residents as the reimbursement rate (even if it only 80%) is much, much better than whatever Medicaid would pay. So if he still has Medicare paid days, that is definitely in your favor as the NH is making $ if Medicare pays.

But if he is a large man and really can't move or do on this own, Medicare's rules do not allow for him to continue if no progress. try to find out what / how many days realistically he can get.

What families tend to do when this happens is to then either private pay for their stay; or hopefully they have LTC insurance; or more likely they apply for MedicAID.

this will continue in another post on Medicaid
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Thanks so much for your reply. All of your answers seem to be inline with what I thought. I have expressed my opinion to the family that we really can't preserve anything at this point. Unfortunately, he is still in GA and the social worker at the nursing home is making no effort to connect us with any assistance in AL. Since posting this, I've found the website for AL Medicaid and have told the family we should apply. I am thinking they are ALL in denial here. I am at my wits end. His nursing home benefits will run out next Wednesday. My mother-in-law intends to pay the 20% to stay 2 extra days, so they will transport him to a doctors appointment. I've tried to explain to her that on that Friday she should already have a plan lined up for him to go home. Once he gets to AL then we can reach out to them for assistance. No one else in the family seems to see the urgency of pre-planning here. Does anyone know if we could go ahead and apply for AL Medicaid while he is in a GA facility or do we need to wait until he is physically in AL?
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In a nutshell, it's too late to be thinking about trying to "preserve" any assets....your Dad needs nursing home care, not home care, and needs to spend down to meet your state's Medicaid asset qualifications. There won't be need to sell the trailer if your mom is still living in it, BUT after your mom dies they will place a lien on it for MERP (Medicaid Estate Recovery).
Right now, focus on that application to his current state's Medicaid. Your dad desperately needs to get that process started. I am surprised Social Services at his current facility did not offer to help with that (for his current state of residence).
Once you have the Medicaid, keep records of everything! your mom will need to document ALL purchases for everything, so don't go paying cash for anything! it can be a spiral notebook with receipts stapled on there, but essentially, you need to keep receipts 100%. Also remember some receipts have "fading" ink so you might want to make photocopies (non-fading ink).
There is no Medicaid that will cross state lines for nursing homes (once in aa while they might do it for kidney transplants or something like that, but not for seniors in need of daily care). There is no Medicare for nursing home.

If your DAd was a veteran there might be some benefits thru the VA, but in my experience it took almost 2 years to see a payment, so (after you apply for Medicaid) get that started as well.

Once he's on Medicaid, they will coordinate (account for) all payments from Social Security, Medicare, VA, and any other benefits....nothing can be hidden, and if they discover money somewhere, they will stop paying the nursing home until the newly discovered asset is drained for the NH bills. So don't waste time to try hiding anything. Be up front, honest, and document document document.
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