Update on Medicaid fair hearing...

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Hi everyone! Just a little update. I’ve got a little less than 3 weeks for my fair hearing before the judge for managed long term care approval for mom who is in a NH. She was denied. They said not enough info to prove I’ve been her primary caregiver. House in my name since Oct 2014; 5 year look back. Spoke with the attorney the other day, and she feels if I get more in depth caregiving details from the doctor, (which I thought I more than provided) Guess not. They may be able to present it before the hearing and get it approved. They will now have 1100 pages of hospital chart records for the past 2 yrs. Also a 5 page letter from the doctor describing in detail all my care to the letter that I provided. Ex: bathing, toileting, preparing meals, monitoring B/P and glucose and all med administration. I pray this is what they want! This whole process is a nightmare!! Well thanks for letting me vent. Needed it.

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Darla - ok so it’s a medically “at need” appeal. And not a Financial / transfer penalty appeal over the house and caregiver exemption.
If it’s strictly medical appeal, just what is the NH doing to provide documents to support that she’s medically “at need” for the hearing?

every state administers it’s Medicaid programs uniquely, but for what it’s worth, for my mom, we had to deal with a medical appeal. She entered the NH coming in from IL. Bypassed the AL phase totally. Her RXs were left off her admit intake medication list paperwork by NH staff. Her health chart was full of items showing needing skilled nursing care. But no RXs caused ineligibility. The NH took the lead in the appeal as she was under their care, although I as dpoa had to sign off for the appeal to be filed (done via email & fax). The medical director of the NH was also mom’s old gerontologist as he had a private practice as well, so her chart & old hospital notes copied over easily. His office staff was on it. Appeal placed the hearing like 5 months out. It took about a month for DON to get medications snafu corrected and they added in couple of other co-morbidities and my mom got an at need medically determination letter from TXDADS like a month after NH DON filed the update. Hearing never happened as all cleared before hearing date & Hearing board sent an all clear letter like week before old hearing date. But for our situation, the NH took the lead and had to as they controlled her care. I’d suggest you ask your atty if NH needs to submit their own document stack to support at need for skilled. Good luck and please let us know what happens, ok.
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Darla3 Sep 13, 2018
Hi. No this is strictly to prove that I have been her primary caregiver. The house was put in my name 3/ and 1/2 urs ago. There is a five year look back period. This is so the house remains mine. I did get a bit of good news yesterday though. My attorney spoke with the county caseworker and asked for 3 more documents, which I will have the last tomorrow. Stated in his email if I have them in within the next ten days, which I will, they will review it and will probably settle without a fair hearing. Prayers needed🙏🙏. Thank you.
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Darla - I’m going to approach this from another viewpoint. If you’ve got reams of health chart info, then it’s not a medical “at need” part appeal that’s the issue. Its not that she didn’t need care or that you didn’t provide care.

Im guessing that the State position is that you cannot be viewed to be a “true” full time caregiver. And if order to possibly get around the transfer of your mothers home to you within the 5 yr look back and the property transfer done before a determination of caregiver exemption allowed by your states Medicaid, you have to beyond clearly show to be full time caregiver. And your work history or income taxes filed don’t show a significant decrease that could be accounted for by caregiving.

If you were working over 40 hr week anywhere else probably for BOTH 2 years from the date of mom’s medicaid application signed AND 2 years before the date her property transfer was done, states not gonna view you as possibly full time caregiver so no exemption allowed so therefore her application is determined ineligible as there’s a transfer penalty due to house put into your name as you don’t meet caregiver exemption. Comprende? Yeah, it’s a long sentence....

In my not an atty viewpoint, you have to, HAVE TO show significant income decrease over time due to you stopping being a full time paid professional (your a RN right?) and becoming a nonpaid caregiver. The caregiver exemption to me is awarded/allowed to basically compensate the caregiver for wages & future SS income deceased due to your stopping work to caregive for free.

This type of governmental maze is maddening. We went thru Hur. Katrina. I’m a freelancer & own my own biz. & could get LA federal waiver disaster unemployment. Reams of paperwork filed in post storm New Orleans - fun times with no potable water! About 7 mos in I had a single 2 day job with one of the producers I work with who also had relocated to TX. I like a good citizen reported it and got taken off unemployment. I appealed. Phone in hearing with judge in Dallas & I faxed over bank statements from 1 year preKatrina and post Katrina. Significant decrease obvious & only blip was the single job. She ruled in my favor and I got several mos back unemployment. Had I not faxed documents over to show a continuing decrease in income, I would imo not have won my appeal. I mention this cause if you were working during the caregiving timeframe or showing to still be getting your usual income, well you haven’t shown had a financial setback. Really talk with the atty as to whether this could be an issue to present at the hearing.

Also ask atty, if after the hearing it’s that you’ve screwed the pooch on the appeal, IF you sign the house back to mom IF that could allow her to be eligible for Medicaid AND the state lifts any transfer penalty against her application. Yeah it’s not idea but gets her onto LTC Medicaid and buys you time to come up with a plan on the house & to clearly find out how your state does post death MERP / Estate Recovery. If this atty is MERP clueless, find a probate atty who has dealt with MERP. Good luck and let us know what happens.

Also dress conservative, no noisy or expensive jewelry or purse, wear flats. If you have a nurse brooch watch wear it.
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Darla3 Sep 10, 2018
Wow. A lot of info but THANKS. My hours actually are part time 2Ohrs per week. Spoke with myattorney on Friday and received more info. During my part time hours, someone stayed with mom. This woman, a neighbor will be a witness at the fair hearing if necessary. It’s seems they want more detailed info from the doctor which is presently being worked on. Also they will have 1100 pages of medical hospital charts as per their request. My attorney informed me that my own personal letter was quite acceptable. She feels if the doctors is, which will be I should prevail. She informed me it could be settled by them before the fair hearing happens. It doesn’t seem to be an issue about my part time hours as someone did stay with her while I worked. Seems to be the medical documentation. And after all, if I’m wasn’t working that meant I had no income or health benefits, unless of course they wanted to give ME Medicaid.
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Thank you so much!!
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Good luck
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