Dad needs a nursing home. How do we get him on Medicaid?

Lindi - I posted some things for you on another post over the weekend. Medicaid requires that they be "at-need" both financially and medically. The financial part you have to document and deal with. It's hard to to when you are not there to have the documents needed to do the application in the timeframe required. Especially if you are getting stuff piecemeal from mom. It could be there were things they needed to do and didn't so application declined. You may have to go the elder care attorney route to do the process for you. There are FL attorneys as experts on this site who are most knowledgeable, perhaps contact them.

The medical usually comes from them being hospitalized and then discharged to a NH for 2 -3 weeks of rehab (all of this MediCARE pays for) - so they get into NH via that route and then end up staying in NH and apply for MedicAID to pay for. If they have been living at home, they often won't have the fat medical file to show the need for skilled nursing care, so you will have to move them to MD's - like a gerontologist - who understand what is needed within their medical history to make the approval for Medicaid work. Understand?

His bladder cancer may allow him to be hospice (MediCARE pays for hospice) eligible whether for at-home services a couple of days a week or in a NH.

Medicaid financials are 2 fronts: "income" (what they get each month, like SS) and then "assets" (like savings, annuities, home, car, property). Home, 1 auto are exempt assets by & large. Most states have the "income" limit at about 2K per individual for Medicaid.Your mom as the not going into the NH spouse, is called the "community spouse". A community spouse is allowed to have assets ABOVE the 2K asset ceiling. The exact amount depends on the state - most have it at 110K. Now on the face of it Dad seems OK for his income limit. So there must be an "asset" problem. The Medicaid applicant non-exempt assets have to be under 2K - so anything that takes them over that will disqualify them. It could be a life insurance policy with a cash value, ditto for preneed funeral or burial policies. If they have an annuity with a redeemable value, that will disqualify them. Anything that has a cash value and doesn't qualify as a non-exempt asset, must be cashed in and all the proceeds used towards their care. My mom's application had a delay until her life insurance policy status could be established.....it was from the 1960's and like 20+ pages. Now the caseworker does not have the time or the ability to decipher the policy as to whether there is a cash value. But they can sent you a letter of inquiry on the status of the policy. I had 48 hours to get this done otherwise her application would go into the documentation not provided file and she would be rejected for Medicaid. I got a broker who hold a TX insurance license to do a note on letterhead that the policy was NCV (No Cash Value) so all OK there
and faxed it over the next day. But for most folks, they don't have a stockbroker who will just do this and like right now for you babe. My experience is that the system really requires someone who is pretty OCD to shepherd the application as there will be something amiss. My experience is that you have to find the time to go to their home and go through their stuff and make copies of all needed and then carefully do the application that the NH gives you. You kinda need to have a big binder with your copies of their financials at the ready to be able to answer whatever question right then. The NH should give you a list of documents they require. Both my mom & my late MIL are/were in TX NH and the list was similar but different from their NH's. Go figure.....

How have you gone about applying for Medicaid? It seems that if you do this on-line they often get rejected as there is no coverage for at home room & board so there is nothing for Medicaid to pay for. They make too much for food stamps or the other traditional Medicaid programs. For us with my mom, the application was done in tandem with the NH application to the state for Medicaid payment (for her room & board costs @ $ 145.00 a day). I found the NH who's medical director was in her gerontology group and they had room at 1 facility, so that is where she went. It was not my first choice of NH and I moved her to another much better 1 within the year, but the important part is that she got into a NH and through the initial NH Medicaid process. I did her application (over 100 pages mainly due to her old-school insurance policies); and then the NH reviewed it (to see if they would even accept her as a Medicaid Pending resident); then the NH sent the application & documentation I did ALONG with their bill to the state Medicaid program for their (NH) room & board bill. It went to a specific state caseworker who did the NH in that area. On my own, I could not apply for Medicaid for my mom, it had to go within the NH application system.

For probono law, the best situation I've found is from law schools. Most law schools will have a set probono clinic. It usually will be set in low income areas and tends to be about tenant & domestic situations but they can do the DPOA, MPOA that work for your state. Remember it is free so what they do may not be tailored to what would really work best for your parents, it will be just in general documents. Good luck and keep a sense of humor.

Thanks igloo, your information is helpful. I will continue to pursue as best I can. The do not have any assets. one car 12 years old, dad doesn't drive anymore, he is mostly bed and wheel chair bound. mom barely drive, she gets lost easily so my sister uses it for grocery shopping and dr appts for them. Dad has a 25k life insurance policy with Metlife who refuses to help convert to long term health care plan (not policy), he would have to forfeit the 20k he has paid into it over the years if he gives it up as spend down(?) if this is required. Fla is a very difficult state to deal with. I do what I can from Mass and go to fla when I can..but I am in my 60's with issues as well. I have come to the conclusion that it is better not to grow old in this country and when I hear of elders committing suicide together, now I understand why. :(

you found the problem....It's the life insurance policy that's the issue as it's 20K in assets that is in Dad's name. It's probably a whole life policy with a cash value. MetLife isn't being evil, it can't just get converted to LTC as the underwriting and baseline requirements for LTC is totally different and plus most big insurers are getting out the whole LTC policy biz as it's a PIA for compliance. Just as an aside, some NH will not take LTC policies either because of the heavy paperwork on compliance to get paid.

Until the paperwork is done to show that they have applied for the policy to be cancelled and cashed out, he will continue to be declined.

Did you ask about changing the ownership of the policy? Not the beneficiary of the policy but who owns the policy. (If they are like most couples, they are each others beneficiary, which will be an issue for mom if she gets 25K and needs a NH soon, it will have to be spent-down). Sometime ownership change can be done with a rather small fee to process and it would then go into moms ownership so it would not be Dad's asset. It should be OK since they are married but that is a elder care legal ?. If that can't be done, then you have to cash it in at a loss and then do a spend down. But with the 20K, Dad can spend whatever is FL limit on preneed funeral or burial or cremation and he might be able to buy a small NCV life insurance policy, at his age and health issues it will likely cost the face value of the policy and probably would have to be limited to $ 1,500 or whatever FL has as it's limit. BUT it would be $ provided to the family after death to do stuff (rather than pay to the NH). He can also do the spend down on any of his property - so if the car needs 3K in repairs or they want to trade in the car for one that is newer and more dependable and pay in full, that should be OK to do Medicaid-wise. He can get a newer and more comfortable wheelchair above the basic one that Medicaid does. New glasses or hearing aids can be bought for the spend-down too.

The life insurance policy is now a known entity for Dad, so until it gets cashed in, he will be over the resource limit for any at-need program like Medicaid. If family can deal with him at home, I'd suggest getting him qualified for at home hospice.

I've had to deal with TX & LA for Medicaid, and I don't think states are being difficult per se, it's more like the obvious asset issues (house, car, life insurance, bank deposits, interest earned) can't just go away or be ignored as it's tied into their SS # and the info is just keystrokes away to find out. If you live long enough, unless you are multigenerationally wealthy, you will run out of $ eventually in the US. Not pretty, so start planning & investigating where to move to outside US.

Thanks again igloo!
The only options we were given for dads life insurance was to A. Stop paying and lose the money, or B. transfer ownership, C. Continue to pay premiums and be disqualified for Medicaid. We are trying to get hospice services in home through his Island Doctors and Humana. Waiting for eval to be done. Needles to say, both mom and dad will need some kind of placement. Dad, as I said is already 24/7 needy, mom eventually. So, all this information is helpful and I th ak you for your input...all info greatly appreciated. Xoxo

Lindipan, MY MOM is on the Medicaid Diversion program - get to an elder care lawyer ASAP - she's a Godsend to us - she/he'll divert Dad's assets so he can qualify for Medicaid for nursing homes - but do it ASAP - mom's been on Medicaid for almost 2 yrs now!!!She/he will HELP you with everything you need to know & do!!! Just please do it ASAP!

The only choices we were given for fathers insurance coverage was End payment and reduce the money, or exchange possession,. We are trying to get hospital solutions in home through his Isle Physicians and Humana. Awaiting eval to be done. Small needles to say, both mom and dad will need some type of positioning.

Ever think about assisted living places that also have nursing homes on the other side? Once dad is placed who will bring mom there everyday and take care of her, how sad to get old. If the life ins is changed it could pay for their funerals , lots, and headstones now. If they own a house that can be sold for their care too. Best of luck to you. Sorry if I repeated someone else at all, feeding mom and read fast.

Lots of good information from others. I agree, though, if you can afford it, or you can get someone from a law school clinic who is studying elder law, it is well worth having someone who has that knowledge on your side. I have paid approximately $1500 to get good information and to have the lawyer do some of the calling for me. Well worth it. Good luck. I feel for you. This is such a difficult situation. It is hard enough to see your loved ones be in this condition but then to have to worry about how they will be taken care of is so much harder. We, as a country, have got to figure out a better way.

thank you all for your input. I will look into the NH/assisted living possibility. That might be an excellent solution. I have never heard of Medicaid diversion, I will look into that as well as help pro bono from a law school in their area.
These are no assets except for dad's life insurance policy for burial expenses which might be a problem as it is for 25K. They already have their burial plot and marker, but since they live in FL and their plots are in MA.

Someone from hospice came to their house today, brought supplies etc. She was there for a couple of hours, she also brought a preacher. The hospice nurse was disgusted with the way Humana has been taking care of dad's status and supposedly going to do something. We shall see. Meanwhile, I thank everyone, and wish you all well as we continue to navigate this sad and long journey. Please keep suggestions coming. Hugs and prayers for all.

Igloo572 - how very and importantly informative. Let me ask, back in 1995 for MediCal (CA's name for Medicaid) you could put your money in an annuity that made monthly disbursements. You had to count the disbursement as part of your monthly income but the value of the annuity was not counted as an asset. Do you happen to know about that or if it's still true?

CarolLynn - gee whiz the 90's are a fog to me although I do remember a great George Michael concert from that era...... From what I've heard, annuities are just sticky to deal with for Medicaid compliance.

Well, actually, we did it in 1994. But we had an advisor who knew the laws. He had to go into County with me and challenge the social worker on my dads case. He had the appropriate codes but we ended up having to speak with the supervisor because the social worker didn't know what we were talking about. So it can be messy but we conserved $140,000 on my moms behalf as the well spouse. It could be worth it if its still an option. It just has to be done right from the get go. I would look into it if it were me.

CarolLynn - annuities like oil & gas revenue is waaaaay above the pay grade for the caseworker. Is your mom's a SPIA?

Dear Lindipan, Since both your parents already have dementia, you won't be able to get DPOA for either of them, since they have to be mentally competent to appoint you. I don't think you can get the MPOA either, but I'm not sure about that. As far as the insurance policies go, if you are not already the owner of their polices, it's too late to transfer ownership to you, because they are mentally incompetent to do so. Even if they could, Medicaid has a 5-yr look-back period for transfers of assets. But you should DEFINITELY consult an Elder Care Attorney, pro bono help from a law school, or contact your county legal aide services to see if you qualify for free legal aide services. Once you get the required designation to legally represent your parents, be sure that any documents you sign on their behalf contains your legal designation letters. This will protect you from being personally responsible (as an individual) for any of their debts. Check out the resources on this site under Money & Legal as well. You can also go to the Florida govt website and the Medicaid website to learn as much as you can about institutional Medicaid requirements. I know this is hard - it' like a another full time job, but has to be done. Patience, fortitude and prayer!

Igloo - I don't think so. It was for a fixed term, at the end of which she would get her entire principal back. After my dad died, she waffled, got nervous and took the money out with an early penalty. That doesn't sound like a SPIA, does it?

You should speak with an attorney who specializes in this area to have an advocate who can guide you through the process.

Evidently they look at household income. Because dad gets 1600.00 SS and 33.00 and mom gets 610.00 SS per month, they do not qualify for Medicaid. Dad will need NH and they can not afford it at all. How can this be fair for elderly US citizens....