My dad has severe dementia and was recently approved for Medicaid in a skilled nursing facility. His monthly out of pocket was $1,342.50. My mother is also disabled and was just approved for WA State COPES (in home assistance) for a mere 20 hrs. per month. Now that she was approved, my father's monthly out of pocket payment increased to $2,267.13. They are broke and this will actually put them in a negative state each month. I am POA and live in another state and do all of their paperwork and applications for them. I am in shock and am not sure what to do.

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Your mom should have gotten CSRA or MMNA diverted from their combined income to her as she is the still residing in the community spouse. I'd bet the state is not filing their status correct..that each application was done as an individual application...yeah a real clusterF! There should be an appeals notice on the letters from the state and you need to file an appeal on the both of them. Don't just speak to someone either, you kinda have to do this by both certified letter with the return registered receipt (green post card) from uspo (about $8.00) AND by fax. For the fax send ths sucker from a FedEx/kinkos where they provide a transmission report. The transmission is mucho importante as its legal

CSRA -community spouse resource allowance.
MMNA - monthly maintenance needs assessment (or allowance)
Basically it's like alimony for the non NH spouse. Like TX MMNA about $ 2,800 maximum, so if their income is $ 3K a mo, his required by Medicaid copay to the NH would be $ 200 ($3000 -2800).

You may need to get an NAELA atty to get all this resolved. personally I'd get the fax & mailings off and once you get the green cards back schedule a NAELA atty visit in your parents state. Your folks still have their home, right? Also ask the atty how to deal with the home as well - there may need to be a document done so that any expenses on the house that you or others pay is a priority claim or lien on the property before Medicaid's MERP. Has anyone talked to you about what MERP is? Also you could get a personal services contract done to manage their affairs which is paid from moms CSRA or MMNA funds if she really doesn't need all the $ to make ends meet. Most personal services contracts are done for family provided caregiving but can be done for financial & health care management. If your a professional and get paid for this type of work, it could be at whatever rate you charge for other clients & your business is paid & goes into biz income for taxes.

Get on the appeal like today......ok! Good luck.

Get that appeal done ASAP as those tend to have a set timeframe to request. The great thing about appeals is that during this phase, they are on the programs without issues although dad may have to pay his anticipated after CSRA copay.
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