Mom in nursing home on Medicaid -her assets exceeded limit for one month. Will renewal be denied?

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D

daughterTX Asked April 2019

Mom in nursing home on Medicaid -her assets exceeded limit for one month. Will renewal be denied?

Arrgh, I had to send in my mom's bank statements for her Medicaid renewal, and I realized that I accidentally let her assets exceed the $2000 limit at the end of one month, several months ago. I've been told that the end of the month is the key date - that at the end of every month, balance must be under $2000. One month it wasn't. Does anyone know the effect of this? If she lost benefits for one month I could pay the nursing home bill for a month, but I can't pay it every month. Will they just dock us the month, or cancel everything and make us start over? So frustrated and anxious.

Asset Limits Medicaid Paying for Care

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score 0 · Answer 1

Happened to my mother once when she was in the hospital and the NH charges were down; she was only slightly over the limit, but my brother went out and spent like mad because the social worker told him there would be a problem. As a result, she ended up with nothing because the next month she was back in the NH and the balance was way down - but thanks to the social worker and my brother she was also broke. The social worker later apologized amd said she should have realized it would be under as soon as the NH bill was paid. I wish he'd have asked me how to go about taking care of the non-issue.

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score 0 · Answer 2

Not at nursing home yet. So no one to ask.

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score 2 · Answer 3

No need to worry. You have to spend down the amount by the end of the current month, if you do this it will not affect her Medicaid status.

When I was an Ombudsman Director we had a facility who took their residents to a Casino for an activity. One of the residents who was on Medicaid won $5000 and they were terrified that that would disqualify her for Medicaid! However, we let the family know to end down any assets over the $2000 by the end of the month and it would not affect her Medicaid status.

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This cannot be legal! That gambling money should have to go to the government for program costs, not as a spend down. As I understand it, the spend down is BEFORE you qualify for Medicaid, not after. Any assets gained AFTER the initial spend down cannot stay with the person but must be given up to the county running the Medicaid program. Any month there is a change, I report it to the Medicaid office and they adjust from that.

(3)

score 2 · Answer 4

You would do yourself a favor by seeking out the answer from an elder law attorney.

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score 0 · Answer 5

Sounds sticky & been on your heart & mind too long.
Check your mother's medicaid application & paperwork.
I'm not certain if you are required or responsible to report it because DHS doesn't monitor your mother's bank account. If you find out or not, check with the nursing home director or administrator explaining the situation.

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score 0 · Answer 6

Consult with the Nursing facility Social Worker so you Both are on the Same page.xx

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This is good!

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score 1 · Answer 7

Usually the DHS will do redetermination of eligibility once a year. I would spend the excess on something of daily living needs; clothes, shoes, etc.

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Yep, keep her funds under $2k.
Good point.

(1)

score 1 · Answer 8

Also be aware that any personal funds kept in the facility for your loved one (for their own miscellaneous expenses, etc) also counts toward their monthly limit, not just what is in the bank.
All the best!

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Yep.
I have mother's AL accounting do autodraft from her account for her share & the rest spend on her personal items.

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score 2 · Answer 9

Before spending money on an attorney, as someone who once did this as a job, contact your mom's Financial Worker or Supervisor if they pool cases in your state, and explain. This happens every now and again, and what they used to allow was to "spend down" the excess by getting her a color TV, etc. If you do this within 30 days, they should be able to re-open, and remember, you have a right to appeal this decision and I would - the appeal process should keep the case open during the appeal time.

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score 5 · Answer 10

Medicaid is a living nightmare and laws vary from state to state and you need an attorney to understand it.

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Medicaid is an abusive assistance program that has different rules for people of different ages and the disabled. They make the disabled work to qualify for Medicaid without having to meet a spenddown and income allowances are much greater than for the elderly. Now they have a program that allows those between 19 and 64 to qualify for free Medicaid if they perform healthy behaviors (going to the doctor), but if you're over 65, you don't qualify. Been working on this for a long time. One disabled woman was bedridden and couldn't get Medicaid, but social worker told her sister if she could sign a check for someone and get paid $5 for doing it, she could get Medicaid. It's sheer insanity. If you're ready for the nursing home, you can qualify for it by going on the Elderly Waiver program and they help with repairs on your house, lawn mowing, ramps, garage door openers, and will transform your home into a nursing home room. Otherwise, if you're over 65 and crippled, but not yet ready for a nursing home, you don't qualify for any of that even if you're on a Medically needy program with a huge spenddown and can't afford to pay for snow removal 3x/week like this last winter. Again, it's sheer insanity.

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score 0 · Answer 11

I spoke with a lawyer several months ago and she said they have recently increased it to $5000 /month, so hopefully you won't have to worry. She deals with this all the time, so ask a lawyer who is dealing with this, not just anyone.

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It is NOT $5,000 / month in my state, and I would imagine most other states.

(4)

score 3 · Answer 12

Mom was in a nursing home twice in one year. She gets two checks s month one on the first for $350 for SSI and the second on the third for $650 for basic social security. The first time I thought that the financial department would handle everything. I found out later that I needed to let social security know that she would be staying longer than 30 days. She stayed 90 and had to pay back 3 months of disability that she shouldn't have still received. They said that if she were to stay past five months then they would take all of both checks except for $30. Her brother use to send her a $100 check every month for taking care of my grandma and she use to just deposit it. She got a letter from her bank saying that if this kept up for more than 10 months they would have to report it to social security and she should just cash it instead of depositing it. This was 25 years ago so I'm sure things have changed probably not for the benefit of the elderly.

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score 5 · Answer 13

This is something I learned from this site. That the PNA (Personal Needs Acct) becomes part of the spend down. So, it needs to be spent if you already are to the $2000 spendown. Anything over that 2k has to be spent on the person. Buy new clothes, shoes. As the Medicaid rep told me...be creative.

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A dresser, a lift chair....

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score 0 · Answer 14

I'd like to know too. Over by $125 as there was a change to her SS. She is on Medicaid but we are waiting for bed at a Nursing home. How does this effect???? Anyone???

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Someone just posted about a $300 increase. It maybe reimbursement for her paying her Medicare B, now Medicaid pays it. I would talk to the office about this.

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score 3 · Answer 15

When my mom was in the NH under Medicaid, I really relied on their financial department for guidance. I spent so much time in the financial manager’s office, I probably should have been charged rent. These people know the ins and outs of Medicaid and know how to negotiate with them. Visit the office at your mom’s facility and ask them for help.

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Mom in nursing home on Medicaid -her assets exceeded limit for one month. Will renewal be denied?

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