Applied for Medi-Cal for my mom and was denied. What can I do? Frustrated in California.

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Melodicmom Asked December 2021

Applied for Medi-Cal for my mom and was denied. What can I do? Frustrated in California.

I feel really defeated. My 87 year old mom is on her last month of paying for her assisted living bill of $4100.00. I applied for her to receive Medi-Cal so she could be placed in a nursing home for LTC. She is a complete invalid and on hopsice requiring 24 hour care. She was denied because she made a couple of hundred dollars over the income limit of $1366.00. Come January she will be out of money and I can't afford to pay for this and she will have to leave her assisted living facility. What are my options? Was she denied also because she is on hospice? I don't know what to do. Bringing her home to my house is not an option. I want to scream!!!!

Financial Planning Medicaid Paying for Care

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score 0 · Answer 1

https://www.vcaaa.org/about-us/advocacy/nursing-facility-services/

This link has a phone number that may be able to help you find a place for your mom.
California does not have the Miller Trust program.

https://ombudsmanventura.org/services_ombudsman/BudcaregiverBROCHURE27.2.08.pdf

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score 0 · Answer 2

You can appeal. Yes, see if a Miller Trust is OKd in your state.

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score 0 · Answer 3

You call elder protection services immediately and let them know. It sounds like your mom needs an attorney to set up a Miller trust to qualify her for LTC Medicaid. She would qualify if the application and preparation were done properly. if you don't have the resources or help to have that done, call APS and let them know the situation. They may have to do an emergency guardianship or perhaps they can help qualify her for the Medi Cal.

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score 0 · Answer 4

You need to ask Medi Cal Why she was denied. Not due to hospice.

Over income level (she may need to document her medical spending); are layme ts to the AL documented as such? If the were paid in cash or not properly accounted for, they may look line gifting.

You need to get info from Medi Cal about why.

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score 1 · Answer 5

Here is an informative article from this very website that may answer some of your questions:

https://www.agingcare.com/articles/medicaid-and-long-term-care-133719.htm

"Hospice care, including room and board, is covered under Medicaid whether the individual lives at home or resides in a nursing home, assisted living facility, or rehabilitation center."

Source: https://www.seniorliving.org/hospice/medicare-medicaid

It seems your mom maybe just makes too much income. You may benefit by consulting with a Medicaid Planner to see if she will ever be able to qualify. I'm so sorry you're in this distressing situation.

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score 1 · Answer 6

No not yet. I just found out she was denied. The AL she is at is a private home and they don't have a social worker. The one who applied for her is a social worker from the hospital where she was last admitted to. What does not medically at need mean? Did she get denied because she is in hospice?

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score 1 · Answer 7

Have you asked the social worker at the AL for help?

Have you spoken to a MediCal planner about why she was denied?

Have you looked at why she was denied? Missing information? Gifting? Not medically at need?

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Applied for Medi-Cal for my mom and was denied. What can I do? Frustrated in California.

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