My mother is in a nursing home with Alzheimer’s and was denied Medicaid. Any suggestions?

Which jives with the way I understand it. Medicaid limits for people that are married are for them as a couple, not individually. The lawyer should be able to solve this for you.

Medicaid is looking at both of their income. His social security check is $1400 and hers is about $600 monthly and he also has a small pension. They said that their income is too high. We are looking for an attorney to help us. Thank you for all of your help!

I agree with needtowash hair, the medicaid income cut off is higher. From the income coming in, I'm not sure their income seems to be the problem. My mom made $5000/month and my dad barely made anything, and he still qualified for medicaid somehow in New Jersey. Review your ineligible letter and maybe a consult with a elder care attorney would be best.

I thought that for couples, medicaid eligibility is based on the couple's income and assets, not just an individual. Since their assets are combined. It can be an advantage since instead of like a $2K limit in cash accounts for an individual being the limit, it can be $100K or more for a couple since the spouse not receiving medicaid would still need money to live on. Also there is no medicaid recovery if there is a surviving spouse. But from what I've seen, they are treated as a couple and not 2 individuals.

Miller Trust imo is NOT the solution. 
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.....

Applying for Medicaid for a single person is not terribly complicated, especially if they have few assets. But for a couple it is not a do-it-yourself project. A lawyer specializing in Elder Law (that is critical) can help your parents set this up in a way most likely to be approved and be to your parents' best advantage. Yes, it will cost to hire a lawyer. But the mistakes you might make on your own could cost you a whole lot more.

Thanks!

LeslieSho, needstowashhair is correct, a Miller trust or otherwise known as Qualified income trust "QIT" can be set up when someone's monthly income exceeds the amount for medicaid. I had a lawyer set up my mom's as I am not good with this but did my homework before going in. Basically the trust accumulates the excess money over medicaid qualification, however when the person passes on, you do not get the trust but medicaid receives what is in the trust to try to recoup money they have laid out over the time frame for your loved one. You can be the trustee on it as you will also have to manage it. I hope some of this helps

Get an eldercare attirney! Yes, a Miller trust, but when there is a community spouse, there are provisions for the spouse at home to not become empoverished. Spend some money on a CERTIFIED eldercare attorney. Worth every penny.

Thanks for your help! I will look into that.

From what I understand she can set up a miller trust to bring her income down in order to qualify for medicaid. A miller trust is a mechanism to pay back the government some of her social security. It's all silly in my opinion. Just a medicaid hoop to jump through.

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.