Mother in nursing home is getting set up for Medicaid. What do I do when it is denied?

Welcome, Caregiver00.

How is the NH currently being paid? Is she currently there for rehab after a hospital stay?

Medicare pays for rehab; I'm going to assume that's who is paying now.

Is the Social Worker saying that for mother to go home to live alone would be unsafe? Can your mother afford full time in home care?

Most states have ways for patients who are MEDICALLY in need of NH-level care who cannot afford to private pay to qualify for LTC Medicaid. There are Miller Trusts, spend down plans and deduction of medical expenses from income.

Have you looked into that, or talked to a Medicaid Planner or Elder Law attorney?

She needs to pay down her money in her bank account towards her care. Then she will qualify for long term care Medicaid. The SW should know how to proceed. The SW won't allow her to come home likely because it is an unsafe environment for her. Are you dependent on her income to stay in your home?

She pays for medicaid until that amount necessary for spend down is gone. Varys state to state. In California you can now keep ,ore than 100,000 of your own funds and still qualify.
If this is a matter of INCOME being too large, then that entire income will go to pay for her care, and medicaid will cover costs over and above it.
You say she wants to come home. She needs care. If there is no one to care for her in her home she cannot go to her home.
You mention a Social Worker. She is the one who can answer these questions for you as she is the one who knows your Mom's case.
And yes, the SS money will go directly to the nursing home in most instances.

I can't see your previous posts so have no idea why Mom is where she is. Can u give us some info on what led up to Mom being where she is?

What reason are you being given why Mom cannot return to her home.? Is she now 24/7 care? Is no one willing to care for her in her home or theirs? If she comes home, will you all be set up for the type of care she will need? Are they saying "unsafe discharge".

You mention Medicaid for Long-term care and Community. Is the facility saying Mom needs to stay passed the 100 days allowed? Because I can't understand why the need for Community care if she is being placed in LTC permanently? And Community Care you may not get the hours you need. There is no 24/7 care. Family needs to be involved.

If she has been there the 100 allowed with no progress, and you are willing to take care of her in her home, I see no problem in her going home. Usually SWs push family to take care of their own.

Yes, Moms 20k will need to be spent down before Medicaid will except her. In my State of NJ, you have 90 days from the date you apply to spend down any assets, give them info needed and find a place. If not done in 90days you start all over. I started my Moms application in April. She had 20k, I placed her May 1st and she paid May and June which spent her down. June I confirmed the spend down and that the caseworker had all his info, Medicaid started July 1st. If this is a permanent or long term situation, Moms 20k will need to be used for her care either way. Thats how you spend it down. Her monthly income needs to be under the income cap, my State its $2523. If Mom pays for her care with the 20k, no need to pay with her SS.

Really need more info in why Mom is being asked to apply for any type of Medicaid.

Can NH force her to stay? Probably not. But can you and the rest of her family provide the level of care needed and with 24/7 oversight in her home?
How did she end up in this NH? What is her needs assessment like?
Is there a POA? What was her living situation before all this?

I think you are overwhelmed & rightfully so.

Medicaid is a huge HUGE program & it’s confusing. Hang with me on this…
How NH LTC Medicaid room & board costs are paid by your State Medicaid is by dedicated (required) funding by federal government with a % share by your state. HOWEVER state can file for “waivers” to shift some dedicated NH $ to go to fund programs for the same demographic. Often community based Medicaid programs will be funded via waivers and the income & asset requirements for community based programs are NOT as tight as those for NH because as they are “community” they still are not yet considered fully 100% custodial care so in theory spend income & assets to live. If your mom somehow is in a waiver program, she might be ok on that 20K assets. I’d suggest that you try to ASAP make sure that you’re doing appropriate application for mom and submitting right documents for right application….. asap speak with SW so that SW clearly knows mom has 20K in assets showing end of month balance in her bank statement before you turn in moms Medicaid application. Income is $ paid by Social Security or retirement each mo.

In general, Community based Medicaid usually is IHHS/ In Home Care. Like if mom were to go back home & you and other family were living there, she might be able to have IHHS have a paid by the State care come over 2 or 3 times a week for 3-5 hrs OR mom goes to a PACE center 2-3 days a week. But family needs to be there all the rest of the time & unpaid.

Some states have MC / Memory Care under waivers. A few states have AL coverage under waivers. PACE centers are partially using Medicaid waivers. Again Medicaid is a huge program. Each has a slightly different approach and application. LTC Medicaid NH is not a waiver program, it’s requires them to do a copay of basically almost all income to the NH as now a full time resident in the NH; so if your mom still has a home, she will have zero $ anymore to ever pay costs on her home that exists still in her name which Medicaid allows her to keep as a exempt asset for her lifetime.

Maybe SW made an error. I think SW tend to look at elders SS income & if low, assume no assets. Abt 70% in a NH are on Medicaid so you can see why they think most will qualify. Often automatically SW give family LTC Medicaid application to file. My MIL 1st NH gave all admissions a LTC Medicaid application packet as a matter of course along w/list of documents to attach to it. Hubs dutifully filled it out; caseworker looked it over, handed it all back to him and said don’t even call me till you have a bank statement under $1800. Caseworker was not even starting a file; was a waste of his time till then. Props to him! MiL was there via hip break post hospitalization rehab so NH was getting Medicare payments till that ended. I mention this because if your mom is in this NH after being hospitalized, she is most likely there on a MediCARE post hospitalization rehabilitation benefit... MediCARE is paying for her stay & MediCARE pays significantly more…. so NH is happy… that SW is being proactive as they know Medicare benefits will stop usually abt 21 days… so SW getting ahead by doing this now & assume mom will be eligible.

If you live with mom & it’s her income that keeps your household afloat. It may be that you & the family have to figure out in-home care for her to the best of your abilities & bring her home & flat do it. If so, try to get her in a community based Medicaid program as she can keep her income & assets. Look if she can be on Medicare hospice benefit too. Good luck!

This is ur reply to my post

"the 20000 is included in her social security check. she hasn't touched it. they are getting a burial plot for 6000 to start spend down. i can't use her ss account for bills but the finance person said i can up until 6 months then they garnish her social security check."

You need to give us more info on her situation. I do not understand "the 20,000 is in her SS Check" If your Mom has any money over and above her monthly SS, that is an asset and needs to be used for her care. Here is what I believe is going on.

Mom was placed in Rehab. She has either reached her 100 days allowed or is not making progress so Medicare is stopping payment and Rehab is releasing her. But, Rehab feels that its an "unsafe discharge" because she is considered 24/7 care. For her to go home, Mom needs to prove she will have someone with her 24/7 to care for her. Also, she will have the right equipment for her care.

If Mom can't prove she will get 24/7 care, then she will be transferred to Long-term care. That 20k Mom has should be used to pay the NH to spend it down as I explained in my first reply. I used my Moms SS to pay for her house until Medicaid took over and then her SS and pension went towards her care. Yes, from then on I was responsible for Moms utilities. There was no Mortgage. Taxes I let go, they were paid at time settlement when I sold the house.

The SS law does not allow garnishments. If I were you I would make an appt with a Medicaid caseworker to make sure the info you are receiving is correct.

For now, though, the Rehab cannot place Mom in LTC if she can prove the care she needs can be done in her home 24/7. That means proving that someone will be there 24/7. That she will have easy access to a bathroom that has been made handicapped accessible. That if a family member can't be there 24/7, then aides are hired. This is where Community Medicaid comes in but again, that 20k will need to be used to pay for the aides then u apply before it runs out.

Talk to the SW and find out what you need to do to get Mom home. But, you nor anyone have to take on this responsibility. If you think Mom would get better care in a Long-term facility then place her. That 20k will give you time for the Medicaid to kick in. As soon as Medicaid starts then her SS and any pension will need to go to the NH. Again, using the 20k for care in LTC is her spend down.

Yes, this is all very confusing. Do u know someone who has gone thru this? Maybe they can go with you and speak with the SW. 4 ears are better than 2. Also, if you are able to do what needs to be done for Mom and SW still says she will not allow a discharge, call your State Ombudsman or even Adult Protection services. I would even set up Home Hospice if it meant bringing Mom home. But that too is 24/7 care for family. You can always cancel it once u get Mom home if really not needed. NO. Rehabs are not prisons.