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Dad is in the long term care section of a skilled nursing facility after several falls. He requires a two person assist for everything. He cannot stand or walk. He is incontinent. He gets $1200 per month in SS. That is his only income. At the private pay rate, the monthly fee is going to be $10K a month. He has $2000 in checking. Medicaid says his income is too high. What are we supposed to do? I can't care for him in my home and I don't have $10K a month. I'm the financial POA. Mom has cognitive issues and probably going to memory care assisted living soon. She has a LTC policy. He does not.

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Did the nursing home help you fill out the application? For my MIL, they were very helpful and guided us. They have a vested interest in getting paid. Does he have investments? Other property? If so, I imagine some of that will be needed for his care.

Good luck. The application process is NOT fun.
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I don't see where Dads income and assets, if 2k is all he has, is causing the problem. Did you or the NH fill out the application? If the NH that maybe your problem. There is certain criteria that has to be met within a certain time frame. In my State its 90days. If you don't supply all info needed and spend down assets in that time, you start all over.

Five years ago I made an appt with a Medicaid caseworker. He filled out the application on the computer. I supplied what info I brought. He gave me a list of other things I had to supply. Mom paid privately for 2 months giving me time to do what Medicaid needed. I sent everything thru email and caseworker confirmed receipt. In June I contacted the caseworker confirming he had all the paperwork needed and Medicaid started July 1st. You need to be on top of the process.

Are Mom and Dad married? If so, its not just Dads income that maybe considered but Moms too. She has to claim Community Spouse and have assets split. Was she considered in the application. You can appeal the findings but you need to find out why Dad was turned down. Were they supplied all info requested? If the NH filled out the application, ask them for a copies of the application and correspondence received from Medicaid. This will show you the Medicaid caseworker. Call them. It maybe be you didn't supply one piece of paper. I learned a long time ago not to depend on someone else to do their job.

My grandson was on short-term disability and was turned down for benefits because they say a form was not returned. I appealed the findings and sent everything that had been sent by them and returned. From then on, I sent everything certified mail. That form was probably sitting on someone's desk to be entered in the system and wasn't done before the cutoff date. And because of that, my grandson was not paid for months.
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Medicaid won't pay for SNF. They will only pay for a nursing home.
Are you certain he was denied for having too much income when his entire income is 1,200 and he has no savings?
You need an expert now on applying for medicaid in that case. I think there is something here missing. Perhaps a second home? Perhaps some other income?
See an elder law attorney.
Dad's SS will go entirely to the Nursing Home in all likelihood with a small monthly allowance for personal items.
Do know that medicaid almost certainly won't cover SNF in my opinion for any length of time.
Do get expert advise. Without access to your denial letters we cannot know the reasoning here. It should be stated; and after doing the applications already I know you will understand contact info for them.
Best of luck to you. I wish I knew more about what expert could help you with application, but I think an elder law off ice WOULD know.
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mstrbill Feb 2022
I think OP is in North Carolina. North Carolina has unique rules/qualifications/procedures for LTC Medicaid as I remember looking it up for another poster a while back. Basically it revolves around medical need. If the person is in medical need of a nursing home, Medicaid will cover the balance of the monthly bill after the resident's funds have been exhausted. In the case here, it would seem OP's father would certainly qualify for at need, being a 2 person assist.
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Were you actually denied after application? If you asked about the income limits and they told you his is too high, that may be the standard answer for someone living at home. For nursing home care, the level is usually a good bit higher, depending upon the state. My advice would be to 1.) Find your Area Agency on Aging for your county and make a phone call, asking your questions and 2.) Speak with the case manager at the facility. You don’t have to figure this out alone.
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You refuse to let the facility release him to your home. Call state elder protective services and let them know your father is a vulnerable adult and you are not able to safely provide any care. He will qualify for ltc Medicaid when the cost of his care exceeds his income. Medicaid will pay the difference. Don’t pay for an attorney out of your money in this case, there is no need. Get the state involved they will figure it out.

Also, make sure you don't sign anything at the facility stating you are the one financially responsible.
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medicare attorney is needed to help you get him approved. But it’s very very expensive. Like $15,000. However I did the legwork needed and so it ended up costing 2500. But without her, it never would have happened. I used my mothers SS to pay for it since I am her POA. Once approved all NH payments will go back retroactive so don’t pay for anything until it goes through. Also that goes for any outside medical bills. They will ultimately get paid from date of first application as well.
my mother was initially denied as well for not having all needed paperwork. You must have every single blessed required item. You can get a list of those needed items. And you must have those items as proof including all those bank statements for past 5 years. Your attorney will walk you through all this.
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See a certified elder attorney well acquainted with Medicaid to help him get approved. Ask the NH if they have worked with one in the area. Are your parents married? It can make a difference.
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Does he have alot of assets? I'm not very knowledgeable about Medicaid and qualifying for it, etc., but his income does seem like it is low enough that he would be eligible. As the other poster stated, your best bet would be to talk to a Medicaid planner in your state. Here is something I came across while trying to check into the issue: https://www.medicaidplanningassistance.org/medicaid-eligibility-north-carolina/
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I would consult with a Medicaid Planner for your state since rules can vary depending on where you live.
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