The for profit Long Term Care plan is limited her of all services and keeping most of her money. Advice?

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My mother has ALS. she is dependent on all ADLs. The Long Term Health Plan is being paid to manage my mothers Long Term Care. Out of the 85% which is supposed to be used for my mothers care. The care plan is only spending about 30% of it. My mother nee3ds alot of care. I left my job 3 years ago to take care of her and have been living off my savings , and have even lost our home. The plan has been provided with a summery and orders by a board certified Neurologist clearly stating that my mother is dependent on all ADLs and requires up to 24 hour care. The plan has failed to acknowledge that. The plans case manager and supervisor came to our home and did their own assessment. That assessment is totally different then the one we had done by a Board Certified Nurse Practitioner. The plan has only allowed 2 hours of personal care personal care, 1 hour of companion care and 1 hour of homemaking services per day. The plan provides chucks, a box of gloves and adult diapers monthly. This is ALl that my mother gets and nothing else fro all that is offered by the plan. Would this be considered Medicaid Fraud?

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If you are getting 4 hours of paid care per day, that is a LOT for a Medicaid Plan. Managed care aims at minimizing cost and keeping the patient at home. Once your patient needs more than 4 hours, it is more cost effective to pay for a Nursing Home.
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I also don't understand the situation but would have suggested an appeal if Carla hadn't already suggested it.

I would read the terms of the plan and see when and how to appeal these decisions. It sounds like your mother isn't getting much from this plan at all.

However, I'm also not clear on what primary health care coverage is providing. Does she have Medicare?
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I'm so sorry you and your Mom are in this situation. That said, I'm having trouble understanding the terms of the plan your mother is under. Is this a long term care plan that administers Medicaid in your state? If so, what does the 85% and the 30% represent, and how do you know how much is being spent on your mother's care? Clearly, your mother needs more help than she's getting. Is this a situation where you can appeal the plan's decisions to a review board or ombudsman?

I hope you get some relief, and some answers, soon.
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