OmgWhatNow Asked February 2014
If Medicaid is denied what should I do?
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How does one afford a nursing home? Nobody can take care of grandma forever.
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If she has given away everything recently in a poorly-conceived plan to 'hide' it from the government, then she will probably still qualify for Medicaid, but there will be a period where she is expected to pay her own way with the money and assets she gave away (either by getting them back or coming up with money another way). That period of time depends upon how much she gave away.
You have to get all these documents together in order for the Medicaid caseworker to evaluate their financial status to qualify for Medicaid. The NH reviews it too - as they need to look at it to see if they think there will be a problem for "Medicaid Pending" (not all facility do Medicaid Pending even if they take Medicaid so you need to make sure the ones you look at do).
Also although the whole financial $$ issues are what most fixate on, mom / gran will also have to medically qualify for Medicaid for NH. She will need to show the need for "skilled nursing services". So think if she is at that point. Just because they are old or have dementia, those in & of themselves are not enough for NH placement. They need to require "skilled nursing services" for Medicaid. So speak with their current MD to see if they will do a letter on this - this can often be an unexpected issue for those who are in their home and move to a NH. Most NH admissions come from a hospital discharge (the usual story is that they had a fall, were hospitalized for 3 or more days and now are discharged to a NH for "rehab" and all these costs are MediCARE paid), so for those there is a fat medical file to justify the need for skilled nursing. When they are @ home, that tends not to exist so you may find you have to take a few months to create the file for this. My mom was in IL (private pay) and moved from IL to a NH (Medicaid pending). She totally bypassed the AL stage (private pay). It meant seeing her gerontologist who also was a medical director of a NH and doing visits every 4 to 6 weeks with testing done. The day she was a 10% weight loss and a bad H & H and a couple of other things, he wrote the order for skilled nursing care needed. So she had the fat medical file needed for Medicaid. Had I just moved her from IL to NH without all this, she would have been denied as it was not medically necessary.
So start gathering up & finding her documents to show she is impoverished at whatever level Medicaid requires in your state and speak with her doc. Good luck.
TP will be a # of days situation. A state that pays a high R&B rate - like many on the east coast - will have a shorter penalty oeriod. Keep in mind that Facility will get ineligibility letter as well as the elder and the elders point person. You or other family will be asked and expected to pay during the TP days.
Now you can appeal the ineligibility & during the appeal they continue to be consider medicaid pending at the NH. You want to file an appeal, comprende? The blue book value is somewhat subjective & can be lowered with supporting documents. Like if there are photos to show damage to car; a litany of repair bills that show car has serious problems, it's on a recall list, the penny saver has almostnidentical cars selling for less than value, etc. It will be up to you to get any documentation found, organized and sent for getting an appeal. Getting car value reduced if it's an older car should be pretty easy to do if you provide the documents to the caseworker.
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