If Medicaid is denied what should I do?

While this forum is an excellent source of information and support, you should look for local resources to help you advocate for your family. Your local office of aging should have, or should be able to recommend a benefits specialist, planner or manager in your area. Go to eldercare.gov to look for your local office and call them today.

Don't assume your grandmother won't qualify for Medicaid. IF your grandmother has very little income, savings or other assets AND she hasn't given away large sums of money or property in the past five years, she will probably qualify for Medicaid.

If she has given away everything recently in a poorly-conceived plan to 'hide' it from the government, then she will probably still qualify for Medicaid, but there will be a period where she is expected to pay her own way with the money and assets she gave away (either by getting them back or coming up with money another way). That period of time depends upon how much she gave away.

OMG, no the retirement home does not take out a loan, they sue the people who got her money. In Pennsylvania, a NH sued the children and the judge ordered one son to pay $93,000 to the NH because "he had the means". Abandoning relatives after you got the cash will have consequences. Too many relatives are being dumped on the state.

OMG - you need to have hard details to see if mom or gran will qualify for Medicaid. Right now it seems you are all worry about "what-if's", try to move past that to get to the documents together to see if she will qualify for Medicaid in your state. The NH will give you a list of what they need to see in order to have her enter their facility as "Medicaid Pending".

You have to get all these documents together in order for the Medicaid caseworker to evaluate their financial status to qualify for Medicaid. The NH reviews it too - as they need to look at it to see if they think there will be a problem for "Medicaid Pending" (not all facility do Medicaid Pending even if they take Medicaid so you need to make sure the ones you look at do).

Also although the whole financial $$ issues are what most fixate on, mom / gran will also have to medically qualify for Medicaid for NH. She will need to show the need for "skilled nursing services". So think if she is at that point. Just because they are old or have dementia, those in & of themselves are not enough for NH placement. They need to require "skilled nursing services" for Medicaid. So speak with their current MD to see if they will do a letter on this - this can often be an unexpected issue for those who are in their home and move to a NH. Most NH admissions come from a hospital discharge (the usual story is that they had a fall, were hospitalized for 3 or more days and now are discharged to a NH for "rehab" and all these costs are MediCARE paid), so for those there is a fat medical file to justify the need for skilled nursing. When they are @ home, that tends not to exist so you may find you have to take a few months to create the file for this. My mom was in IL (private pay) and moved from IL to a NH (Medicaid pending). She totally bypassed the AL stage (private pay). It meant seeing her gerontologist who also was a medical director of a NH and doing visits every 4 to 6 weeks with testing done. The day she was a 10% weight loss and a bad H & H and a couple of other things, he wrote the order for skilled nursing care needed. So she had the fat medical file needed for Medicaid. Had I just moved her from IL to NH without all this, she would have been denied as it was not medically necessary.

So start gathering up & finding her documents to show she is impoverished at whatever level Medicaid requires in your state and speak with her doc. Good luck.

If Medicaid is denied, it's usually because assets were gifted away. So those people who got the house, car, savings, have to pay it back. They either take out a loan or start paying the monthly fee to the nursing home. And yes, they do get to take care of grandma forever, until it is paid back in full.

Yeah, well, as far as I'm concerned the states should take care of the people who paid them countless thousands in TAXES all their lives. They need to take some of those damn taxes and take care of them. The way I see it, too many elderly are being dumped on RELATIVES. The consequences to my family for abandoning my mom to the state? None.

Nobody wants to go to a nursing home. The best way to assure you never do is to give all your money to your kids. Then they are stuck with either keeping you or magically coming up with tens of thousands to pay the nursing home. Sorry, but that is the ugly truth. No exceptions either.

If you get a denial, look at the reasons, if they are correctable, correct them, if they are wrong, appeal. Get help from an eldercare attorney if it looks more complicated. Keep copies of all correspondence and document phone calls too.

jimmy they don't care about face value, just the cash value.

Daughterof - no, no you don't have to wait 5 years!! - the car transfer will come up eventually as its registration is within the states system. The transfer penalty roughly will be based on a equation of the value of the car (like the Blue book value) & whatever your state has as its daily reinbursement rate that medicaid pays for room & board @ NH. For example a car "worth" 10k resale value transferred in TX which has a $155 a day R&B payment rate would be 65 days penalty. $10,000 divided by $155. So family would need to private pay the NH for 65 days.

TP will be a # of days situation. A state that pays a high R&B rate - like many on the east coast - will have a shorter penalty oeriod. Keep in mind that Facility will get ineligibility letter as well as the elder and the elders point person. You or other family will be asked and expected to pay during the TP days.

Now you can appeal the ineligibility & during the appeal they continue to be consider medicaid pending at the NH. You want to file an appeal, comprende? The blue book value is somewhat subjective & can be lowered with supporting documents. Like if there are photos to show damage to car; a litany of repair bills that show car has serious problems, it's on a recall list, the penny saver has almostnidentical cars selling for less than value, etc. It will be up to you to get any documentation found, organized and sent for getting an appeal. Getting car value reduced if it's an older car should be pretty easy to do if you provide the documents to the caseworker.