Follow
Share

My mom was admitted to a NH in September after hospice dropped her services. She was admitted contingent upon being approved for medicaid. Her income between SS and VA aid and attendance is $200 over what is allowed in the state of GA. I sent all the info requested plus set up a QIT for the $200 which is required in GA to help qualify for medicaid. I provided them with checking accounts statements for 3 months and life insurance info.She has no other assets. I was sent a letter from the state that she was denied coverage because I had not provided them with award letters for VA and SS. I did fax those to the NH. Unfortunately,in all the paper work coming in I overlooked the deadline for appealing.My mom is still in the NH but I need to know what can I do to appeal now and who do I contact in the state of Georgia.

This question has been closed for answers. Ask a New Question.
@igloo - I didn't suggest she complain to the people we elect to represent US. I suggested she email them or talk to them via phone to see if they would intercede for her. Many people do not do this and those who do often get at least a second chance. She's not complaining, she's asking for a second chance to do it right.

As for her being over the limit, while that's true and she will have to spend down that money, I believe I addressed that in my post.

:)

AND I still believe an attorney and/or a Medicaid mediator is extremely helpful. It would have prevented this from happening, i.e., she would NOT have missed the deadline with either. And from the very beginning, they would have informed her that her mom had too much money to qualify. They would have shown her how to spend it down to get the most out of what remained.

Also, they have connections with various nursing homes (hate to say this but it's true) that allows their loved one to get into one quicker than would normally be the case.

Yes, a person can do this themselves, but given mom's situation, i.e., too much money to qualify, she could have used that money on the lawyer and/or the mediator. One way to spend down the money.
Helpful Answer (0)
Report

Even the people at the VA and Medicaid have trouble with a definitive answer regarding A&A. Medicaid treated the $90 as an ongoing pension, which made it an asset so it gets added to the SS and Dad's pension on the NH statement.
Helpful Answer (0)
Report

igloo, the way it worked for my mom is that she got/gets $67 personal needs allowance. The $90 gets added in with the SS and Dad's pension and that amount goes to the NH. And yes, we do have to keep an eye on the NH trust account, but have found that a monthly haircut and a few misc purchases in the NH store keep it under control.
Helpful Answer (1)
Report

Hollarfats situation is kinda involved:
Her mom is over the income limits, that's why she had to do the QIT (Miller trust). It's not a matter is sending letters to elected officials to complain about Medicaid, the problem is she missed doing her moms appeal within the date required.
So either medicaid waives the date and accept the faxed over complete paperwork or she reapplies with a new day 1 application date.

Added to this is that mom was in a NH in 2013 but they took her home as she qualified for hospice. then she became better but in Sept 2014 disqualified for hospice. Caregiving at home just beyond feasibility. Then mom went back into a NH medicaid pending. So mom has a pretty involved file. Now It's 5 months and probably teetering on a payment issue / 30 day notice for the NH as mom admitted as medicaid pending and shes going to be declined due to not doing appeal in time. Getting the deadline waived would be -IMHO - the best situation.

Linda, I thought the VA $90 is viewed as the personal needs allowance is - its the residents $ and not needed for their copay or required SOC to the NH? So like if, this was TX the PNA is $60 plus VA $90, each month they have $140 disposable. They just need to spend it so that they don't ever get above the 2K asset limit for Medicaid. If they let it build in their NH trust account, they just need to spend it & keep it under 2K. Perhaps someone knows the definitive on this?
Helpful Answer (0)
Report

If her income is only A&A and SS, she shouldn't be over. Check out the Georgia Medicaid manual (often a part of a state's administrative code)- in many states, their Medicaid manual often states that Aid and Attendance is not to be included as an asset in the determination of eligibility. The reason for this is that once a person is Medicaid approved, the VA will reduce the monthly pension from about $1100 to $90 (which goes to the NH).

I just went around on this one with my local Medicaid case worker. The document that really did it was a letter that my sister received (in person) from her local VA, which stated that once Mom was Medicaid approved, her A&A would drop to $90. This clarified (on their letterhead) that this was not a pension that would continue even with Medicaid.

Once a person is Medicaid approved, it's best to submit notice to the VA of this fact so they can start processing things. Do this in writing. It took nearly a year for them to stop Mom's A&A and they keep putting money in the account thru this period. At the end, they sent a letter stating they'd overpaid and a request for the return of the money. What would've been helpful was had we known there is a form you can fill out, asking that the amount be reduced to $90 per month while it's being processed.

Good luck.
Helpful Answer (0)
Report

Susie - I don't think you need an attorney to do the medicaid application. Now for getting the POAs, will, codicils, personal care contracts done, yes you need experienced legal. To do proactive planning to get assets transferred & moved in to assets outside of medicaid purview & ahead of the lookback, yes a good attorney or financial advisor is priceless. If there are significant assets, they are likely going into a trust or other vehicle that requires beyond the grave administration, so legal or FA till forever makes total sense. If you know there will be gifting transfer penalties for MIL, then yeah you need very good legal for MILs application.

But most arent in this situation. For the application, somebody will flat just need to get their awards letters, bank statements, property & insurance info, their IDs and perhaps proof of citizenship. There is no reason why family can't find, go on-line or get these items needed to accompany the application. If your state does an annual renewal, you are going to have to be able to resubmit these again and their updated awards letters & perhaps some banking every year........again & again for her lifetime.

This time of the year (dec-jan) is most excellent for getting items needed for future Medicaid application. Their awards letters are bring sent; tax stuff also so you know what their income was; ditto for dividends; property taxes due. Start finding & organizing their bank statements. if you start now, it's not overwhelming.
Helpful Answer (0)
Report

I'm not sure I am really the one to answer this question, but I have been looking into Medicaid coverage for my MIL. From all I have read it is best to get an Elder Lawyer to oversee something like this. They know all the laws and ins and outs of how to obtain coverage. I really don't think I am going to have a problem getting coverage, but if I run into a road block with Medicaid then I will look into getting an Elder Lawyer. They do charge a fee but in the long run it is much less expensive to have someone working for you than to be denied coverage. Best of luck.
Helpful Answer (1)
Report

One senator's name is Isakson and he does have email....there are options, one of which is Health Care. In the box below I'd type in capital letters: Medicaid.

The other is David Purdue. I don't see a web email address but that doesn't mean he doesn't have one. I'm sure his telephone number is listed somewhere on that link.

You may have to spend down that money to a point where she does qualify.

I also Googled Medicaid Help In GA and found some private websites with info. Once again, you have to discern who seems reputable.
Helpful Answer (0)
Report

Also, to the right of this message board is a place where you can punch in your zip code. Punch in the zip for your mom's town/city and see what comes up in relationship to Care Providers. I don't believe this website would advertise anything other than reputable people but you still will have to check them out to make sure they are good.
Helpful Answer (0)
Report

Try this: Georgia.gov. Write to all the people who are listed on Elected Officials. I'm presuming the state senators are listed. If not, go to: Senate.gov.

In FL it's six months documentation. I just applied via a Medicaid (I'm going to call her a facilitator) who was recommended to me by the SNF (i.e., nursing home).
Helpful Answer (0)
Report

Should read " and signed off on by whom", old iPad issues.
Helpful Answer (0)
Report

Then check on line fed ex to see when envelope delivered and signed opby whine. Then call your states program to find someone to speak with. Local caseworker probably isn't going to work as this is at appeal level.

Only 3 months documentation, that is amazing. I had 3 years & 6 months of history to provide for my moms application for texas. Over 100 pages. And the annual renewal with about 24-30 pages of documentation. If GA does renewal with supporting documentation required, you want to keep a current file going so this doesn't happen again. Btw renewal had a 14 day submission window and always always the notice was delivered either on the due date or up to 10/14 days after. Never been an issue as I just faxed all as soon as I could. Good luck Just stay atop all this.
Helpful Answer (1)
Report

On medicaid letter requesting the specific additional documentation there should be an address & fax to send documents to. Resubmit all - like everthing from her id to bank starements, the awards letters, insurance, just everthing on the list - and fax tomorrow & overnight ship as well. You can do both at a Fed Ex business center (old kinkos). Fax will produce a transmission report;. Fed Ex you get sender copy.

Then speak with business office at NH. They will probably be ok for letting this go through the cycle again with mom paying her SOC & some degree of private pay by you. Yiu may need tomsign a contract.The Miller Trust /QIT, hmmm that could be an issue - so all her income is going to miller/QIT starting when? Where does the overage go? She's gonna need that towards her private pay. Speak with the attorney who did the Miller as to how to deal with this.

See if you can find out the exact $ amount your state pays for Medicaid room& board. Like TX is about $155 a day. Will give you an idea of just how short mom is & what you may need to come up with. Mom at $2200 a month has a lot of funds bring paid, some older residents just on SS may just have income of a few hundred, so those may not work for NH but your mom has a good bit of income. Which they are going to get. Which could make them happier.

Now a long shot would be IF mom has something possibly that needs hospitalization - if there is the outside chance that she has something that perhaps could need to be done & she can get a 3 night stay at hospital, then mom gets released from hospital to NH for "rehab". Rehab is a mediCARE benefit. Medicare pays 21 days @ 100% then 80 % for up to 100 days if she is progressing. Not the solution but does buy you some time to get out of this clusterF. Has to be a full hospitalization not under " observation". btw Medicare pays like triple of what Medicaid pays, so everbody happy with rehab placement, Nh gets paid & you get extra time & mom get rehab level care.
Helpful Answer (1)
Report

Medicaid wants five years of records. Faxing the award letters to the NH instead of the Medicaid office was a mistake. Work with the Nursing Home or the Benefits Counselor they referred you to.
Helpful Answer (2)
Report

This question has been closed for answers. Ask a New Question.