When should I apply for Medicaid?

Please note: this is more of a vent with a little advice thrown in at the end:

I can only give you my experience in applying for Medicaid for my mom in Iowa. My dad is still living and they are both in their home. The DHS needed all kinds of paperwork and they needed EXACTLY the right kind of paperwork. Right now, I am on my fourth try...the first time, DHS contacted my mom (who has dementia) and she said she didn't need any services. The second time, Mom was denied because they wanted a certain paper (no, not the assessed value of the house, the MARKET VALUE of the house; no, not a yearly IPERS statement, a monthly IPERS statement--apparently they can't divide by 12) within 14 days and it took about 3 days longer to get it. The third time, they said my mom was over the $2000 limit. When I called to find out how she could be over the limit, the DHS didn't know my dad was still living, and having a community spouse makes a big difference. I don't how they couldn't know that my dad was still living...it's right there on the application. This time, they are fussing over an annuity in my dad's name because even though we have given them papers showing the amount of the annuity ($6,538), they want a paper showing the payment options. I filed an appeal, because they keep coming back asking for new information, instead of telling us up front exactly what type of documentation they want. Last week, the insurance agent sent me a copy of a fax from the insurance agent showing the total amount of my dad's annuity. I sent that on to the DHS agent, but Friday, she sent me an e-mail saying she needed to talk to the insurance agent to ensure that the amount is current. The date is on the letter which came straight from the annuity company which I forwarded to her, it was October 8th. How could that not be current enough!

I work Monday through Friday from 7:30-5:00, exactly the hours the DHS office is open, even if I were able to reach the case manager on the phone rather than playing phone tag. I am now using e-mail, but she sent me a secure e-mail through the state of Iowa which I could not get open. I called the Help Desk, but they could not get it open either. There went another 5 days...

Last Thursday, I was told through e-mail to get my parents' bank statements for October 1st and to re-apply for my mom. I received those statements and forwarded them on Friday. I am re-applying today. I'll let you know how it goes.

Anyway, that's a long scary story about dealing with the government. Maybe your situation will be totally different. I know I'm not really answering your question, but I do know your dad won't be approved until the money is spent down. I would contact the Medicaid people in your area and try to get a list of exactly what information they will need (there's always that 5 year lookback period to worry about) and start collecting the information. I got to the place where I looked up the Legal Aid Hotline for Elder Care, because my next step was to call them. I did try to call them once at 4:30 in the afternoon, but of course, they were closed. BEST OF LUCK!

My father was in a nursing home in New Mexico. He had been in the hospital for 3 months, then into rehab, then into a skilled nursing facility. After being in the skilled nursing facility for 3 months we were told that they would have to send him home because his Medicare only covered 100 days in a nursing home. He wasn’t in a well enough state to go home and we didn’t have the money to pay for his care at home. It was recommended to me that we file for Medicaid.
I consulted a Medicaid attorney in the state of New Mexico and was given some excellent information. What they would look for and what to do about any assets they may have. They were allowed the home, one car (they had three and we gifted the other two to a niece, they weren’t worth anything). We did other things to make sure that my father’s assets were less than the $2000 in his checking account. My mother is living and she was allowed a certain level of money. The attorney really helped.
In the nursing home, my father was not discharged because the management knew that I was filing for Medicaid coverage for him. At the time I was told that he would receive payments, retroactive back 3 months once he was qualified for Medicaid.
I went in and got the appropriate paperwork and filed it with Medicaid. I was living in California and drove the 11 hours to their home once a month and was able to take care of the paperwork then. The important thing is to make sure that you develop a friendly repoire with the person you are dealing with. I was able to take care of the filing and getting my father qualified and Medicaid paid for his care 3 months back.
Medicaid does not cover the full cost of the nursing home, or it didn’t for my father. We ended up paying $700/month in addition to them taking his social security check.
Consulting an attorney who deals with Medicaid filing is the best advice I can give to you. It cost me about $200 for a phone consult with her and she mailed me lots of information that was helpful.

TimC - what you are reading all points up the maddening maze that is Medicaid. Medicaid is a joint federal & state program.....each state manages or administers it's Medicaid program according to their own rules and state law situation but within the overall federal guidelines for the Medicaid program. So what works in TX may or may not be valid for how it runs in Vermont. This is going to be long.........

I've dealt with Medicaid in both TX & LA and have been executrix for estate in TX that had assets in TX, NM & LA. State laws make a big difference in all this and it can be simple to understand but that I've found is a rarity. Your mom has $$ till spring, and I would NOT apply till she is right about impoverished for Medicaid, so maybe in February, 2014. BUt there are things you should be doing now.....

My suggestion is first & foremost is to go onto your state's (VT) website for Medicaid program. There should be a listing of what your state has as it's ceiling for the Medicaid applicant's assets & income. These are the 2 categories that must be met in order for her to qualify. You need to find & ferret out all the documents needed to provide to the state in detail your mom's "assets" & her "income". This could be quite a few items, my mom's application was slightly over 100 pages. So get a binder and get yourself organized and get yourself a case of scotch or whatever to keep your sense of humor (you will need it). I'm assuming that mom is a widow and currently living in a NH, so she will already have passed the medical necessity evaluation for needing skilled nursing aka a NH. My answer is based on her being a widow (no community spouse issues).

Income is easy...that will be whatever she gets each month, like her SS and retirement. Income ceiling is set by the state, like for TX it is $ 2,094.00. If mom is over the income limit, there are things you can do to get her within the limit. (The most commonly done technique is a MILLER TRUST, so if you find mom is over your state's income ceiling, post a ? and I'll go into what Miller does for this). You need to find out what the limit is for Vermont. Now SS sends out a statement each January and most retirement programs do the same. These are VERY IMPORTANT. The SS one is a lightweight trifold document (not in an envelope), when she gets this in January you want to put this in your binder. Ditto for her retirement statement. All this gets sent in January for tax purposes. If mom is getting her mail addressed to her at the NH, I would suggest that you change that either to your address or go an rent a p. o. box at a storefront parcel & ship type of store. Many UPS stores do this, also many independents ones by college campuses. There is going to be alot of paperwork that will need to be responded to in a short time frame and stuff going to her at the NH will get lost, confused....

Now on her SS, if she is not getting this direct deposit, you want to have that happen and into her bank account. If mom has any bank accounts that are commingled, you need to close those out. Mom needs to have her checking account so that it is hers and hers alone (you can be a signer on the account and you or whomever is her executrix can be the POD on the account) Personally if this is the case, I think you need to see an elder care attorney as a joint account is fraught with transfer penalty issues for Medicaid review. Start finding all of her bank statements for the past 3 years. You may need them for Medicaid, or you may not but if you do, they will be needed to be sent in like a couple of days. So you want to just be prepared for all this. Now it is my belief that the caseworkers look for a pattern of spending in approving the application. If you mom has been in a NH for a while, then where her money has been going is easily documented and she probably won't have an issue on that. Its the one who have been living at home or with family, that are more suspect in doing ineligible transfer of funds. My mom was in IL before going into NH (bypassed AL totally) and she still has her home, so her money was clearly documented as to where it was going and being depleted. Now I did have to provide a detailed accounting of where every bank account, CD or other financial asset that was closed the 3 years prior went. Fortunately, as a CD's, T bills, etc expired, they went into my mom drawing account. But still it took the better part of a morning with a bank officer to go over my mom's items and have them do a detailed letter as to this on bank letterhead. I was not charged for this, but some banks will not do this readily or for free. All in all, it was a 3 year & 6 month banking review for my mom.

For assets, those will be any insurance policies, funeral or burial policies or contracts, savings, or any investment accounts or anything she may own that has a value. Home, land, autos or other property too. Now all this is tied into her SS # and is reported, so don't try to get cute and leave stuff off the application. It will surface eventually and be an issue. For my mom, they wanted front & back of each page of her insurance policies too. Loads of fun coping all this too.....

If her insurance policies has a cash value, that will need to be spent-down before Medicaid will pay for her. So find her policies to see what's what. If she has a whole life policy, there will be a cash value. Cashing it out will take some time and you want to start this now by contacting the insurance company to find out what they require to do all this. The good thing about doing this now & before she applies, is that the $ can be spend however you wish on things for her or her care. So if mom needs dental work (totally not there under Medicaid), then she can spend-down that way. For my mom, it was thousands in dental work and well worth it. If mom does not have a prepaid no cash value funeral or burial policy done, then I would have her money pay for that now too. The FH will know how to do the funeral & burial policy so that it is "no cash value" and OK for Medicaid. If she has an old funeral policy, check it out to make sure it is NCV or if it's got a value then go to the FH to get it changed to an NCV. Eyeglasses, hearing aids, walkers are all pretty crappy under Medicaid, so those are good to get for her now with her money. Also you should spend some of her money to have all her legal updated....like go over the will and if things need a codicil done (like someone named in the will has died), go ahead and do that and use her $ to pay for this. I'm assuming you already have DPOA, MPOA but if you don't then this too needs to be done and paid for. If the NH charges for extra items, you can look to prepay for some of that too.

If mom has sold or transferred any assets in 5 years prior, you should have the documents on all that. So if she sold her home 3 years ago, you want to have a copy of the act of sale. Ditto for auto's too. The caseworker may or may not ask for it but you want to be at the ready for it. All this stuff is recorded by the local assessor and then dovetailed into the state system, so it will show up eventually.
If you don't have the documents or can't find them, most county assessor site have it so that you can for a small fee get a copy of all documents on land & house sales. You may not need it but if the caseworker asks for it, you don;t have time to waste in getting this.

Also they may ask for her birth certificate or other document to establish citizenship. It depends on the state just how much detail is needed for the Medicaid application.

Now once mom is on Medicaid, don't get rid of all this BECAUSE your state may have an recertification or renewal program. TX does and every year about 1 year and 6 week to the date of mom being on Medicaid, I get a 8 page form that has to be submitted along with the current month and 3 prior months of bank statements and other income documentation to recertify her for Medicaid. Any it has to be submitted within 14 days of the date of the letter. For even more fun, the letter arrives either on the due date or 2 maybe 3 days before it is due. So really, keep that binder going on......

Yes it is a total PIA but everyday I am so grateful that Medicaid & Medicare is out there and available. Good luck, get organized and keep a sense of humor.

Be so careful, where I live they put a lein on their assets and when they pass away they collect! My Mom was over by $25 a month so we couldnt get anything. I am keeping Mom with me anyway but diapers and pills, heat, etc, all add up and her ss isnt that much. I also use that to give me respite and hired a cna. Good Luck

Reverseroles - so mom is $ 25.00 a month over the income limit? Depending on what type of income your mom gets, she might be able to do a Miller trust to get her income under the Medicaid limit.

How Miller works is that if they have income from a guaranteed source like SS or most retirement programs, their income goes to the trust and then the trust pays them. Say mom has $ 1,200 a month from SS, and then has a federal retirement of $ 1,200.00 a month from her dead spouse. Mom gets $ 2,400 a month and there is no way for her to ever get less. Income is guaranteed. So a Miller trust is done in which the trust is the recipienet of the income and mom gets from the trust each month whatever is the amount allowed under your state's medicaid program. This amount is mom's required co-pay to the NH for her share of the Medicaid program. So if mom lives in TX, the Medicaid income limit is $ 2,094.00 so each month the Miller trust increases by the $ 306.00 that she is over. Upon her death, all the funds in Miller revert to the state to reimburse the state for it;s payments for her Medicaid. But mom qualifies for Medicaid. Miller is not a DIY project and you need a good elder care attorney to do it for you all, but really if she needs a NH and can qualify for Medicaid by Miller you should look into seeing if it can work for her.

As far as the lien on their assets, all state are required to have in place a MERP program (Medicaid estate recovery policy). But all states are required to have all sorts of exemptions to MERP which family or other interested party can file for. But it is up to them to do the documentation and apply for the exemptions. State laws on death and probate make a huge difference in whether MERP can be done as a claim or as a lein on assets of the estate too.