How is it possible to be on hospice, have no assets, only income is SS, yet be denied Medicaid?

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Therefore then not able to afford a nursing home?Our mother is under hospice care and currently staying with us at our home. She is getting to the point where she needs more 24 hour care and needs to be in a nursing home. We applied for Medicaid, only to learn that she is over the income limit (which was a huge surprise to us). We have learned that Ohio is a 209(b) state, allowing patients to spend down their income. What is the best way to do this and how do we document it? We have appealed to the state and are awaiting a conference with the county to try and overturn the ruling. I want to believe that between reduction in income and being on hospice, she should be approved for Medicaid. Thoughts?

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JoAnn29, I think you are right. You need legal advice. Make sure the lawyer you see specializes in Elder Law. That is very important.

If your mom has enough money to pay for AL for another 5 or 6 months, then I wonder if that money is what is preventing her from qualifying for Medicaid?

Does the hospice company have a facility for care? Medicare would pay for the care and the money that is currently going to AL could go to pay the room and board there. Is that feasible?

The same would be true for a nursing home. The money would not last as long in the more expensive NH, but considering that Mom is on hospice, that may be enough.

I am really sorry for the situation you are in. We handle healthcare very poorly in this country, and that goes doubly for the care of our elders. Hang in there!

Please keep in touch here and let us know how this works out. We learn from each other.
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She is only allowed to have $2,000 in countable assets, else she will be denied.
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Igloo, thanks but still confusing. Moms money runs out August maybe September. I am going to see an elder lawyer next week. My daughter says my Mom falls into the long-term nursing requirements. (She is an RN in NH/REHAB Facility). Before I make any decisions that will effect other people, I need legal advice.
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Talk to the Social Worker from Hospice. They should be able to help you sort this out. If there is an attorney that you have used they may also help.
Depending on her prognosis the Hospice may have an in patient unit that she can stay in for a while until she is approved and can be moved to a long term facility.
Most of the in patient units are for a short duration for Respite, to control pain and the goal is to allow someone to return home. Or at the very end of life if being at home is not possible. (by end of life I mean days or hours.)
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JoAnn - about the "2000 thing"…… 2000 is used as a reference figure for assets & income for Medicaid rules. & yeah unless they have a huge $aving$, elders just flat cannot private pay for NH. Most at my mom's NH had SS at around 1K a mo. So they end up applying for Medicaid which is a "needs based" entitlement for eligibility & they have to be able to show both medical need and financial need.

Medical need for NH is to show in health chart & doctors orders that they "need" skilled nursing care.
Medical is done by others

Financial is 2 separate categories: income & assets
- income, which is the $ mom gets each month, like SS, retirements, an annuity. States each set their own exact amount for the maximum income allowed each month. By & large it's in the 2K range. But usually is an exact #, like when I first applied for my mom for NH Medicaid in TX, was mo income max of $2,064
&
assets - assets are divided into 2 sub-categories: exempt (usually the "homestead" home & 1 car, a funeral policy, a small term life insurance policy). The states can place a limit on the value of exempt stuff.
& also
non-exempt, which too have a exact $ amount. I think all states use $2,000 as maximum non-exempt limit. This could be $ left in their checking account or savings account or placed in their personal needs account at the NH. It just needs to be so that mom starts the month at or under 2K and ends her mo at or under 2K to be OK for Medicaid.
Doing all the financial falls on family, DPOA, guardian to find, report, update…….. yeah it's can morph into a lot to keep up with unless they just have only SS.

Hopefully you can continue to do for your mom and mom can continue to be fine on her ADL's to stay in AL. But things can change, and you may need to think about Medicaid and a NH if her AL does not take Medicaid. Mom will have her SS go to the NH and Medicaid will reimburse the NH for the rest of the costs. If all she has is 1K income and no assets, she will qualify financially
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I don't understand the 2000 thing. No ones SS is going to be able to pay for longterm nursing. $2000 won't pay for an aide around the clock. I was told the cost of the lawyer could come out of Moms money. Which I won't do because I'm trying to keep her in her AL as long as I can.
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My experience is that hospice as a Medicare benefit will not cover the room & board costs if their placement onto hospice is viewed as for long term. So although the hospice medical costs are covered by medicare the Room&Board daily charges from a NH or other facility are not. So R&B is going to need to be paid another way like private pay, other health insurance or Medicaid.

My medicaid pending status mil went from her NH to hospital and then into a free standing hospice. Hospice team at the hospital arranged for it. Severely septic & shocked & died in about 2 weeks & within the limited short-term Medicare in-patient coverage period. What I noticed was that majority of others at this free standing hospice were NOT elderly but much much younger. In speaking with families, they kinda were the same situation with a late stage cancer or major trauma; there for weeks; were on serious black box warning pain or chemo medications & requiring 24/7 oversight and for most payment was coming from 3rd party style health insurance (BcBS, United). Some were medicare and 3rd party insurer as still working or their spouse still worked. If my MIL had lived longer (so used up her in-patient coverage), she would have gotten transferred back to her medicaid bed at the NH with 3 or 4 times a week care visits by hospice (paid by medicare) with all other care, R&B provided by the NH & paid by Medicaid. I will say the hospice evaluation team based at the hospital was spot-on as to evaluating mil & time left.

My mom was already in a NH & on Medicaid & fell shattered a hip, became bedfast and onto hospice. Remained at the NH but with outside hospice group added to her care plan. For my mom, hospice essentially added extra hands to help in moms care. For a NH, hospice is a plus especially for time consuming tasks like bathing. Hospice can add on speciality nutrition, like for my mom it was Twin Cal high protein with probiotics. Hospice can order speciality equipment, like pressure changing beds, geri bathing & regular chairs. Mom was on hospice 18 long, l....o....n....g months.

To me, it would be worth the time for you to go ahead and continue trying to get your mom on Medicaid, getting past whatever is the snafu in eligibility so she can move into a NH on medicaid and also be on hospice. I'd ask your current hospice provider what NH they currently are in. Then contact admissions at those NH. Vitas, Compassus & Southern seem to limited the # of NH they are in and to me those tend to be NH with better nursing & social work staffs. Best of luck in all this & try to keep your sense of humor going.
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Does your Hospice agency have a freestanding hospice center? You may be able to move her to in house Hospice. Or maybe there is a hospice wing at your hospital. Ask you Hospice manager.
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Assets includes things that have to be spent down. Hospice is covered by Medicare. Time is short, maybe too short to even find a nursing home.
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Yes. Get a lawyer. You will pay about $3000, but somehow, magically, lawyers can get done what mere mortals cannot. Best of luck!
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