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My mother had stroke Aug 27th was released to acute rehab care for 20 days then discharged to skilled nursing facility aka NH but received therapy, it was explained to me that medicare would pay for up to 100 days of mom's SNF stay. The only bed available is 5hrs away so after 20 days at one facility they transferred her to NH under goal being coming back home. I applied for her LTC Medicaid because I was told NH would not except until application for Medicaid was applied and proof of it was in order. So I applied. Now Medicaid told me my mom could not pay her bills if it went over 60 a day allotted funds from SSI which is only income or a transfer penalty would be filed. Now she can't pay her bills to keep her shelter because rent $350 plus insurance for her automobile, cell phone bill, dog care bill, and her storage unit bill are over $60 limit. What do I do and what exactly will happen if transfer penalty is filed? I'm so confused I can't afford to pay them for my mother but don't want her to end up with no choice but nursing home. Her stroke was major but Dr. said with rehab she would be able to go home, even tho wheel chair bound and would need help from bed to toilet and such and possible permanent peg. She lost her ability to swallow but has began to regain and is on puree diet.

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Jeannie, Yes I mentioned Mediçare.
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Hate to see these situations, but Why or Why do people keep voting for these tight-fisted conservatives who basically hate poor people (and that includes us ordinary working people). Clean up the corruption in the military industrial complex (warmongers) and we could all ride around in limousines.
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Mom1946, dealing with Medicaid is overwhelming. There are things that you should look into but you imo need to calmly and clearly take a realistic look at the overall situation for mom & for yourself.

If your mom was born in 1946, she is still pretty young and there probably was no thoughts or plans discussed to how she would live or afford a LTC facility. The stroke was sudden. I’m assuming that you applied for Medicaid as the facility told you it needed to be done IF mom was going to stay there and you were not going to private pay or she did not have a LTC policy that would pay. The facility needs to be assured in some way that her stay is covered & Medicaid does that. So you applied for her without being clear on what Medicaid requires for copay & compliance. She was at first covered by Medicare in the immediate days or weeks post stroke  ( via Medicare rehab benefits) so her SS monthly income not affected then; but now, months after August, I imagine she is considered a permanent resident of a LTC facility & as such, she is required - as she is on Medicaid or Medicaid Pending- to do a copay or share of cost of her monthly income less the $60 PNA. Once Medicaid filed and their on NH Medicaid, the choices are stark; they essentially have no more $.

The view is probably that as they now reside in a NH, their old living situation is of no concern to Medicaid unless they have a still living in the community spouse. Ditto for needing a car. (Medicaid takes much the same position on debts, they are of no concern to Medicaid that they are paid or what fallout occurs from debt defaults). That your mom could complete rehab in a few months and go back to living in the community is not a given or on a set timeframe, so hard to place a definite on. Renting as it stands right now, is not needed as mom lives at the facility. But you should see - by speaking with her caseworker, not billing at the NH - if there is any way that there could be a waiver (it could be called a diversion) for a set period of time to pay the rent at the apt for her eventual return. For some states, If they have a home, they can keep it for their lifetime as an exempt asset but family will need to pay for all its costs OR if your state has a waiver for mortgage payments (or maintenance for a period of time so it can be sold & not be lost to a foreclosure, so they get $ from property sale to be spent down so lessens medicaid costs), you file for the waiver. Your likely not to find much empathy for dog care costs, or her cellphone bill, or her storage unit cost. The choices are stark.

What often seems to happen based on posts on this site, is that a caregiver child is living with thier widow or widower parent and the situation is that the parents income is needed to keep the household afloat.  Once parent goes onto NH Medicaid and it’s requirement for copay or SOC (share of cost) sets in, it’s a panic for the caregiver as they cannot afford where they live. Often families move them back home and just do the best they can and apply for in-home community based Medicaid which does not have the overarching SOC that facility Medicaid does. Or they are able to themselves be paid for some caregiving, like what CA has with its IHHS medicaid system. It’s not ideal but often is the only option to have a roof over everybody’s head p. Mom will still have a debt for whatever care that Medicaid pays for both from her facility stay and then at-home care but will not have to be dealt with till after she dies via MERP (Estate recovery). Sounds like she will have no after death assets, so there will be no recovery to deal with other than your completing the MERP questionnaire.

Really it seems your overwhelmed & rightly so. But if not for Medicaid, what then?
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Mom1946, you are correct and I agree how we treat our elderly at the end of their days is awful. 
I don’t know the answer, either. 
It’s a very sad situation. 
Best of luck to you. 
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It is very, very sad, Mom1964. And it is shameful that taking care of our elders works out this way.

I didn't mean to imply I thought Medicaid paid 100% of all costs of living. They don't pay off debts, they don't pay for personal items like shaving cream or fancy face cream, etc. But the number of days and the percentage of coverage of the care center costs do not apply when Medicaid is doing the paying. Those figures apply to Medicare. That is all I was trying to point out.

My mother's nursing home costs were paid for by Medicaid and all but $90/month of her meager SSI check. The only part of her income that she got to keep was that personal care portion. With it she paid for her hair appointments and an occasional take-out meal the NH brought it. She did not have to pay for her food, her utilities, her room, her medical care. That would certainly not be true if she only had Medicare.

It is a lousy system that Medicaid is considered welfare and not something we are all entitled to because we have been paying taxes all our lives. But that is the way it works now.
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Ever being able to live independent again in most cases. ? Kinda the same as an ex con who gets released has no income no safety net no nothing and is like set up to fail again and again with very slim chance of breaking free from the cycle or in elder cases the assistance they spent their entire lives building by paying at the least taxes for their SSI safety net Arg the sadness of it all
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It seems to me that when state assistance for the elderly is needed and with the approval of assistance it takes away any chance of most elderly
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Before i send this high tense response thanks for all the answers and comments and apologize to those offendef maybe tomorrow when cooled down on the subject I will communicate my mom's situation and wwhat my question was meant to ask! But until then ....... No medicaid does not pay 100% once you become a resident of a facility. At least not in the state if south Dakota (ex: not my mom's siitch but average jane\John doe) persons who chooses a nursing facility to reside in when daily activities of their own become too much to handle. this is the break down bare with me:
1. Elder desiderate nursing facility is best to live.
2. Has Medicare part A and part B and pays the Medicare premium's for such. Comes right off the top of the SSI that this elder began to draw at the time the age SSI can be drawn for elders 65 67 or what not I believe the exact age to do so has changed recently. Mind you this elder had paid taxes into the SSI fund for the elders WHOLE entire time the elder has been working educated guess being approximately over 50 yrs of most the said elders life.
3. Only source of income is SSI
Which is the majority of the elder population. In my opinion if you truly look back over 50 yrs or more other means if retirement funds were not obtainable by the majority of working people and still are not feasible to come by today for the majority which is about to get a hell of a lot worse starting directly.
4. NH desicion it is elder's safety is at risk so checking in wether they love it or not right....
5. Now anyone here that looked at the Medicare book and wasn't like holy snails this makes no sense is probably full of poo! It is garble to an elite scholar and to us lamens as well add in the fact that the rules change before the ink is dry it can be a disaster and a disaster or not this person has no other choice but move in day. Sign in its done well the holiest of snails come crawling in with the first monthly bill. Usually billed a month ahead I won't share my opinion on why this occurs due to the pain my heart feels when I think the reason. 222 per day years figure that they outta be having a he'll of a good time for the price tag huh? Not many make a ton more per month retired then they did pre-retirement or even tho worked really dammhard were fortunate to have not only the option for affordable ltc insurance on top or to save let's say 800000 figuring 10 yrsish they have left in em just hypothetically speaking.
6. Last resort must turn to medicaid which for just living due to aging is long term care and elder medicaid from state. All the other assets house savings anything worth a cent disposed of at fair value for cash to pay has been depelted. They do have one resource to money that is monthly SSI CHECK. Average Joe say just an educated guess around 17000 yes seventeen thousand. That being said once approved a monthly SSI check is deposited to elders bank account of approx $1416.00 the elder must hand over 1356 of her hard earned monthly income to Nursing home and can buy her high end luxuries with the whopping 60 bucks left to spend on whatever her heart desires but not much of what ever her desires may be .
Now I could be way off on how state assistance works but I highly believe I'm pretty close by saying IT'S A DAMM SHAME THE OPTIONS OUR ELDERS THE ONES WHO PAVED A CUSHY LIFE FOR US ARE LEFT TO PICK FROM FOR THE LAST OF THEIR DAYS. IT'S EMBARRASSING THAT AMERICA IN WHOLE DOESN'T SEE A PROBLEM AND MAKE THE CHANGES NECESSARY
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JoAnn29, Medicaid pays 100% forever once you are in a care facility (unless you win the lottery, etc.) Did you mean Medicare? If her family keeps her at home, a different part of Medicaid kicks in and she can pay her own bills. She is not limited to a certain allowance. Paying her normal bills is considered taking care of her needs when she is home.

Or did you mean if she is in nh permanently and she wants to keep her house? I believe she lives in an apartment so that is not a factor here. The other expenses will have to eliminated or subsidized by her family.
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There is no allowance involved in in-home care while on Medicaid. Once the recipient is in a facility then they have only the allowance set by their state. My mother had in-home care with Medicaid benefits for a few years. When she needed long term care (nh) then she had $90 a month for personal expenses -- haircuts, a new coat, etc. She had no bills at that point. She didn't have an apartment or a car or utility expenses, etc.

Your Mom's situation is different. She was already in a care facility when she applied. Find out who her Financial Case Worker (different from her regular Case Worker) is and contact that office to see how to switch to a program for in-home care when she is strong enough to go home.

What is the prognosis for Mom? How much longer is she likely to be in the NH? Can somebody else cover her bills for that length of time? If it becomes clear that she won't be able to go home (perhaps she has another stroke, or develops dementia, etc. -- no prognosis can foresee the future), then she won't need the apartment or the car, the contents of the storage unit should probably be disposed of, a forever home found for the dog, etc.

Even Medicaid does not expect anyone to live at home on only $60 a month. There are different rules for people who get in-home help and those who are in a facility. You need to get advice on this directly from Medicaid. Write a succinct letter to her Financial Case Worker outlining the situation breifly, and asking for an appointment to discuss it .
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First, Medicaid only pays fully the first 20 days. From the 21st to 100days only 50%. A supplemental may not pay the other 50%. In my Mom's instance, she was responsible for 150 a day. Medicaid must think she is there permantly. Has the NH taken her SS and any pension towards her care? To keep her home, someone else will need to pay her bills. Any money she has go to her care.
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Who is living at the house? Who is driving her car? Medicaid will place liens on the house that amount to the cost of care thAt they are paying. The house is an exempt asset because it can provide an additional income stream in the form of rent from the person living there.
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My understanding is that IF she is still on the Medicare rehab benefit after the first 100% covered 21 days, Medicare pays 80% and her secondary insurance policy (like Humana, Bcbs) pays the remaining 20%. Or she private pays the 20% or Medicaid pays if she has no other insurance and qualifies. The max time on rehab is 100 days. I don’t think there’s a copay of income if still in rehab as it’s post hospitalization related.

But if she’s moved from rehab benefit and into LTC, so she’s a LTC resident in a facility,  Medicaid becomes Payor for her room & board & medical costs shared between Medicaid & Medicare. Now she is required under Medicaid LTC rules to do a copay or SOC / share of cost of whatever is her monthly income to the NH less a small personal needs allowance. Your moms pna is $60. Some states have waiver that can be submitted to get a diversion of the SOC to pay for the existing mortgage or rent costs. You need to clearly speak with your Medicaid caseworker (not billing office at the facility) to see what waivers exist and then file for one for her. Like TX has one to divert the mortgage payment from the SOC so property doesn’t get foreclosed on. The facility has to accept the determination of copay the state sets, even if it’s zero. (Sometimes if there’s a community spouse with kids situation, they can get all the NH spouses income as the CS need it to cover living expenses).But other than that, if they want to keep their exempt asset home or car or rented apt, family will have to pay for all from their own pocket.

I’d suggest you have a talk with her MDs to get a very realistic take on what her recovery is likely to be and what the timeframe might be. And seek a SOC waiver for that period of time. I’d imagine there are going to be costs you end up paying no matter what to have the apt stay at the ready.....
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