Mom is in a good nursing home an hour away. She was denied Medicaid (monthly income slightly outside their cut off amount) and can only afford her copay for another month or so. She just qualified for hospice which essentially moves her from rehab to a different part of the facility and doubles the cost of room and board. I have resigned myself to bringing her back to my home. The thought of another parent dying in my house is very upsetting but it seems there is no reasonable alternative. Meanwhile, there's been a COVID outbreak in her unit at the NH including her roommate. I haven't seen Mom in three weeks although she continues to test negative. I feel if I keep her there, the chances of her contracting it will be high, so planning to bring her home and quarantine for two weeks. She is no longer mobile so not sure how I'll cope.
"Income Eligibility Rules
A nursing home resident is eligible for Virginia Medicaid long-term care assistance, if the resident’s income is insufficient to pay for the resident’s nursing home care at private payment rates. The nursing home resident must spend down all of his or her income, less certain deductions, by payment to the nursing home. The deductions include a small personal needs allowance (see attached Appendix for the current figure), a deduction for any uncovered medical costs (including medical insurance premiums), and, in the case of a married applicant (“institutionalized spouse”), an allowance he or she may pay to the spouse that continues to live at home (the “community spouse”). The Virginia Medicaid program pays the nursing home the difference between the amounts paid by the resident and the Medicaid contract rate. All income and wages received must be reported, including earned income such as wages, as well as unearned income such as Social Security, interest on savings, retirement pensions, Veteran’s benefits and other public benefits."
Also, you mother can get Medicaid if she's in a nursing home. Does her monthly income come out to more than the nursing home charges for a month? Does she have valuable assets like real estate or retirement accounts? If she has either then no Medicaid will not pay for her because she's able to pay for herself. When her assets are spent-down on her care, then she will get approved for Medicaid and they will start paying and they pay for custodial care.
The Medicaid rules for a person living in a care facility are different from the ones for someone still at home. When a person is in a nursing home their income can be quite high and they still get Medicaid. This is because most people don't have enough monthly income to cover the their nursing home bill. Living at home costs less so Medicaid has different financial requirements.
You mention your mother has a copay. Does this mean she has a long-term care insurance policy for nursing home care?
Regardless of how good your mom's actual care is, the people who run the business end of a nursing home are sneaky, greedy snakes in the grass. You would do well to remember this. They will always try to get a family members to reach into their own pockets to keep the cash pay coming for as long as they can.
Ask the nursing home administration department to give you the name of your mother's Medicaid caseworker if you don't already have it. Your mom has a Medicaid caseworker because the nursing home started her Medicaid application the day she arrived. The caseworker is the person to talk to (not the nursing home) because they will help you sort everything out.
It would pay to appeal the denial, apply again and/or consult an eldercare attorney.
If she needs Skilked Nursing, and if she is paying her entire income to the NH, less a personal needs allowance, I don't see how they can deny her on the basis of income.
When I spoke to an attorney about a Miller trust it was around 3k to set it up, this would have taken a month and a half of my dads only income. For 14.00 monthly.
Some states are very rigid, some have untrained personnel and some are so overwhelmed by the shear numbers that they blow anyone off that doesn't have representation that knows how the system works.
I don't know about Virginia but, AZ has such a high number of relocated retirees and so many immigrants and refugees that the Feds never pay the state back for, that it is a complete mess to deal with them. I know that I said forget that crap, we'll figure something out. That was their intention and I often wonder how frequently it works.
It is a catch 22, need an attorney to help you get public assistance because you have no money! That's a dog chasing it's tail.
I think consulting with the hospice about where mom will be cared for would be important as soon as possible.
And if her family member is in a nursing home that is trying to charge additional room and board...contact the ombudsman! I have heard of this is small care homes and assisted living facilities, but not in skilled nursing homes.
There will be a way.
With upcoming 5.9% increase in SS benefit starting January, going to be a chit ton of folks who will suddenly be ever so slightly over the LTC Medicaid monthly income max. States will have to find a way to make this work and get info as to how to do a Miller, QIT or whatever acronym your state uses.
FWIW how they work is: say mom gets $1567.89 a mo from SSA and mom also gets a separate old pension of $ 789.00. Total of $2,353.00 income per mo. Her LTC Medicaid has income max of $ 2,250.00.
Mom is over the limit by a teeeny tiny $103.00. Fun!
SS $ is considered guaranteed income resource so it’s “Qualified Income” BUT the pension is not as it is investment based so it could go kaput. What Miller does is places just the guaranteed income completely into the trust…. Trust now fully owns SSA benefit and then “pays mom” whatever to make up the difference between the pension $ amount to get mom to the LTC Medicaid max each month and mom “pays” the NH all this less her personal needs allowance. The “payment” is done via direct deposit to the NH. What happens for the excess $ 103 depends on the legalities of your states laws & administrative code…. Some pay the NH the excess $ ea month directly so no build up; other states have the excess $ ea mo. build up in a dedicated bank account and then upon death it becomes an asset of the estate & dealt w via probate or recouped via MERP (estate recovery). Miller / QIT need a state approved partner bank for the $ to run thru. Banks that do ABLE accounts (another type of income resource account for those getting Medicaid benefits) will tend to do a Miller / QIT.
As every year your income from SSA, retirements, pensions can change, so every year the Miller/ QIT changes. That change is why every year Medicaid is going to want to see the “awards letter” for the incoming year to determine the exact copay. It’s not necessarily simple to do the Miller / QIT if there’s $ from sources other than SSA as the atty has to do some sort of research to establish “qualified”, direct deposit amount changes in January, etc. Miller’s seem to run $800-$2K but if it gets your elder fully eligible for LTC Medicaid, it’s $ very well spent.
There’s other incomes that have their own lil specialness to muck up a Medicaid application. My mom had a single annual dividend that for the month paid, would take her over the Medicaid monthly income maximum. Often those with old fully paid up term life insurance policy have this happen. And sometimes those with old old (non fracking) oil & gas royalties also get an annual payment that for that month only take them over the max. For stuff like this, you might can do a notarized statement to show the payment is annual and you do it amortized for the year & so under the income limit for each mo if amortized. The $ becomes an asset (so not a copay to the NH). As long as they kept their assets under 2k every mo, it’s all good.
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