What can you do if Medicaid denies you for reasons that are not correct? - AgingCare.com

What can you do if Medicaid denies you for reasons that are not correct?

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We have applied for Medicaid for my mom because we have spent all her money on assisted living. She is in a memory care facility and they just raised the cost by $1000. We are paid up to February 28 and have no more money. We have been fighting with DHS since the first of December with no results. They will not return my phone calls. The denial form letter they sent me said she makes $3552 annual income. News to me. They also said she has too many assets. She has no cars, no money and a house. As far as I know she can keep the house to be able to apply for Medicaid. Any ideas what to do?

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You have to live in the house you own in order for it not to count against you. Medicaid feels you can sell and live off the profits.
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Appeal.
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It us my understanding that transferring ownership of her house would raise all kinds of red flags. I would definitely investigate that before doing it.
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Actually, recipients are allowed to own their own homes as long as they live there. As mentioned here, you may want to do some digging and investigate to see what assets maybe out there that no one else knows about. Meanwhile, you may want to contact a lawyer who specializes in this area and maybe even consider talking to your mom to see if she'll consider transferring her house or putting it into a trust
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Appeal, ask for a Fair Hearing.
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Vicki62, you didn't mention what state you were located in. From personal experience, I had to hire a medicaid attorney and a care manager. I had to borrow the money to do that but the end result was worth it. They were able to get my mom 24/7 in home care after arguing with the top people over several weeks.
Now, nursing home care is a different route with Medicaid because they have the 5 year look back period, etc. But, if you have not been successful on your own getting anywhere with DHS and they will not return your phone calls then you are stalled with your own effort.
Honestly, the facility where your mom is should have resources to help you with the process. A lot of care managers work with the different facilities and maybe the facility could recommend a good care manager.
Push the staff at the facility she is at. They should, ethically, help you keep your mom where she is and help you get the help you need to keep her there.
Look into an attorney who specializes in medicaid. Often times you can get a free initial consultation. I know how time consuming and stressful this process can be, but keep pushing for the rights of your mom. You can get there, just keep pushing. Good Luck. Take care of yourself.
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My question is, if ur Mom will never be living in her house, why not sell it. Maybe showing ur trying to will make a difference. With my Mom, selling of her house would mean another year in AL. It would free up her SS and pension which are right now paying utilities and taxes on the house. I would call Medicaid and ask for proof of their findings.
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They included my Mom's small insurance policy value. My Mom was $40 over. I received a letter from the county letting me know what assets were included. I ended up getting rid of the policy. She is now re instated after a lot of stressing and not taking no as an answer. Good luck!
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Perhaps her name is on a joint account with someone that you are not aware of? $3552 annually is nothing they would squawk at, but if it is a monthly income, a Qualified Income Trust, aka, Miller's Trust will need to be set up, her income transferred to that each month and then the home paid from that minus Medcaid personal allowance (for my dad, $50/month) and any medical expenses (doctors, underwear, etc.).

I would try to get an in-person appointment with the Medicaid representative assigned to her case so you can go over what they found, presuming you have valid Durable POA. I would also talk with the facility. Most all facilities that take Medicaid have someone there that is well-versed in the application process that could help you. Many/most have a provisional clause in the entrance agreement that they will not kick the resident out while waiting on Medicaid approval if you have met their personal-pay requirements (usually 1-2 years personal pay, based on my experience).
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