We had the same concerns until we found a private care home. Mom has been there for over a year now. It costs half of what a nursing home does and she gets more hands-on and personal contact than she would being stuck in a nursing home.
Probably a case of needing to use up all parent's assets to pay for their care.... THEN, apply for Medicaid. If so, find a place that accepts Medicaid payments and has a case manager/social worker that will help with Medicaid application when the time comes.
Some good information here from others on how to try to get Medicaid but again if all else fails do not take parent into your custody. Get APS involved or have parent sent to ER.
In my experience, state Medicaid offices are sorely underfunded, under staffed, and their technology is 20 years old. You have to be on them constantly. Notices get sent out late, emails get sent out late, it’s a mess. Gird up for a prolonged siege.
Get a skilled nursing facility that takes Medicaid. Have parent pay from their own resources until they "spend down" enough to qualify. Case manager/social worker can help parent apply for Medicaid when he/she does qualify.
I am assuming your parent was denied Medicaid because they have too much money or bring in too much money monthly. If they have too much money, then they will have to do what is called "spend down". So for example your parent has $50,000 in the bank. They would pay the monthly fee of the nursing home until the $50,000 is gone. If your parent brings in too much money monthly like my mother does, they may have to create what is called a Miller Trust. You put so much of your parents money into the Miller Trust and Medicaid pays a certain amount every month to cover the cost of the nursing home or memory care. An Elder Lawyer can assist with the application and educating you on how it all works.
It is a pain in the butt, but it was the only way I could get my mom into memory care. I see some posters stating that maybe your mom doesn't have enough medical issues to be in a nursing home and that might be the reason for the Medicaid denial. Maybe she just needs memory care like my mom. If that is the case, start looking for a Medicaid accepting memory care facility.
I am confused. How is your parent now paying for assisted living? Also, in general, Medicaid does not pay for assisted living, only long-term-care/nursing home care (unless the person is living at home and receives community Medicaid which has different qualifications). Was the application for Medicaid in a nursing home setting?
Hi, If denied by Medicaid you can apply again. But, first just know the reason you were denied. The primary reason is probably that your mom's assets are over the state allowed limit for medicaid. ($2,000 asset limit; home equity limit $1,033 or $688k check these numbers with your state office)
So, you just spend down her assets to qualify. There are a number of clever ways to do this.
One way is to put some of her money directly into an irrevocable trust. (Medicaid Asset Trust) You can still use that money to pay for her medical related needs. But, in the trust, medicaid cannot count it as part of her assets.
Second, you can use some of her money to prepay for her burial expenses; Next, buy long-term care insurance; and other things. (A medicaid attorney can explain the Medicaid Long term care Partnership Program options).
Also, to lower her assets, place her home in a "Lady Bird Trust" which prevents its equity from being counted as an asset...
And or, to protect her home from a medicaid lein after her passing. (Note: you have to pay back medicaid from her estate assets after she passes). Have her to transfer ithe home to her live-in care-giver daughter, if you have taken care of her and lived there for at least 2 years and 1 day.
(P.S. Dont try to give away, hide, or put her assets in another name---they will check and disqualify her.)
So, looks like you've got a little work to do before re-applying! I hope this helps.
It's much too late to try to buy LTC insurance for her parent! In fact, her parent would not have qualified for most LTC insurance once she was disabled. The time to bein buying LTC insurance is when you are fairly young and still healthy.
OP, your profile says that your mother is ‘79, living in AL with age-related decline, incontinence, mobility problems, and UTI’. The UTI should be cured. The other issues are fairly normal, and wouldn’t normally justify 24 hour nursing in a NH. Perhaps that’s why Medicaid was refused.
OP, your profile also says that you ‘take care of everyone in the family who needs it now’. Perhaps you could reconsider all the needs of ‘everyone’, and prioritise your time. You can’t do ‘everyone’ or ‘everything’.
Couple options, first get the details of why the application was denied. Previous responses shed insight into possibilities. DSS who reviews the applications are meticulous with making sure the paperwork is complete. Also be aware of the look back period with Medicaid - it is 5 years. If any assets were transferred during that period and was NOT at fair market value, Medicaid may issue a penalty - pay privately up to a certain value. Once the penalty is paid, the app is usually approved.
Second, look for a nursing home that takes Medicaid pending, meaning the app is in and is pending, make sure you have the Medicaid workers name to share. Medicaid no matter the state has an amount of $$ someone can have. In NC, it’s $2k. As an example, if I have $10K in the bank, I spend down to $2K in a nursing home, then switch to Medicaid.
Last, know what the amount is someone can have in their bank account in your state and keep track of that. If you set up a patient account at the nursing home, they will do it for you if you have the social security check go direct to the nursing home.
This has been my experience working with families who need nursing home placement.
* Confer with Elder Law Attorney They can often review Medicaid Application and help with it or have other significant input to consider
* Request a Geriatric Case Mgr or Licensed Social Worker be assigned to case. . They can help with care options and, assist with communication to PCP , and help with Medication application etc
* You can always call APS , report PT as " unsafe" in home . APS makes home visit and assess the situation and go from there... ( This may be last resort but sometimes it takes a drastic step like this)
If patient is a Veteran or spouse of a Veteran, speak ASAP with VA Services in area . There are sometimes significant veterans' benefits for veterans and or their spouse
You used the word “if” in reference to Medicaid for your mother. Does this mean that you have not yet applied for Medicaid and you are just using this as a scenario to decide whether you should apply for Medicaid for your mother? Please elaborate on your question so we can get an understanding of what information you’re looking for.
Being denied Medicaid usually means there are some resources which will have to be spent down before the person will qualify for Medicaid assisitance. Medicaid will not help out as long as there is any other money available,. When the person is suffidiently impoversihed, they can apply again for Medicaid.
My father worked with an elder attorney to file the Meidicaid application on behalf of my mother, and she was accepted the first time. It is a ton of work, but they know exactly what to do to get approval. It cost him 15 grand and I know that’s exorbitant, but there was a ton of time put into it and it’s important to do it. Otherwise, you’ll probably keep getting denied because the application is not being filled out in such a way that you’ll get approval. Please go to an elder law attorney with plenty of experience doing nursing home Medicaid applications.
For context, my mother went in as a private pay individual and I think she paid the first month private and then Medicaid kicked in. But the attorney can guide you around the strategy for this as well. Don’t mess around, you don’t have time.
I had to apply for Medicaid for my BIL at least 3 times before he got it. They kept denying him because all the paperwork wasn't sent in correctly.
On the form letter saying it has been denied did it tell you why because they have to do that. I just received a letter stating my BIL is canceled from Medicaid as of Dec 2023. There is a worker's name on that letter that I called and she told me that the review wasn't sent in and that we had time to send it in so that he stays on Medicaid. I don't handle his Medicaid anymore the nursing home does now because they are rep payee but until the nursing home sends in that letter stating they are his legal rep payee I will still get that paperwork.
Call the person on that letter to see why they can't get it. If its spending down their finances until they are under a certain amount for Medicaid. Which we had to do for my BIL because he was already in the nursing home I had to spend down his finances that meant to pay the nursing home what he had in savings then the Medicaid took him on.
We had to apply for Medicaid 4 times before being accepted. My mom needed 24/7 care, she had no money left, no assets of any kind etc. The good news, as soon as she was approved, medicaid covered the months for me that we were billed from the nursing home, while we were applying for her.
Possibly you dump in the ER. Would need more information to better advise. If she’s in AL now you refuse to pick her up, you tell APS you are not able to take care of her. AL will likely send her to hospital when she runs out of money.
Tim, Mstrbill has been on AgingCare for a long time, a valued member of this community dedicated to try to give advice to those who write us questions. Mstrbill has a long history of giving valuable and valued advice.
You, on the other hand, are quite new. As a new participant, you are almost certainly unaware of the site's rules. I want to warn you that the page has rules, and let you know where you can find them. You can see them top of the threads put up by AgingCare admins by clicking on your avatar, then clicking on "newsfeed". The page rules will be first things you see.
Among those rules is that we do not judge the advice of others critically and with certain language. First time gets us a week time out, further infractions can get us banned from the page. It isn't necessary that we agree with the advice of another poster. We SELDOM agree. It is just that we say "I don't agree, ____________. I think it would be better to do this". The OPs then get to pick and choose, pick up what they want and leave the rest at the curb. So, welcome. We hope you will stay. But you don't want to start with a week time out and your name replaced by the moniker "anonymous". Take care and Happy Thanksgiving.
Mom needs to be 24/7 care for Medicaid to pay. What you have listed on ur profile does not seem to be 24/7 care. Is the AL asking your to transfer her because they no longer can care for her? Does she have Dementia? Why was she turned down?
It would be time for some expert help. I would attend an elder law attorney. When you call the office be certain that you want to spend an hour discussing Medicare eligibility option for your state. They should have it at their fingertips. Take with you the POA and all documents about assets.
Each State is Different. Sometimes things can be done that help. When expert medical input is needed you go off to the doctor, and here, as Igloo who is so SO smart on all this medicare and medicaid stuff says, this often isn't a DIY project.
Wish you good luck going forward. Hope you will update us.
It is a pain in the butt, but it was the only way I could get my mom into memory care. I see some posters stating that maybe your mom doesn't have enough medical issues to be in a nursing home and that might be the reason for the Medicaid denial. Maybe she just needs memory care like my mom. If that is the case, start looking for a Medicaid accepting memory care facility.
If denied by Medicaid you can apply again.
But, first just know the reason you were denied. The primary reason is probably that your mom's assets are over the state allowed limit for medicaid. ($2,000 asset limit; home equity limit $1,033 or $688k check these numbers with your state office)
So, you just spend down her assets to qualify. There are a number of clever ways to do this.
One way is to put some of her money directly into an irrevocable trust. (Medicaid Asset Trust) You can still use that money to pay for her medical related needs. But, in the trust, medicaid cannot count it as part of her assets.
Second, you can use some of her money to prepay for her burial expenses;
Next, buy long-term care insurance; and other things. (A medicaid attorney can explain the Medicaid Long term care Partnership Program options).
Also, to lower her assets, place her home in a "Lady Bird Trust" which prevents its equity from being counted as an asset...
And or, to protect her home from a medicaid lein after her passing. (Note: you have to pay back medicaid from her estate assets after she passes). Have her to transfer ithe home to her live-in care-giver daughter, if you have taken care of her and lived there for at least 2 years and 1 day.
(P.S. Dont try to give away, hide, or put her assets in another name---they will check and disqualify her.)
So, looks like you've got a little work to do before re-applying!
I hope this helps.
Cheers!
OP, your profile also says that you ‘take care of everyone in the family who needs it now’. Perhaps you could reconsider all the needs of ‘everyone’, and prioritise your time. You can’t do ‘everyone’ or ‘everything’.
Second, look for a nursing home that takes Medicaid pending, meaning the app is in and is pending, make sure you have the Medicaid workers name to share. Medicaid no matter the state has an amount of $$ someone can have. In NC, it’s $2k. As an example, if I have $10K in the bank, I spend down to $2K in a nursing home, then switch to Medicaid.
Last, know what the amount is someone can have in their bank account in your state and keep track of that. If you set up a patient account at the nursing home, they will do it for you if you have the social security check go direct to the nursing home.
This has been my experience working with families who need nursing home placement.
They can often review Medicaid Application and help with it or have other significant input to consider
* Request a Geriatric Case Mgr or Licensed Social Worker be assigned to case. . They can help with care options and, assist with communication to PCP , and help with Medication application etc
* You can always call APS , report PT as " unsafe" in home . APS makes home visit and assess the situation and go from there... ( This may be last resort but sometimes it takes a drastic step like this)
If patient is a Veteran or spouse of a Veteran, speak ASAP with VA Services in area . There are sometimes significant veterans' benefits for veterans and or their spouse
You used the word “if” in reference to Medicaid for your mother. Does this mean that you have not yet applied for Medicaid and you are just using this as a scenario to decide whether you should apply for Medicaid for your mother? Please elaborate on your question so we can get an understanding of what information you’re looking for.
For context, my mother went in as a private pay individual and I think she paid the first month private and then Medicaid kicked in. But the attorney can guide you around the strategy for this as well. Don’t mess around, you don’t have time.
On the form letter saying it has been denied did it tell you why because they have to do that. I just received a letter stating my BIL is canceled from Medicaid as of Dec 2023. There is a worker's name on that letter that I called and she told me that the review wasn't sent in and that we had time to send it in so that he stays on Medicaid. I don't handle his Medicaid anymore the nursing home does now because they are rep payee but until the nursing home sends in that letter stating they are his legal rep payee I will still get that paperwork.
Call the person on that letter to see why they can't get it. If its spending down their finances until they are under a certain amount for Medicaid. Which we had to do for my BIL because he was already in the nursing home I had to spend down his finances that meant to pay the nursing home what he had in savings then the Medicaid took him on.
Prayers
The good news, as soon as she was approved, medicaid covered the months for me that we were billed from the nursing home, while we were applying for her.
Mstrbill has been on AgingCare for a long time, a valued member of this community dedicated to try to give advice to those who write us questions. Mstrbill has a long history of giving valuable and valued advice.
You, on the other hand, are quite new.
As a new participant, you are almost certainly unaware of the site's rules.
I want to warn you that the page has rules, and let you know where you can find them.
You can see them top of the threads put up by AgingCare admins by clicking on your avatar, then clicking on "newsfeed". The page rules will be first things you see.
Among those rules is that we do not judge the advice of others critically and with certain language. First time gets us a week time out, further infractions can get us banned from the page.
It isn't necessary that we agree with the advice of another poster. We SELDOM agree. It is just that we say "I don't agree, ____________. I think it would be better to do this".
The OPs then get to pick and choose, pick up what they want and leave the rest at the curb.
So, welcome. We hope you will stay. But you don't want to start with a week time out and your name replaced by the moniker "anonymous".
Take care and Happy Thanksgiving.
Each State is Different. Sometimes things can be done that help. When expert medical input is needed you go off to the doctor, and here, as Igloo who is so SO smart on all this medicare and medicaid stuff says, this often isn't a DIY project.
Wish you good luck going forward. Hope you will update us.