Dad hit by car. Medicaid just denied. Now what?

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My Dad is 60. He was hit by a car while riding his bicycle on May 31, 2013. I am his oldest child and only person assisting him. He is unable to eat (g-tube), walk, had craniotomy and does not have skull flap on left side, and half of his brain is dead. He is in a nursing home and I filed for medicaid. Finally after months and months, I find out from his previous nursing home that his medicaid claim has been denied and I am responsible for his bills. I signed his admitting paperwork and asked the social worker then if, by signing this paperwork, I was responsible for his bill. She repeatedly told me no. --Out of my depth here and worrying to death. I am not POA or anything. It's Friday night so I can't call anyone to get any help. Thank you.

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Igloo has it right. I had to do a Medicaid appeal for my Dad once. Mom couldn't get the paperwork together as requirements had become tighter since over the years since she had done it before, and neither she nor I initally realized she was having enough cognitive decline she couldn't cope without chewing out all the people who would have helped her. It sounds like you are on your way to having your ducks in a row for this, and Medicaid just needs some i's dotted and t's crossed with documentation of his level of disability that either someone didn't send or someone there lost. Keep dated copies of EVERYTHING and make friends with your fax machine. My dad's nursing home made a try to get his Social Security rep payee rather than wait on us to sort it all out, which would have immediately impoverished my Mom, but I got it instead. They did just need to wait, and then they got all they were owed when the dust settled, as they knew they would...they never even considered trying to give him the boot. Glad things are looking up.
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Hello, all. I finally got answers from the nursing home and with your help in knowing what to ask, they know that I know that I'm not responsible for his bill. That is taken care of. --I've called the Medicaid caseworker and repeatedly left messages the last two days. Hopefully, she'll call me back tomorrow. I did receive a letter in the mail from Medicaid stating that he was denied because he didn't meet the eligibility requirements for "disabled." WHAT??? He is on a g-tube, difficulty with speech, doesn't know his name most days, has limited use of his right arm/hand, cannot walk, and half of his brain is dead. He also does not have his left skull flap. This just doesn't make sense. Hopefully the caseworker will call and help me figure this out and appeal.
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What a nightmare, this could happen to any of us. I feel for you.

For me, the central question is WHY was he declined by Medicaid? You need to find that out to determine what to do to get him qualified.

Medicaid has 2 tracks that have to be done - financial & medical. Now the financial will deal with all his assets & income and each state sets their own cap or ceiling on what those amounts are. Like Texas Medicaid for NH has assets @ 2K and monthly income at $ 2,094.00, so if you get $ 2,095.00 in SS & retirement a month, you are $ 1.00 over and will be declined Medicaid (there are things you may be able to do if this is the situation too). His having a home & a car is OK as their home & a car are an exempt assets for Medicaid (except if the home is over your state's limit or if they are viewed as unable to do a "right of return") - the home or car does not have to be sold, the state will not seize it but someone other than dad will have to pay for everything on the house. If dad has items that have a cash value - like a whole life policy or a term policy with a cash build up or a funeral policy that can be cashed in - or if dad has any other assets like a boat, rental property, 401K, CD's, investments, etc, then he will be declined until those items are cashed in and all those funds used for his care. You don't mention his wife, but if there is one Medicaid will look at all their assets & income to determine acceptance. So could there be $ that has to be cashed in or spent down?

Another thought is that since there appears to be a "secondary payer" & a lawsuit or other legal that could be involved (like the hit & run is found and their insurer will end up paying), that Medicaid is declining until they know that no one else could be out there to pay. There is a whole set of federal regulations on "Secondary Payer" that went into effect in 2012 and basically if Medicare or Medicaid pays for something which later on is paid by another (like via a insurance claim or lawsuit) then before you can get any of the money, the M & M's have to be reimbursed for whatever they paid. The settlement can be held in an escrow like account until all that is worked out by the attorneys, then the balance is released. Maybe Medicaid assumes that since he is young and this was due to an accident that there will be insurance &/or litigation and won't pay until the insurance &/or litigation is resolved. You need to find out just what is keeping him from being accepted.

If he does eventually get a settlement, it will likely suspend him from Medicaid as it will be an asset that will have to be spent-down.

About the medical - that has to be done by the facility. Maybe he is being declined as the facility he is in does not provide what the state will reimburse for. Like some trauma rehab places are very VERY specialized and expensive and Medicaid although they will pay for skilled nursing will not pay for the higher level of intense care at that type of facility. If he moved to a regular NH, then they might pay. I would speak with the social worker where he is to see if this is the case and if so, where else he could get into.

Really speak with the actual state Medicaid caseworker to find out what is causing the decline of his application. Whatever the case, you need to file an appeal and within whatever timeframe is on the letter from the state stating the decline. If he was admitted Medicaid Pending and you are documented to be in the appeal stage, the facility cannot force you to move as per Medicaid regulations. They can however do 30-day notices to you during the appeal process. they will probably also try to get you to sign off to be financially responsible so hold firm on not doing that. Best of luck and let us know what you find out.
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apassmore, it is a difficult situation. I have been trying to think of things you can do and realize that what others said about bringing the state in may be the best option. It could take time to liquidate his estate and he needs help faster than that. You need to get a state caseworker going through this with you. The NH your father is in may know a caseworker who would be dependable. It would be nice if you could get a referral to one. When you cold-call, you never know what you're going to get. All state workers were not created equal when it comes to being helpful. The good thing about social workers is they know how things work, and they know what resources are available.

I hope that you are able to find someone to walk through this with you and your dad. You are both victims of this crime. I am mad at and feel sorry for the person that hit your dad and fled. I wonder if he/she lives daily with what they did and not having the courage to face up to it.
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Champagne Charlie - it's a kind of frozen syllabub with crushed ratafias blended through it - highly recommended. Don't know about the gas, was probably too merry to notice.
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Your father is a victim of a crime, hit and run...... Not sure what state you are in, there might be some assistance that way. Is there a remote chance while he worked, he had some kind of insurance plan that might cover expenses... AFLAC or whatever. Just a thought. I agree he should be eligable for disability. Be careful when you mix wine and icecream..... gives you gas!
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A hit and run would complicate things with Medicaid. If the car has been identified, the auto insurance company would pay all of his care plus lost wages and then some. A good personal injury attorney should have filed a lawsuit. If dad has a lawyer, call him Monday morning. Dad shouldn't need any kind of Medicaid, the person who hit him PAYS ALL OF IT.
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Well, yes, the insurers would have to pay up - unless it was a hit-and run. Is insurance, or a police investigation, complicating things with Medicaid, could that happen?

Awful timing to learn this - late on a Friday, with no one to call. Try to get some sleep, it may be a cliché but it's true that things always look better in the morning. Tomorrow do some homework, including on guardianship - you're not going to be able to set up POA, by the sound of your father's injuries. Terrible thing, I'm so sorry.
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Thanks, gang! It was a hit and run situation...big mess unto itself. I will try to catch my snap with a big bowl of ice cream and a glass of wine! Ha! Veronica, I needed that! ;) I'm feeling calmer. Monday won't be here soon enough and it's rare that I say that about Monday!
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Someone suggested a website where you can get free legal advice. There is much involved here that can't be solved over the weekend. The website is AVVO. Signing up is easy... find the category for personal injury. You can be lead to an attorney in your area who may answer your questions. I know this is very stressful and sorry to hear about your father.
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