Medi-Cal and skilled nursing. Anyone have any knowledge about this? - AgingCare.com

Medi-Cal and skilled nursing. Anyone have any knowledge about this?

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My question is aimed at anyone with knowledge or experience with the Medi-Cal program in California. Assuming a doctor documented that a skilled nursing facility was medically necessary, and if Medi-Cal agreed to that.....if a person had been paying for a facility out of their own pocket, and their funds ran out, prompting them to seek Medi-Cal...would Medi-Cal let them stay where they were or have them moved to a "not so nice" facility? I guess I have heard of some places that I would not want my mother to stay in, and I am not sure how that works with Medi-Cal. My mother is not in any facility at the moment, but she may be soon and has good funding for a year or so before her funds would run out with no other finances available. Anyone have any knowledge about this? Thank you.

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clrsky58: Your statement "she has good funding for a year" could be questioned or deemed shocking. My late mother's rehab bed ran @ $410 for Medicare purposes.
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clrsky58: Here's what will happen when your mother suffers a life-altering trauma--
#1 She will have to use the services of the ER and then be admitted to the local hospital in Santa Ana, California.
#2 Then she will, more than likely, but not always (here's where your promoting comes in) be sent to a NH when a Medicare bed becomes available.
#3 She will either private pay or apply for Medicaid (Medi-Cal).
#4 If your mother is not in any facility at the moment, I'm not sure why you're asking about changing facilities under the umbrella of Medi-Cal?
#5 Are you over thinking this, as it's not yet a dilemma?
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My advice and experience as a Nurse Practitioner with evaluating ANY facility includes making spontaneous, unannounced visits. Listen to staff/client dialogue: tone of voice, body language, compassion vs irritation. Lastly, but equally important. ALWAYS THANK the staff for whatever...they are seriously overworked and underpaid!
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And nice is not the most important thing. Quality of care is. Some rundown facilities offer excellent care. Check California's Department of Health for licensing of facilities and ratings of them.
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If she is not in a facility now, it is important to find one that also accepts Medi-Cal. Most facilities require a period of time that is private pay, meaning paying from mom's resources before agreeing to keep them on Medicaid. Do you homework, there are some nice facilities that also accept Medicaid.
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Some places will keep residents that go on Medicaid if they have been residents of the facility for a Year or more.
There are also "nicer" and not so "nice" facilities. You might want to check now and get your Mom on a waiting list at one or more of the "nicer" facilities. If her name comes up and you/she are not ready you can tell them that you would like to postpone her residency and to put you back on the list.
Begin the application process for Medicaid now. By that I mean make sure that you have all the documentation that you need and that as far as you can tell she qualifies. Then submit the application, when and if she is denied you can repeat the process and it will go faster. You might be better off with an Elder Lawyer that is familiar with the Medicaid application process so that she does not get denied the first time.
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Yes you would have to move your parent to a facility that accepts Medi-Cal but you may live in a county that has none and then obtain a waiver for a nicer place, although wait lists are high. Do it now.
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The first thing to do is to get yourself a Lawyer that specializes in Medi-Cal Asset Protection Trusts and create one to protect her IRA from being recovered, her car, etc. The house is no longer subject to recovery since the Governor signed a bill last year or even this year stating that Medi-Cal recipients don't lose their house to Medi-Cal for asset recovery. The trust can also put in a special bank account to protect some monies your mom might receive or up to $ 8,000 per day that can be gifted out from her. Don't wait until she runs out of money like we did but do the trust and get it all corrected before she needs anything. These elder lawyers are also tied into people who file the medi-cal application for you. It is 25 pages. Good luck.
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