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Hello-I have been caregiving for my mom with dementia for 13 years now. She is at a point where she needs Memory Care. She was denied Medicaid. My sisters help on and off on weekends with no consistency. I am told I cannot force their help. Mom's dementia has become a safety issue for herself and my family. She is violent at times with my kids. She is mean to us but very sweet to everyone else. I told my two sisters everyone takes mom for a month giving the other two a two month respite. They refuse. We decided we would pay out of pocket. I did all the necessary paperwork needed by mom's doctor, It took three appointments. I had mom assessed for a facility my sisters found, I sold my big house for a smaller one to insure I could make my share of payment. Then on the day they were supposed to sign her in, they decided neither of them wanted the financial responsibility. So here I am, in a smaller house. Mom is sleeping on a couch living out of a suitcase. I am burned out. Does anyone know anything I can do to get mom the help she needs and deserves, or if there is anything I can do to force my siblings. Thank you

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Why was your mom denied? Does she have funds? If so you need to get her into memory care where those funds will be spent on her until there are no longer funds; then she will go on medicaid and she will go wherever she can be on medicaid.
I hesitate to say this because I have recommended it before and I loathe it. But you are down to what we call
THE ER DUMP.
You will have to take your mother to an ER. You will have to say she cannot return to your home, that she at this point constitutes a danger to your household. She will be admitted and assessed. You will get in touch with hospital Social Workers on DAY ONE and make it clear. No argument. No listening to the platitudes of "We can make this work" "we will get you help". They can't make it work and they won't get you help. Have the finances ready to give to Social workers. All Mom's assets and all her bills. Let them know you cannot take her and if they wish to have her put on State Guardianship through the courts that is fine.
Give your Sisters one week notice that this will happen.
This sounds cruel. But what you are going through cannot work and no, there is no way you can force your siblings. In fact I agree with them. I would not attempt to care for your mother in my home were I them. I would not spend my savings on your mother when I will need them (sorry. So sorry) for myself.
I couldn't be more sorry but you are down to bare bones reality now. This cannot go on. If you need to give over guardianship of your mother you will have no control on where they place her, but she will receive care. Many elders don't have children. Many people don't have sisters. That's about where your Mom sits now. Everyone has been all used up.
I am so very sorry. I hope you will update us. Please spare yourself further speaking with your sisters until you have a plan. They are not obligated to care for your mother. They do not intend to do so. Nor can you anymore.
Remember, the Social Workers and hospital want to/will do and say ANYTHING to make you take your mother back home to this life you and she have. Do not allow that to happen. 13 years. You have given up more than a decade of your life. This could go on a decade more if you allow it. What will be left of you? To say nothing of what will further attacks do to your children? Why must they live this way for no reason.
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AnnReid Oct 2019
So very VERY well said. And NO, when you are “living this life”, this DOES NOT sound “cruel”.
We all wish that there was some simple, peaceful, comfortable way to resolve conflicts, assuage guilt, provide humane care, all of that. THERE IS NO WAY, except as detailed above.
Your Mother has dementia and additional physical issues, of her three daughters you are the only one who has cared for you, you have paid your dues, it is time to MOVE TO A NEW PLAN.
Hopes and best of luck that you have the courage to make the only choice that will benefit all of you.
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I don't understand, you should not be paying out of pocket out of your own money for her care. It sounds like Mom needs to go to a nursing home. How the Nursing home is paid for is out of your Mom's money. If she doesn't have enough to cover the cost, she pays what she can and the state (LTC Medicaid) picks up the difference. And yes, Alva's advice is the route to follow if you can't get her into a nursing facility on your own.
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Tiredmomma Oct 2019
Hi mstrbill-I just saw your reply about LTC Medicaid. I will look into that now. Will that help if mom only has Social security and small pension but no assets? Thank you for any info, Much appreciated.
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Why was your mom denied Medicaid? When your mom was denied Medicaid, had she applied for health insurance or for long term care? Because there is Medicaid health insurance and Medicaid for long term care and the requirements are different for both. for long term care Medicaid, they look at her income and assets. If she’s got no assets, just a monthly income & it’s too high to qualify for Medicaid then look into a qualified income trust or Miller trust. Her excess income will go to a trust account that Medicaid is beneficiary of.
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sudalu Oct 2019
worriedinCali, thank you so much for the info on qualified income trust or Miller trust! We live in a "cap state" and my mother's SS exceeds the limit for Medicaid. I had no idea this trust was in place. All though she doesn't need it now, I was concerned for the future. Very helpful information.
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I can understand not wanting to take on the financial responsibility for mom. I'm wondering if she's not eligible for Medicaid because she gifted her house to someone less than 5 years ago? They are the party that should be paying for her care.

You absolutely should not have an unpredictable, abusive elder in your house abusing your kids.
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Tiredmomma Oct 2019
Hello surprise-No, my mom never owned a house. She has zero assets. Her only money is her social security and small pension, $1400 monthly, To clarify, she is verbally abusive. Has raised her hands to my kids though, but not physical at this point.
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I’m not clear as to why mom doesn’t qualify for Medicaid (did you actually apply and she was denied or did something simply give you the idea she would be rejected?) or why you and your sisters would have to even consider paying for residential care with your own money and not mom’s if she has too much to qualify for Medicaid. None of you individually lol collectively should be even considering taking money out of your own pockets monthly never mind preparing to do that by selling your own home to support mom. Medicaid denials can be challenged too but given your current situation I would strongly recommend consulting with a Medicaid/elder planning attorney now before doing anything else. While you should be using mom’s funds to pay for it if that is too complicated I would use some of the savings you just created to pay for her care and figure out how to be reimbursed later.

Your mother shouldn’t be living with any of you at this point by the sounds of it and while I know how difficult that is to accept, especially for you who has been her primary caregiver, you said it yourself the current situation isn’t safe for your mom or your family, you might even want to consider putting mom in the hospital for observation (and safety) while you figure out the next step, this won’t give you much time but it will alleviate both the safety issue and the issue of mom on the couch for a few days as well while you find an attorney and make a plan. Only you know if this is the time to make the hospital move or not, it is not something you can keep doing so you might want to keep it in your back pocket too.
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Tiredmomma Oct 2019
Hi Lymie61-So mom is denied Medicaid because her social security payment and small pension go over the income limit. She brings home $1400 monthly, but Memory care starts at $3700. My mom has no assets, she never owned a house in her life. Really do not understand how that amount monthly could possibly be considered to high. Something is wrong with our Medicaid system, Might have to try the hospital strategy,
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Why exactly doesn't she qualify for Medicaid? If she is sleeping on a couch? If she has money she should private pay for a facility. I do not get this.
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Tiredmomma Oct 2019
She is denied Medicaid as she is over income limit. (by less than $100 I guess), Mom has no assets, no money. My sisters and I decided to pay private out of pocket. I sold my bigger house and downsized to insure my share of payment. New home does not have bedroom for her as I thought she would be placed at the same time as my move. My sisters were supposed to sign papers at the facility. That day they called me and said they will not be financially responsible for payment. I have called atty's and Medicaid specialists. Everyone says same thing. When Medicaid denied because of money there is nothing you can do.
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OMG 😳 First of all, you will never be able to force your sibs to be financially responsible or become caregivers. You’re burnt 🥵 out to a crisp. My advice is take her to ER & say you’re not able to care for her anymore as you are not well yourself. Demand to have meeting with Social Worker at hospital. Tour a couple of facilities near you while she’s in there. You can work with facility Medicaid office or hire Elder law Atty. Funds from sale of house can be used to pay or maybe it can be put in trust. Don’t ask sisters for anything as you can’t depend on them. You deserve a life too! Hugs 🤗
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Tiredmomma Oct 2019
Hi Caregiverl_ Someone else told me the same thing about emergency room, Thanks!
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Well said AlvaDeer I completely agree with you!!!
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I haven't read the responses so hopefully I am not repeating.

Check into a Miller Trust aka Qualified Income Trust.

This is what will get her income lowered to be approved for Medicaid.

Go to www.nelf.org and find a certified elder law attorney in your area, they will know exactly how to help you get her qualified. Please don't use your money to pay for mom. You and your family need this.

Best of luck and I would never trust those siblings again, that is rotten what they did.
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Tiredmomma Oct 2019
Hi Isthisrealyreal-I did look into a Miller Trust with an attorney and was told not possible in my state.
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If she’s less than $100 over the income limit then spend down the money. You can get her a dental insurance policy or something like that. Her out of pocket medical/insurance expenses lower her countable income.
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Tiredmomma Oct 2019
Hi worriedinCali-She is over limit due to social security and a very small pension. Medicaid told me they go by her gross pay, so I am not sure that another plan for expense would be the answer.
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Your Mom absolutely will qualify for LTC Medicaid, please see an expert in your area who can structure her income (via trusts that can be set up where her excess income goes into) so she can qualify. How do you think the hundreds of thousands of elderly just like your Mom in Nursing homes are having their bills paid? If you can't find an elder law attorney who will help you, and I understand they cost a lot of money, what you will need to do is give her up to the state. They will find a place for her. You typically do this by not letting the hospital release her to you (alva's advice). You do not sign any paperwork from any nursing home stating that you will be held responsible. in fact don't sign anything at all. The social workers at the hospital and nursing home will get her approved so they can get paid.
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Tiredmomma Oct 2019
Hello mstrbill-Not sure what LTC Medicaid is, however her income is due to her social security payment and a very small pension. I talked to an attorney in my state who said a Miller Trust cannot be done here. Thank you for your advice.
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Read AlvaDeer's response below. And then read it again. And a third time.

I want to particularly stress that you are NOT to believe anything any hospital SW (or anyone else) says about they will help you "make it work." No, they will not. They just want her OUT of the hospital and to be YOUR responsibility. You see, when THAT happens, they are off the hook! And easier than making the many phone calls and arrangements to find her a facility. Do NOT let them guilt you into taking her back home.

There is nothing anyone can say to give you help on how to guilt your sisters into sharing payment for a facility for your mother. Most here agree that your sisters should NOT be paying....but neither should YOU be paying!

One question - you say your mother is violent towards your children. How old are they?
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mstrbill Oct 2019
Agreed, and to add, the hospital must be made aware that OP's home environment is UNSAFE, for both Mom and the family.
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Yes, mstrbill mentions an important point -- "Unsafe discharge" will become your mantra if they talk about her coming home. Keep it on the tip of your tongue!
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Hi Tired momma, I'm not as well versed as others here (maybe Igloo can hopefully join in) in LTC Medicaid (Long Term Care Medicaid, that pays for nursing care ) rules for different states and what happens when your monthly income is above the monthly limit. You stated you are in a state that doesn't allow Miller trusts? And her income is higher than the monthly limit allowed for Medicaid? There must be an answer, if you let me know what state you're in I'd be interested in researching myself. I can't believe there isn't a way to get Medicaid because there are thousands in a situation just like you. But if that is the case, what you are going to have to do, either sooner or later, is to "dump" her at the hospital. It sounds horrible and it is horrible but if you are out of options, that is the final one.
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Tiredmomma Oct 2019
Hi mstrbill-I am in NC, Thanks for your advice.
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If Mom was denied because she was over the limit, see if your state allows a Miller trust or something similar.

With a Miller trust, the extra money goes into it. When Mom passes, that money reverts back to Medicaid. I know, weird but thats what u would need to do.
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elaineSC Oct 2019
JoAnn, the admissions lady gave me info and then I went to DHHS office (you can call them too). BUT, my best source was an elder law attorney that specialized in Medicaid and Probate. It cost me $300.00 for an hour of great information. Worth every single penny too. I was confused and it was driving me nuts so I went to the attorney that would know the facts.
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https://www.familyassets.com/nursing-homes/resources/medicaid/north-carolina

Tiredmooma, it appears North Carolina has such a convoluted system! They don't do Qualified Income Trusts, but what have a deductible system in place for those that make too much monthly for Medicaid. Basically from what I'm reading it all works out the same, your Moms income goes toward her medical bills and the state will pay for the rest (as long as she is deemed medically needy). In your state, It is just set up in a weird way involving paying deductibles every 6 months that seems too complicated. But ultimately the state will pay the difference. You need a good county social worker to help you place Mom, but if that service is lacking then you may need to drop her at the hospital.
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Most Memory Care and AL facilities are private pay and will not accept Medicaid. A Skilled Nursing Facility may be the best option. If the elderly have no one, irregardless of income, the state will make sure they are cared for, though it may not be the choice facility we would place them in. So there is a way. Speak to an Elder Law Attorney. And research your state Medicaid laws, speak to a representative even, just to be well versed on the subject. Good Luck, and yes, please share your solution when all is settled.
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Myownlife Oct 2019
That is NOT true about Memory Care and AL. It would be hard in my state to find ALF for MEDICAID ONLY. BUT most have Medicare / Medicaid and CAN go to ALF. Now I am not in NC so not sure about that state, but my state has them.
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God bless you for caring for her for so many years, and the sacrifices you have made. I, too live in NC and I’m trying to figure out how to get my Mom into a facility as we do not have the money. She has no assets but I’m afraid her income is too high. Do you remember the limit? I’d love to walk through this with you! It’s all so confusing and my mm needs to be placed soon.
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elaineSC Oct 2019
Go to admissions at the nursing facility and they will tell you about how it is paid. Your Mom will have to pay a portion even if she qualifies for Medicaid. I know because I was Mom’s POA. Mom paid until her money was spent down to $2,000. Then, a portion of her social security will be used to pay for her stay there along with what Medicaid pays when you reach that threshold. You can pay it out of her funds or allow the nursing facility to handle it. I kept Mom’s checkbook and paid her portion out of it. She is allowed to keep enough to pay for her clothes and getting her hair done, etc. Just go to the business office or admissions and they will explain. I have been through the whole routine.
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Do you have that much guilt as far as putting your Mom in a facility? If so, talk to a therapist because at this stage, she will take you down and it sounds like your siblings don’t care and are putting it on you. I hated putting my Mom in a facility but we did it. You can check on her anytime you like. Mom was wearing my Dad out and he had congestive heart failure and couldn’t tend to her anymore. Just no other way.
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disgustedtoo Oct 2019
Guilt? Where is guilt coming into play here? OP wants to place mom, now that she has more advanced dementia and is becoming a threat to her children. Income is over NC's MEASLY limit and sisters won't pay (no one can force them to either.) She is between a rock and a hard place, no guilt involved!

Also, another comment you made talks about spend down, etc. OP's mom has no assets to spend down - rejection was because mom's income (gross) is over the Medicaid limit in NC.
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You have horrible family members as they won't help. You have gone way above and beyond and now it is your turn to have some peace. Most likely a nursing home would be the answer so there is more financial help. Start seeking out professional advice from medical organizations and aging organizations. You cannot and must not allow this to go on. And walk away from your siblings. They are simply not worth having them in your life.
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You can have her placed in an assisted living facility tomorrow. The fees in my State are around $3-4,000/month for a nice one (I didn't research the not-so-nice ones). Use the money she has and add the difference from yours and, if possible, your sisters' money. This can be a temporary solution until you can get her on Medicaid.
My mom was in a very nice facility for $2900/mo. Fortunately, her assets did hold out until she died so we never had to address filing for Medicaid.

Another option, find her a senior apartment, maybe one that accepts HUD payments.
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TXGirl82 Oct 2019
The OPs mom has dementia, so the senior apartment thing is not an option. Her sisters are refusing to contribute.

OPs mom brings in $1400 month from SS and a pension. OP has her own children and retirement to think of. Making up the difference is a bad idea.
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You need to talk to an Elder Law Attorney. You said your're mother was denied Medicaid. Elder Law Attorneys can sometimes file a "Hardship claim" for an individual who has been denied and get them approved.
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No way to force siblings to do anything they refuse to do, whether it be "chipping in" money or providing actual care. This is very sad, pathetic really, but it is a common theme on this forum. Some siblings are even worse, in that not only do they not help in any way, but they stick their nose into whatever YOU provide and some even try to sue or take you to court for spending the parent(s) money on their care (vs keeping it for them to inherit)!

I took a minute to do some lookup out of curiousity. Wow, is NC cheap or what? WHO could live ANYWHERE for $1,005/month??? That was the limit I saw listed in the following (this link lists ALL states, updated 9/2/19, so could be useful to many of you):

For ANYONE:
https://www.policygenius.com/blog/a-state-by-state-guide-to-medicaid/

This provides a lot of information AND includes (as of 9/2/19) requirements by state. Check it out.

For NC, OP's home state:

"Income requirements: For the aged, blind or disabled, or caretakers of someone with those characteristics, your income must be within 100% of the FPL — $1,005 per month for a one-person household,"

How ANYONE believes 1k/month would cover LTC is beyond belief! Even the amount OP's mom has for income is not going to cover LTC.  It wouldn't even cover expenses to live under a bridge or in a cardboard box! WHAT are they (government who makes these decisions) thinking and/or what rock do they live under???

P.S. reminder to all - mom has NO assets, so there is no "spend down" AND OP stated Miller Trust is not an option in NC.
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Although some recommended the ER drop and run route, this shouldn't be on the table for consideration. Much as it sounds like a desperate move (it is and is not the right thing to do!), it probably won't work and the consequences could be worse than keeping mom at home!

Many EC attorneys offer an initial free consult. Try some others - not just a regular attorney, but those who only do elder care. Perhaps there is one out there who could guide you, rather than just telling you what isn't available to you for help.

Referring back to the link I posted, part of the problem is this:

"President Barack Obama’s health care law moved to standardize Medicaid requirements, specifically so any American making up to 133% of the poverty line could qualify. But that provision was challenged and overturned by the Supreme Court. States could expand Medicaid, but they no longer had to. Thirty-three states (plus Washington, D.C.) did; 18 didn’t. And eligibility across states has gotten even more diversified since the Trump administration announced it would allow states to impose work requirements for low-income and needy Americans receiving Medicaid."

Apparently NC is one of those states that suck in that the article says: "The state has not expanded Medicaid to cover all needy adults."
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OkieGranny Oct 2019
Government has no money of its own nor does it have a magic money tree. Everything anyone gets from government comes from taxpayers, and everything government "pays for" ends up costing more and more and more. There is simply no way to tax people enough to pay for what everyone wants/needs, and every government program comes with a huge bureaucracy to support and billions of dollars in fraud, waste, and abuse.
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Miller trust is free at your bank an elder law attorney gets it started for you. It gets you to Medicaid threshold
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TXGirl82 Oct 2019
The OP has said her attorney said NC doesn't honor Miller Trusts.
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Tiredmomma,

I found the following on the North Carolina Medicaid website. Look at what it says for the “medically needy”, which I assume your mother is. Yes, NC Medicaid will pay for a nursing home for your mother. They require you to pay what you can, then they cover the rest. She will get to keep $30.00 per month for personal needs.

I found this information on my first Google search. Have you contacted Medicaid yet? Please let us know. You sounded so desperate.

Income Limitations – The applicant’s income must be less than the cost of care in the facility at the Medicaid rate of pay. Medicaid must approve the level of care requested and the applicant must use part of their income to pay for care services. North Carolina calls this “patient monthly liability.” If single, but not medically needy, the applicant’s monthly income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than 100% the Federal Poverty Rate. If medically needy, however, Medicaid will pay all long term care costs exceeding the applicant’s countable monthly income. Income that is not considered countable includes a personal needs allowance ($30.00/month per individual); health insurance premiums and medical expenses not covered by insurance or other benefits; certain spousal or dependent family members’ allowance; and a home maintenance allowance if the long term care recipient expects to return home within six months, but there is no one living in the home.
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mstrbill Oct 2019
This is exactly right. I posted the link, but was too lazy to type it out like you did. Thank you for doing that.
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Call an elder-attorney. Start here:


National Academy of Elder Law Attorneys
https://www.naela.org/findlawyer
naela@naela.org
NAELA Council of Advanced Practitioners
1577 Spring Hill Rd., Suite 310
Vienna, VA 22182 
703-942-5711
naela@naela.org

Personal recommendation in Colorado:

M. Carl Glatstein
Glatstein & O'Brien LLP
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Tiredmomma,

I have only read the first few answers, but as your mother has no assets and only $1400 income, she in NO WAY, should NOT qualify for Medicaid Long Term Care. I work in this field, and although it does vary state to state, basically the income limit is approximately $2000 monthly. If she owned a home or a car, that would not count. But as you said, she has no assets. It may be expensive but seeking help for an elder care attorney could help get the process started more quickly. An alternative is to contact the Area Agency on Aging for your area. Google it. Call them .... they will help you file the paperwork for Medicaid LTC. It needs to be filled out very, very correctly.... and is many times difficult to understand to try to do it on your own. It can take a long time to get onboard and in the meantime, if you need to get your mom out sooner, what Alvadeer posted at the beginning is the BEST and "only" way of getting things done RIGHT NOW.

If you won't think of yourself, then do it for your children. You have given of yourself for a very long time. It is now time for you to have the help of LTC so that you can still have a life, and your mother will receive care. Be strong. Do it now, so you can still live.
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disgustedtoo Oct 2019
"...basically the income limit is approximately $2000..."

Not in NC, at least not on their main web page, however the site is geared more for getting insurance - I poked around but could not get any information as to what the LTC max income was - everything points back to the $1,040 listed. The only thing I could find is that they will "evaluate" your. The 2k you refer to is generally the maximum amount of assets you can have each month - mom has NO assets, no house, nothing but pension and SS.

Given that OP has applied and it was denied based on mom's income, it would appear that the $1,040 listed on the page applies for LTC as well?
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Area Agencies on Aging also have contracts with Elder Law attorneys or legal aids under the Older Americans Act. You do not pay for basics to use this service.
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Tiredmomma Oct 2019
I will try. Thank you.
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Your siblings can't refuse when you drop over and faint. Wow. That's far too long to be providing care.
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