I was co-petitioner, with her long time companion, to win guardianship from her family after she had a major stroke. She lost her speech and has some cognitive issues now as well as being confined to a wheelchair. The nursing home she was in, was so bad that her Guardian ad Litem told the judge he wouldn't keep his dog there! We moved her to a private assisted living facility, which her companion paid for with her SS, plus the amount not covered coming out of his pocket. She fell out bed there the first week and they took her to emergency. She was fine, but they informed us that she was no longer on Medicaid. Evidently moving her knocked her off the system. While her companion is financially well off, he is far from rich and he had counted on Medicaid to assist in paying for her doctor and hospital costs, as well as her living aids like a wheelchair. He has gotten a bill from the ambulance service that they say is not covered. I am going to assume that her hospital bill, or 20% of it, will be coming to him as well. This was an unexpected twist! His lawyer says he doesn't have to pay it. They aren't married and the bill is hers. She has nothing. But why would she be kicked off Medicaid just for moving? The money he spent was paid directly to the assisted living facility, which is what our lawyer told us to do. It was not given to her. She is saving Medicaid money IMO! They said she can only go back on if she moves to a medicaid nursing home. That doesn't sound right to me. There are lots of people on Medicaid who aren't in any nursing home. I don't understand why, if her income hasn't changed and she still has no assets, she was removed from the program. Now her guardian is searching for a nursing home that accepts Medicaid that isn't as bad as the one she was at. Instead of having a nice homey place with a private room, she has to go back to overcrowded, understaffed facility not much different than where she was. Not what we had planned. He even looked into bringing her to his home, but was told that he could only get in home assistance for 4 hrs a day, even assuming she can get back on the program. They are both in mid 70's and he can't lift her by himself to change her or move her from her chair to the bed or to a vehicle to get her places. Paying for the other 20 hours a day will cost about double what the private AL home was costing. So it's back to the crappy nursing home. It seems that Medicaid is All or Nothing. It's a shame she has to live this way, when with him contributing toward her living expense, she could have a decent quality of life and cost the government less money. I guess my question is, does this sound normal? Or do we have to spend several more thousand on a Medicaid Attorney to figure all this out? Thank you!

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Talk with the case worker at Medicaid (there is one for each client). Find out why they disqualified her or is it *just* that they won't pay for services provided in a facility that is not Medicaid certified? I don't what you consider "other expenses" - the people on Medicaid not in a nursing home would be on a "waiver" and the services still have to meet Medicaid guideslines. Because it's a government program, they will make you jump through hoops of fire backwards. Going through some of the same things with my son who has a disability.
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Thank you! However we aren't asking for Medicaid to pay for her AL. We understand that it isn't covered. We just want medicaid for her other expenses. I know people on Medicaid who aren't in a nursing home. I don't see the difference here. She literally has nothing but her monthly SS. No insurance of any kind, no savings, no vehicle, no home. I assume she reverted to Medicare, but there are out of pocket expenses related to that she can not cover. The only thing I can think of is that he is using her SS toward her AL and then making up the difference himself. Maybe she is required to spend her SS only toward things her Medicaid would cover, then they make up the difference? Unfortunately, he can't foot the entire bill every month there. So he is being forced to move her to an approved facility. Forces her to be MORE dependent on government assistance when it isn't necessary. Crazy! Thank you though for your clarification on what constitutes approved facilities. That is very useful!
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Fbragg - I looked on
The problem is "probably" that her new facility (the nice one that companion moved her to) is NOT a "medicaid certified facility". The rules are very strict about that. She can probably get back on the program, but she will have to be in a Medicaid Certified facility.
Nursing Facilities (NF)
Nursing Facility Services are provided by Medicaid certified nursing homes, which primarily provide three types of services:
Skilled nursing or medical care and related services;
Rehabilitation needed due to injury, disability, or illness;
Long term care —health-related care and services (above the level of room and board) not available in the community, needed regularly due to a mental or physical condition.
A Nursing Facility is one of many settings for long term care, including or other services and supports outside of an institution, provided by Medicaid or other state agencies.
Where Nursing Facility Services are provided
Medicaid coverage of Nursing Facility Services is available only for services provided in a nursing home licensed and certified by the state survey agency as a Medicaid Nursing Facility (NF). See NF survey and certification requirements. Medicaid Nursing Facility Services are available only when other payment options are unavailable and the individual is eligible for the Medicaid program.
In many cases it is not necessary to transfer to another nursing home when payment source changes to Medicaid NF. Many nursing homes are also certified as a Medicare skilled nursing facility (SNF), and most accept long term care insurance and private payment. For example, commonly an individual will enter a Medicare Skilled Nursing Facility (SNF) following a hospitalization that qualifies him or her for a limited period of SNF services. If nursing home services are still required after the period of SNF coverage, the individual may pay privately, and use any long term care insurance they may have. If the individual exhausts assets and is eligible for Medicaid, and the nursing home is also a Medicaid certified nursing facility, the individual may continue to reside in the nursing home under the Medicaid NF benefit. If the nursing home is not Medicaid certified, he or she would have to transfer to a NF in order to be covered by the Medicaid Nursing Facility benefit.
Who may receive Nursing Facility Services
Nursing facility services for are required to be provided by state Medicaid programs for individuals age 21 or older who need them. States may not limit access to the service, or make it subject to waiting lists, as they may for HCBS. Therefore in some cases NF services may be more immediately available than other long term care options. NF residents and their families should investigate other long-term care options in order to transition back to the community as quickly as possible.
Need for nursing facility services is defined by states, all of whom have established NF level of care criteria. State level of care requirements must provide access to individuals who meet the coverage criteria defined in Federal law and regulation. Individuals with serious mental illness or intellectual disability must also be evaluated by the state's PASRR program to determine if NF admission is needed and appropriate.
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