Medicaid denied after Mother's been in nursing home for many years! Now what?

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My bedridden mother with severe dementia has been in a nursing home with Medicaid paying for over 5 years and just got denied from her last Medicaid Renewal. She was denied stating she had 13 dollars over her legal amount in the bank for October 2013 and the month we received the paperwork was in September of 2013. The nursing home she is currently in said she will be kicked out in 10 days since her Medicaid was not approved. How are we supposed to move a bed ridden patient out of the nursing home after she has been there over 5 years or longer? We cannot afford the $7,000 dollars a month for her care. How can they deny her now?

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You also normally have 30 or 45 days to file for the Hearing/Appeal, but you have no time to waste so do it immediately! Also how could they know the statement for October 2013 was over by $13 when it was September??? Psychic??? There is an error somewhere. Did you check the bank statement and is it really over by $13?
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Everyone has the right of a "Hearing" and when that denial came in, it should have stated that to you. All you have to do if you have access to her account is to remove the $13, maybe buy something she needs and file the paperwork. The denial will be reversed. In the meantime tell the NH you are not moving her but filing for a Hearing and that the matter will be taken care of. I personally do not see how they can make you move within 10 days over such a stupid mistake.

This does show you that you need to keep an eye on her statements and make sure to keep the balance below what they allow. Personally I got into this mess myself only it was a couple hundred dollars, I filed for a "Hearing" dreading the fact that I was probably going to have to go before some judge somewhere and plead my case. Instead I received a phone call from a man who honestly said this to me..."get rid of the excess money, I don't care how you do it, just get rid of it. Take a trip to Jamaica or wherever but get rid of it." I said, "Okay." That was the end of the Hearing for me. When I told my case worker she was floored just as I was, but honestly it made me watch what was going on closer.

Act on this immediately! Tell the nursing home you are not moving your mother and the matter is being handled via a Medicaid Hearing. All you have to do is bring down the balance.
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I must admit that I am really surprised that the nursing home isn't trying to help you with the denial and was certainly surprised that they would just tell you that she would have 10 days left. Don't be nervous, it is just time consuming, but it can be done and "most" appeals (that are reasonable) usually get taken care of very quickly. However, like igloo572 stated above (wonderful step by step instructions that she gave you by the way) time is of utmost importance. Denials are overturned all the time, but once that time limit has expired...it is very very hard. Follow what igloo572 said step by step. Clear copys of letters and her Medicaid number is clear and easy to read. Using her name EXACTLY AS IT IS ON THE MEDICAID LETTER. I am still just shaking my head that the nursing home isn't helping. This is a very common issue and they deal with this all the time, why they would just hand it over for you to figure out has me stumped. Good luck!
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I got scared just reading about this!

Igloo, thanks for your reliable information.
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Oh also, for what you send / fax to the state, attach A COPY of the denial letter and if the NH sent you a letter, than a copy of that too. Make sure mom's Medicaid # is right there easily read on the letter along with her full legal name.
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She is over the allowed limit for assets.

First of all on the denial of renewal letter from the state, there should be a "challenge" or appeals process that HAS TO BE DONE. Usually this is 10 days. So get on all that asap. The appeals HAS TO BE DONE within the time limit.

I;d suggest you fax it to the state program like today and do it from a Fed Ex / Kinko;s so that you get a copy of the transmission report. When you do this from home, no transmission report. Understand? You also send it via USPO mail and this one is done certified & with a return registered mail form (the little green post card) all this @ the USPO will run about $ 8.00. For both the fax & USPO stuff, this provides you receipts, which you can show the NH that an appeal is being done. Again, you have to do this ASAP.

Keep the letter simple and don;t go into the whole $ 13.00 details. Just she was denied and I - as her DPOA - am requesting an appeal.

Once the appeal is filed, mom is in a holding pattern for Medicaid so the NH cannot do a 30 day notice to move. I think under Medicaid rules, it is a 30 day discharge not 10 day. But maybe your state runs their Medicaid program differently. TX is a 30 day notice and they have to sent it via certified or return registered mail to whomever is on file as financially responsible for the resident. Telling you is bs and has no legal authority.

I went through a 30 day with NH # 1 as mom's application took almost 6 months, and at the 5 month mark, this NH group sends out a 30 day notice. Mom's delay was with 2 things - determeination of whether her insurance policy was term or whole (cash value) and on a transfer penalty inquiry on her car (which was almost 5 years prior). Nothing but fun.....there.

I bet what has happened is that mom's personal allowance amount has taken her over her state's limit on assets. So if it is 2K, then $ 2,013.00 will do that. So you have to make sure you are spending her allowance so that it never even gets close to the ceiling. My mom has an annual re-certification and for it, I have to provide the current month and the last 3 months bank statements along with a pretty detailed info on her assets and income and with some of those documents. yes, this is done every year even though she has been on Medicaid now for years. According to billing office at her NH, they are now having to provide to the state the balance on the personal "trust" accounts they are holding for each Medicaid resident too. So if mom has both a "trust" account @ the NH and then also has a bank account, they combined have taken her over the limit.

You need to do something allowable to spend like $ 200/300 on for her. If mom needs new eyeglasses that will easily be a single $$ receipt on something that is needed and not really covered by Medicaid. I would do that rather than go & buy clothes or other small items. Really anything health care would be good...like the expensive batteries for hearing aids, or buy a hearing aid, or a new & nicer walker. Like a cute HUGO one - Costco & Sam's has those for a couple of hundred. All those are good easily approvable personal expenses for mom. Good luck and get on that appeals letter.
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