My mom lives in an assisted living facility in Charlotte, NC. This facility is one of very few that accept Medicaid. Her income is SS and VA Aid in Attendance. She is $1500 short per month and her savings is dwindling. We’ve checked into Medicaid and she makes only $87 over the limit for living in assisted living. She would qualify for Medicaid in a nursing home, The rub is that she would NOT qualify (we think) medically for a nursing home. Even if we could get her admitted, it would cost Medicaid far more to have her there than in assisted living. Any suggestions? Is there any other assistance she could apply for?
First, go to DHS, get a supervisor, often the answer is on page 2 or 3 of their cheat sheets, summary of income limits. For example below 125% of limit, you may have a Spend Down or Co-Pay required each month. With a Spend Down (SD), keep receipts for all medical expenses LO has, gas or fare for rides to doctors appointments ( yes your gas milage), Rx, Dr prescribed OTC meds, etc. Those count as $ Spent on SD. If there is still SD left, you pay only that amount to NH.
In IL my SD was $200/mo. So max. You pay NH is $200/ mo!
In IA, they won't give you Medicaid if on Medicare unless you are working. ( Might apply only to Disabled on SS). I found out 'working' can be self-employment doing off jobs. Maybe she can fold laundry for someone. $5 a basket twice a month, she earns enough. If she knits, find a boutique ( or charity) to pay her $10/ mo. to knit for them. Then have them sign a letter stating that she works for them, (simple job title), for $/ mo. As independent contractor.
It can be like pulling teeth to get to these exceptions allowed by the state. You need to find someone who will tell you..which usually means knowing what to ask. (What do you consider working? How much does she have to make? What specifically counts towards SD? Does she quality with a SD?)
Try Center on Aging more than once. MPE is many workers trained on common issues, not exceptions! I actually spotted the 125% rule on board behind worker. She looked at page 1, I asked her to hand it to me, she had Never looked at page 2 of guidelines!
Good Luck!
If you make an appointment, it's a good idea to take ALL her financial info to the appointment: bills, bank statements, income reports, insurance info, list of assets like home and cars. You can get a list of what Medicaid requires you to report--take all of it with you.
There's an answer to your dilemma, you just need a NC attorney to help find it.
If so, I’d suggest you work on getting her medical chart to show “need”.
Forget abt going to the MD affiliated with the current AL, they are going to have more incentive to continue her as a private pay resident in my experience. Instead find a gerontologist who is also medical director of a NH (or two) & that these NH take Medicaid, and mom becomes his patient. This MD will know what needs to be in her chart that shows “need”. She’s got stuff that’s co-morbities that likely isn’t in her chart.... if she’s old there will be some degree of coronary heart disease, cataracts or something low vision, some sort of spondylitis/ degeneration of various body parts. I moved my mom from IL to a NH totally bypassing the AL phase. Took about 4 -5 mos of every 3-4 weeks visits. The visit she had a 10% weight loss, a bad H&H lab report, and a couple of other markers, he did orders for skilled nursing care. So the move to a NH and dealing with Medicaid approved was on. Skilled can be something simple changed or added to her chart, like a switch from a pill to Exelon Patch which she cannot do, or having a compounded prescription needed, which requires skilled.
Good luck in your quest!