Title 19 re-determination, and nursing home involvement thereof.

Jay - yeah Medicaid renewal is a mice-maze. My mom's documentation runs between 25 - 30 pages depending on how the state questionnaire has changed. For even more fun, her renewal letter is mailed out anywhere from 2 - 7 days after the date it was issued by the state and all the required documents have to be submitted within 14 days from the date of the letter except for 1 item that is due 21 days. So it is always right past the due date or the date of when I fax & register letter it back to TXDAD's (I do both as I am OCD but also have had issues with the whole "we never got" scenario). I have a binder that gets the changes every year items I know they are going to want (annual determination letters from SS and retirement and life insurance statement,her tax assessor valuation); copies of the stuff they get year after year (POA, burial policies, etc) that don't change; so all I have to scurry to get is the banking for the last 4 months based on when I get the renewal letter.

Here's my suggestion: take all the documents they want and go over to a Kinko's / Fed EX office and make copies of everything and the annual form they want returned to them. Then fax it all over (aka "document dump"). You will get a nice & legal fax transmission report. Copy that and mail it with a short letter stating that as per their request you have faxed over all items for annual Medicaid compliance. You send the letter to the state program registered mail & with the return registered receipt (the green postcard at the USPO). This runs maybe $ 8.00. Then about 10 days later you get the signed off card in your mailbox. You have done what is required and have proof of it.

What I've found in dealing with Medicaid or any large governmental that requires financial documentation for qualification (we went through Hurricane Katrina and so I dealt with FEMA, SBA plus insurance co) is that sending in items piecemeal puts you on the Battan death march for approval as each time your file has to be opened and therefore each time stuff gets lost or moved or goes to a mystery zone. For the document dump, well the caseworker have like 8 minutes to do an evaluation and really it likely is all in there within the couple of dz pages so they go through the pages & put it in the approved box & move on to the next person.

Eyeirish is spot-on about the POA. You really need to do it for your parent otherwise they will become a ward of the state and you do not have to ever be consulted on anything on your mom at all. I saw it happen at my mom's NH#1 and it was tragic for all.

About your friends who have parents who their NH seem to "do everything". If their elder really only has a SS check and they have a fully done funeral & burial prepaid NCV, then I can see the NH becoming the POA for the resident. NH gets the check each month, NH "spends" her personal needs allowance by having mom go to the NH beauty shop twice a month to get it to zero each month and then when mom dies they call the FH and then they are totally done with mom. Family doesn't need to ever do anything or ever visit. If mom runs out of socks or could use a better shampoo than the NH has in the dispenser, well just too bad.
Just not pretty and so very sad. I know you don't want that so it's good you are POA. It will work out.

One thing I will tell you about call centers is to avoid peak traffic times, like Monday mornings. Call midweek (Wed/Thu) and usually 4-5 PM is off-peak for most call centers. Why? between 4-5 people are driving home, picking up kids or making dinner.

Igloo has good advice about record keeping. I'm sure all the states are behind in processing medical eligibility paperwork with expanded Medicaid and Obamacare health insurance exchanges. When the paperwork gets approved it's retroactive and things just keep rolling on. You'll have to do this every year, so just be organized and get used to it. It won't hurt you to do this.

The frustration with "the system" is all over the place. Having been on the inside of it in the not too distant past, I can tell you what worked in NV. Take the day off from work and plan to stay the whole day in the office until it's your turn to be seen. Bring everything you previously submitted, and a decent attitude. The worker will tell you how backlogged they are and your case will eventually be processed. Management wants the office traffic cut down so there are fewer angry people in the lobby and spilling out into the parking lot. If you get no where with the worker except platitudes....do not leave. Keep sitting and politely demand to talk to the supervisor. They will gladly be relieved of you to get back to the stacks of paperwork on the desk or more likely surrounding them in piles all over the floor by their desk. The supervisor will be irritated enough to have been interrupted from cracking the whip to tell the worker to move that case up to the top and get it done so you aren't back. Should work. But really, they are going as fast as they can. They are usually in the job because they want to help people. Demand just outstrips resources. Workers often skip breaks and take only half their lunch to keep working. Try to give them a break, but work the system so YOUR case gets done. Also, timing helps. Many places works the incoming cases and renewals in date received order. If you get your renewal notice with however many days to reply, get your paperwork there ASAP. First in, first out, except for those cases they are told to finish up to get rid if you. If you go to welfare office don't go on the first few days of the month. The places are overrunning with upset clients who just realized that they didn't get their check, food stamps or medical coverage on the first as expected (because the paperwork is so jammed up ). There's nothing a worker likes better than to sit across from you at the beginning if the month apologizing all day instead if being at the desk pushing that work during lunch.

Even if you weren't POA, as your mom's son and closest family member, you'd still probably have this responsibility.

When my dad was in a nursing home the social worker went through everything I'd need to apply for Medicaid. It was my responsibility to gather the documents and make sure they made it to Medicaid but she didn't do it for me. My dad didn't live long enough to have to requalify but I imagine I would have faced the same situation with the social worker being available for any questions I may have but the responsibility being on me.

You did the right thing in becoming POA. Had you not your mom might have been declared a ward of the state and assigned a guardian (probably an attorney) and you would have no say so.

In my opinion, the nursing home/Medicaid/advocacy responsibilities that come with having a parent in skilled care are outrageous and practically impossible for one person to deal with. I found myself like a hamster on a wheel more than once, not knowing how to navigate this system or that system. The stress was unbelievable as you're discovering. Seek out the social worker, ask her to go through your papers to see if you're missing anything. Keep going back to her with any questions. I was in constant contact with the social worker at my dad's nursing home. How wonderful it would be to have someone do that stuff for you! Had my dad's NH offered to do that stuff for me that would have saved my sanity as well.

Good luck.

I guess what I'm mostly frustrated about is dealing with the state. I know DSS is overloaded with people applying and the resulting paperwork. But to call them and wait on hold for over 2 1/2 hours....3 separate times! (after which a recording tells me I had more than a 60 min wait to talk to a rep)...and still not be able to talk to a person is absurd. I just thought the financial professionals at nursing homes would be able to help somehow, at least with communication to DSS.

When Mom first went in the nursing home, I had a case worker at DSS that I could call. But that system seems to have changed here in Connecticut as all Long Term Care benefits are now handled through a different (centralized) office. And there is only the 1-800 number now to *TRY* to get info.

Thank you all for your responses.