My mother has been in an Alzheimer’s unit in a nursing home for two weeks in Ohio and my father just received notice that the application for Medicaid was denied because their income is too high. His social security check is $1400 and hers is about $600 monthly and he also has a small pension. They have no assets, lease a car, pay rent at an apartment and have $200 in the bank. The nursing home is $7000 monthly. Medicare is paying for 100 days. Is there anyway for him to qualify for Medicaid or another way for him to pay? He is not able to care for her at home anymore? Thanks!
Also, beware the gap in medicare payments at a NH. I think they pay for 1-20 days but then you are responsible for paying a copay for days 21-40. Then they pick it up again at no cost til the 100th day. I would check with the social worker. The copay is like $165/day.
Miller only can involve the Medicaid applicants (mom’s) income. Mom has only $ 600 a mo from her SS. Her income is way way under individuals Medicaid limit (usually around $2100). Her income not an issue. Miller is for placement of overage on income limit. She doesn’t have an overage. No Miller can be done.
The problem is something else. Could be application not accurately filed, something left out, combined income too high, insurance look like it has a cash value....
The pension I’d bet is taking thier combined income for a couple over the couples resource limit for Ohio. Medicaid looks at all resources not just SS.
Leslie, Did dad file for CSRA or MMNA? Community spouse resource allowance, monthly maintenance needs allowance. Think of it as kinda like alimony for the non NH spouse, which is your dad. CSRA if filed for & needed should allow for some of the income to be paid to the NH as the required by Medicaid copay (share of cost) to instead be diverted to the CS to pay their living costs as a community spouse. CSRA isn’t automatic, it has to be filed for and has to be shown to be needed. The shown to be needed seems to revolaround having a mortgage, dependents but could be the CS has extraordinary at home medical expenses, so they need the NH spouses $.
Couples Medicaid is complex. Really they need an elder law atty to shepherd their appeal and also review their overall situation. Medicaid does NOT require the community spouse to themselves become impoverished. But it’s up to the CS to get advice as to how to do that best with their assets and their income. To me that means CELA or NAELA level of atty. find one for your dad ASAP and help him find whatever documentation needed.
Good luck and carefully look at the ineligiblity letter as it should state what the appeals process is. Appeals have very tight timeframes in which they MUST be filed. If not, the decision is upheld. Time is of the essence.....