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My aunt was admitted to the hospital after being found wandering down the highway over a mile from her home. She has been attending day care 5 days a week and I have been jumping through Medicaid hoops since last August. She clearly can no longer live alone in the Senior Residence. She has a diagnosis of Vascular Dementia but has gone downhill over the past month. The doctor admitted her yesterday to a rehab facility but said that he can only guarantee her 21 days there ... the rest is up to the therapists ... and she ambulates perfectly and probably doesn't have enough deficits for OT and Speech to continue working on. She cannot go back to her apartment as per the police, the building manager and common sense. We cannot afford thousands of dollars per month for Assisted Living or nursing home or private care. Can she be admitted to a facility as "Medicaid Pending"?

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Also another thing, you need to look at the NH & AL contract carefully as to how if they are declined from Medicaid what the facility can charge you for payment. Some places who take them "Medicaid Pending" will charge you the day rate for room & board that is the same as whatever Medicaid pays in your state; while other facilities can bill you their private pay rate.

In TX, Medicaid for NH pays about $ 145.00 a day reinbursement to the facility. So if auntie is declined acceptance for 2 months, and they will accept Medicaid rates that would be $ 8,700.00 ( 145 X 60) owed to the facility by whomever signed her in BUT if they will not accept Medicaid rate but instead their $ 300.00 a day private pay rate ...that would be $ 18,000.00 that they would bill you or whomever signed her in. So this is very critical.

You know the # 1 reason for bankruptcy is medical bills and often those are bills that family incurred on behalf of their aged family members. You can't be too careful.
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Cota -You are right to worry....this is going to be long, so get a cup of coffee. It's alot to evaluate for you especially since she's your aunt and probably haven't had alot of the day to day details on her life, I would imagine. I was executrix for 2 aunts and the first asked me to get involved with her life about 60 days before she died. She had just bought into a CCRC, still had her home, lots of property and had a nephew who was taking clever advantage of her. She died in her sleep at the CCRC and her finances were a snakepit of a hot mess...4 years of probate. So I know what you are dealing with. I've done Medicaid for my mom after IL for admission into a NH. Mom's now in her 2nd NH. Medicaid is a maze and will drive you loco so you have to be very OCD on everything. If you're not bent that way (I'm by nature and by occupation very OCD), then you need to try to be and stay organized & keep a sense of humor (& for me Prosecco) as you will need it.

What is happening right now for Auntie, is that Medicare is paying for "rehab". If they are discharged from a hospital stay of more than 3 days, rehab is a covered Medicare benefit. Medicare pays pretty well to the facility and covers all their medical expenses and probably almost all of their room & board costs. Medicare is totally federal. Rehab is tricky in that they have to measurably show they are "progressing" and the evaluation is usually based on OT or PT stuff in order for Medicare to continue to pay beyond the 3 week initial period. Most rehab to a NH is after a fall and they have to get up and start walking and doing, if they don't or whine about the pain, my experience is that the PT/OT writes them off in short order. So you have to do what you can to encourage Auntie to move and do. Be especially nice to the OT/PT and ask how she is doing. If they tell you flat out, auntie isn't progressing then Medicaid is more imminent to deal with. Understand?

Now legally are you able to do for her, are you her DPOA, MPOA? If not, then you have to get that done ASAP. Imho that is super critical. My aunt had all this drawn up even before she asked me! If Auntie has children, I'd highly suggest that you put together a "come to Jesus" meeting on Auntie situation so that everybody who can complain can talk out and come to a consensus and agreement. You don't want Auntie's worthless son & his even more worthless DIL to take you to court.

Whatever you do, DO NOT EVER sign any paperwork with your name. Everything needs to be signed by your Aunt or if she can't, you sign it as " Jane Smith in her capacity as DPOA for Anne B. Jones". This is very important and you have to do this to cya financially. Also get a copy of all documents signed - again this is very important. What I have found in being on this forum is that family in a rush or panic, just signs whatever and then end up with bills that they have to pay and do not have any paperwork to contest or fight the facility. Even it if means you sit in the admissions office for 45 minutes and do NOT give them a check till you get a copy of all the contracts and agreements.

Aunt was living in an apt, correct? So there is no house ownership to deal with?
If so, that is a good thing as less assets. I would imagine if Auntie has been living in an apt for a while, her spending patterns are pretty apparent. This too is a good thing. For Medicaid evaluation, the caseworker is looking to see if large sums of funds have gone places that would cause a transfer penalty. Like a check of 8K to a niece last year. For my mom, she was living in IL and still had her home before applying to Medicaid for NH. So her pattern of spending was pretty clean cut...$ 2K to IL, $ 100 for utilties, 2 phone bills, annual taxes and insurance stuff. And her bank statements were a steady depletion of her assets and showed where her monthly income went. For my mom, her Medicaid application was over 100 pages with about 1/3 of that due to her old-school style insurance policies. You need to make a copy of everything in the application in case there is a ?. For my mom, we had an issue with her life insurance policy. It was like 30 legal size pages and really the caseworker does not have the time or ability to decide whether a policy has a cash value. (If it has a cash value, you have to get it cashed out and then use the insurance cash in her spend-down) So I got a letter asking for clarification on cash value and must be done within 72 hours or application would go into the info not provided pile and then declined. I got a broker with a TX license to do a letterhead letter stating that it was a term policy with NO CASH VALUE the next day and faxed it over. that hurdle jumped. But it;s this sort of thing that can be a total PIA to deal with and not everybody has a broker who will just do this for you and right now babe.

The Medicaid application process can be quite maddening so you need to be very organized. You probably will need to put on your best Nancy Drew to find the documentation in Auntie's apartment. For my aunt, she had a whole closet with rubber band tied shoe boxes with old checks and receipts, etc. But I was dealing with probate. For Medicaid it;s only the past 5 years that count. But if Auntie sold her house 3 years ago, that's the sort of thing you need to know and where the proceeds from the house sale went. Just in case Medicaid asks. Real property - like cars, houses, land - are things the Medicaid caseworker can easily find out about as the local assessor info is dovetailed into the state database. So keep that in mind when you are going through Auntie's things. Caseworker may never ask but you want to be prepared just in case.

Do you know what Medicaid pays for in your state? Medicaid is a joint state & federal program and admininstered by each state. Some states will pay for AL by Medicaid, some states only do this via a waiver program, other states are really a NH Medicaid program. My mom is in TX and AL is a waiver program with waiting lists. It is much, much easier to get them into a NH and have Medicaid pay for it than to get into an AL on a waiver. A good elder law attorney will know how Medicaid runs in your state. Also the social worker at the rehab facility will know alot of info. I've found the social workers to be a great resource and are NOT trying to sell like admissions does and also social workers are required for licensing so they can be more frank as they have job security while admissions may be getting a cut of the action of admissions. Most AL is private pay and if the profit center for a facility if it is AL and NH. My experience is that often the facility will skew the applicant to be totally good for AL and not have the "skilled nursing" needs that would make them eligible for NH (and therefore Medicaid).

About "Medicaid Pending" what this has meant for the 2 NH my mom has been in, is that the admissions person at the NH has the ability to review the Medicaid application and based on what they see or don't see can or cannot accept the resident as Medicaid Pending. Some NH who take Medicaid, do not do "Pending" and may require private pay for 3 months upfront as a deposit. These are private facilities and can determine how they want to do this. So you need to be very frank with admissions on ability to pay if Medicaid declines Auntie's application.

The facility should have a printed list of items needed for the Medicaid application. For my mom it was 1 page, for my MIL (same state) her NH had it at 2 pages. Go figure. Your aunt's current annual SS statement and other retirement income statement are critical. You need to find the ones she was mailed. You can request them but I've found that is a hornets nest as SSA does not recognize POA, and ditto for most retirement programs. If you have to do this, then try to do on-line as your Aunt (understand?). SSA send theirs out in January and it is a trifold letter that states what her monthly is...how much they are taking out for Medicare and her monthly payment. If she gets retirement, it is much the same. These are VERY important as the facility will use this to determine Auntie's co-pay. Did anyone explain the co-pay to you? Say she gets $ 800 in SS & 1K in retirement and her state has a $ 60.00 a month personal needs allowance. That means that the facility MUST BE PAID $ 1,740.00 each mo from auntie's checking account as her co-pay required by Medicaid. If auntie has alot of debt or expenses, there will be NO funds for her to continue paying on stuff. Some NH try to require their PNA be held at the facility, but you do NOT have to do this. My mom still has her home and I & another family member pay for all on the home and will file in probate for the expenses against her estate. If you are in this situation, you have to keep detailed records on all this. Yeah, it's alot of things to deal with and think about but really at 6K to 15K a mo for NH, you just have to do it. Good luck!
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Medicare will pay up to 100 days but the therapists have to substantiate that she requires therapy ... and physically she's in perfect condition ... especially for nearly 80 years old!!

The doctor says not to worry for 3 weeks, because she's guaranteed that amount of time ... but how can I not??
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You should probably check with whatever nursing home you're considering admitting her to. They would know the answer to that and might possibly be able to check on her status with Medicaid if you've already applied, and if you fill out the forms for admittance that they require. A nursing home wants to have some sort of payment set up prior to admitting a patient. In same cases I believe Medicare will pay up to a certain number of days, such as if she's admitted by her doctor for observation and diagnosis (?) but that's it as far as Medicare goes.
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