The CSRA is only calculated once, which is the first day of the month in which an institutionalized spouse has entered the nursing home and is expected to remain there at least 30 days.
Social workers know nothing about the financial end of things. The difference of "a few thousand" can result in a denial. Institutionalized Medicaid recipients in Pennsylvania with monthly income below $2,130 may now retain $8,000 in total resources; otherwise, the figure is $2,000. So if Mom is at home and has more than $2000 available, she is not eligible for Medicaid. If Mom was not on Medicaid, she would be allowed more reserves. If Mom's SS plus pension is more than $2931 a month she is not eligible for CSRA either. It sounds like the CSRA income is just enough to push her over the resource limit. This is how PA manages to keep only one of them collecting benefits. See elderlawanswers
Mom has been in the waiver program for 5+ years. Last summer's yearly renewal was rejected because the monthly resources were too high. The monthly resources are pretty much the same (give or take a few thousand) every year; the monthly resource amount claimed on each renewal has always been lower than the minimum CSRA. When I visited the DPA caseworker, she was unfamiliar with the term "CSRA" and had to ask her supervisor about it. Supervisor told her it applies only to the initial application. Every time I ask the DPA caseworker (in person, on the phone, during the court hearing) why we're in this mess, she either changes the subject or tells us that she can't comment on past years' paperwork.
What has stayed the same:
my mom's level of care my parents' household resources my mom's income (Social Security and pension, combined are under income limit) the eligibility rules (according to DPA caseworker)
It's been seven months and we're not getting any answers. When I research CSRA, I can find information about applying for Medicaid, but not if CSRA is still considered during renewal process. Can anyone point me to a website that states this, so I can make a copy and show the caseworker what she should already know?
Is it $8000 - $6000 disregard on all resources, or $8000 - $6000 disregard after the CSRA is applied? Mom's income is under $2130 per month. Bank accounts (in both parents' names) total about $11000, and cash value of life insurance is a little more than $3000.
Look carefully. There are different rules for Dad who is institutionalized and Mom who is not. You would be wise to separate their joint accounts, because each of them has different rules.
Do you have an eldercare attorney you can discuss this with? I ask this because our Medicaid case worker was trying to include monies as assets that would be stopping once she was on Medicaid. The attorney gave me the info I needed to prove this. Even the case workers are not always familiar with all the nuances of the laws.
The caseworkers are used to simple straightforward applications and the documentation for all that. The caseworker has about 10 minutes to vet an NH application (for TX Medicaid) and if it isn't readily obvious then it gets denied or a request for additional documents is sent. They seem to assume that there is no community spouse and no real idea on how assets can be evaluated for community spouse situations. You kinda have to have to do an appeal and then the appeal certified mail with return registered receipt to whomever is the district co-ordinator for Medicaid in addition to whatever address for appeals to get your situation in front of someone who understands the nuances of Medicaid.
CSRA stuff can be pretty high-cotton finance and totally above the knowledge level (or pay grade) of the initial caseworker. The CS can file for MMNA - Minimum Monthly Needs Allowance too, has anyone mentioned that to you all??? The MMNA is usually done by a much younger 2nd or 3rd wife who needs the NH spouse's income in order to make ends meet. If they have an outstanding mortgage or they have kids (or she has kids) still @ home, then the MMNA is a shoo-in to get and they could get all of the NH spouse's monthly income so there is no co-pay or "SOC" at all to the NH. But you have to file for all this and dog it through the maze of Medicaid appeals. Personally I think you need an elder law attorney to make it happen. Good luck.
The federal rule (which applies to all the states) may be found here:
42 U.S.C. §1396r-5(c)(2). A website for this statute is here: http://www.law.cornell.edu/uscode/text/42/1396r-5
Good luck with everything!
If Mom was not on Medicaid, she would be allowed more reserves.
If Mom's SS plus pension is more than $2931 a month she is not eligible for CSRA either. It sounds like the CSRA income is just enough to push her over the resource limit. This is how PA manages to keep only one of them collecting benefits. See elderlawanswers
Mom has been in the waiver program for 5+ years. Last summer's yearly renewal was rejected because the monthly resources were too high. The monthly resources are pretty much the same (give or take a few thousand) every year; the monthly resource amount claimed on each renewal has always been lower than the minimum CSRA. When I visited the DPA caseworker, she was unfamiliar with the term "CSRA" and had to ask her supervisor about it. Supervisor told her it applies only to the initial application. Every time I ask the DPA caseworker (in person, on the phone, during the court hearing) why we're in this mess, she either changes the subject or tells us that she can't comment on past years' paperwork.
What has stayed the same:
my mom's level of care
my parents' household resources
my mom's income (Social Security and pension, combined are under income limit)
the eligibility rules (according to DPA caseworker)
It's been seven months and we're not getting any answers. When I research CSRA, I can find information about applying for Medicaid, but not if CSRA is still considered during renewal process. Can anyone point me to a website that states this, so I can make a copy and show the caseworker what she should already know?
Thank you for any help you can provide!
CSRA stuff can be pretty high-cotton finance and totally above the knowledge level (or pay grade) of the initial caseworker. The CS can file for MMNA - Minimum Monthly Needs Allowance too, has anyone mentioned that to you all??? The MMNA is usually done by a much younger 2nd or 3rd wife who needs the NH spouse's income in order to make ends meet. If they have an outstanding mortgage or they have kids (or she has kids) still @ home, then the MMNA is a shoo-in to get and they could get all of the NH spouse's monthly income so there is no co-pay or "SOC" at all to the NH. But you have to file for all this and dog it through the maze of Medicaid appeals. Personally I think you need an elder law attorney to make it happen. Good luck.