My mom was admitted to a NH in September after hospice dropped her services. She was admitted contingent upon being approved for medicaid. Her income between SS and VA aid and attendance is $200 over what is allowed in the state of GA. I sent all the info requested plus set up a QIT for the $200 which is required in GA to help qualify for medicaid. I provided them with checking accounts statements for 3 months and life insurance info.She has no other assets. I was sent a letter from the state that she was denied coverage because I had not provided them with award letters for VA and SS. I did fax those to the NH. Unfortunately,in all the paper work coming in I overlooked the deadline for appealing.My mom is still in the NH but I need to know what can I do to appeal now and who do I contact in the state of Georgia.
Then speak with business office at NH. They will probably be ok for letting this go through the cycle again with mom paying her SOC & some degree of private pay by you. Yiu may need tomsign a contract.The Miller Trust /QIT, hmmm that could be an issue - so all her income is going to miller/QIT starting when? Where does the overage go? She's gonna need that towards her private pay. Speak with the attorney who did the Miller as to how to deal with this.
See if you can find out the exact $ amount your state pays for Medicaid room& board. Like TX is about $155 a day. Will give you an idea of just how short mom is & what you may need to come up with. Mom at $2200 a month has a lot of funds bring paid, some older residents just on SS may just have income of a few hundred, so those may not work for NH but your mom has a good bit of income. Which they are going to get. Which could make them happier.
Now a long shot would be IF mom has something possibly that needs hospitalization - if there is the outside chance that she has something that perhaps could need to be done & she can get a 3 night stay at hospital, then mom gets released from hospital to NH for "rehab". Rehab is a mediCARE benefit. Medicare pays 21 days @ 100% then 80 % for up to 100 days if she is progressing. Not the solution but does buy you some time to get out of this clusterF. Has to be a full hospitalization not under " observation". btw Medicare pays like triple of what Medicaid pays, so everbody happy with rehab placement, Nh gets paid & you get extra time & mom get rehab level care.
Only 3 months documentation, that is amazing. I had 3 years & 6 months of history to provide for my moms application for texas. Over 100 pages. And the annual renewal with about 24-30 pages of documentation. If GA does renewal with supporting documentation required, you want to keep a current file going so this doesn't happen again. Btw renewal had a 14 day submission window and always always the notice was delivered either on the due date or up to 10/14 days after. Never been an issue as I just faxed all as soon as I could. Good luck Just stay atop all this.
But most arent in this situation. For the application, somebody will flat just need to get their awards letters, bank statements, property & insurance info, their IDs and perhaps proof of citizenship. There is no reason why family can't find, go on-line or get these items needed to accompany the application. If your state does an annual renewal, you are going to have to be able to resubmit these again and their updated awards letters & perhaps some banking every year........again & again for her lifetime.
This time of the year (dec-jan) is most excellent for getting items needed for future Medicaid application. Their awards letters are bring sent; tax stuff also so you know what their income was; ditto for dividends; property taxes due. Start finding & organizing their bank statements. if you start now, it's not overwhelming.
I just went around on this one with my local Medicaid case worker. The document that really did it was a letter that my sister received (in person) from her local VA, which stated that once Mom was Medicaid approved, her A&A would drop to $90. This clarified (on their letterhead) that this was not a pension that would continue even with Medicaid.
Once a person is Medicaid approved, it's best to submit notice to the VA of this fact so they can start processing things. Do this in writing. It took nearly a year for them to stop Mom's A&A and they keep putting money in the account thru this period. At the end, they sent a letter stating they'd overpaid and a request for the return of the money. What would've been helpful was had we known there is a form you can fill out, asking that the amount be reduced to $90 per month while it's being processed.
Good luck.
Her mom is over the income limits, that's why she had to do the QIT (Miller trust). It's not a matter is sending letters to elected officials to complain about Medicaid, the problem is she missed doing her moms appeal within the date required.
So either medicaid waives the date and accept the faxed over complete paperwork or she reapplies with a new day 1 application date.
Added to this is that mom was in a NH in 2013 but they took her home as she qualified for hospice. then she became better but in Sept 2014 disqualified for hospice. Caregiving at home just beyond feasibility. Then mom went back into a NH medicaid pending. So mom has a pretty involved file. Now It's 5 months and probably teetering on a payment issue / 30 day notice for the NH as mom admitted as medicaid pending and shes going to be declined due to not doing appeal in time. Getting the deadline waived would be -IMHO - the best situation.
Linda, I thought the VA $90 is viewed as the personal needs allowance is - its the residents $ and not needed for their copay or required SOC to the NH? So like if, this was TX the PNA is $60 plus VA $90, each month they have $140 disposable. They just need to spend it so that they don't ever get above the 2K asset limit for Medicaid. If they let it build in their NH trust account, they just need to spend it & keep it under 2K. Perhaps someone knows the definitive on this?
As for her being over the limit, while that's true and she will have to spend down that money, I believe I addressed that in my post.
:)
AND I still believe an attorney and/or a Medicaid mediator is extremely helpful. It would have prevented this from happening, i.e., she would NOT have missed the deadline with either. And from the very beginning, they would have informed her that her mom had too much money to qualify. They would have shown her how to spend it down to get the most out of what remained.
Also, they have connections with various nursing homes (hate to say this but it's true) that allows their loved one to get into one quicker than would normally be the case.
Yes, a person can do this themselves, but given mom's situation, i.e., too much money to qualify, she could have used that money on the lawyer and/or the mediator. One way to spend down the money.
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