Nursing home self pay. What can I do?

Also keep in mind that they have to be “at need” both medically AND financially for LTC Medicaid. It sounds like medically there’s no question that she needs skilled nursing care. But the medical necessity part kinda gets overlooked.

if there is a medical at need issue, the NH takes the lead in getting this done. You as POA sign off on the appeal but NH staff do what’s needed.

The hurdle, I’m guessing, could be 2 things: she hasn’t fully established herself as a TX resident (like get TX ID, TX address bank account, this part is easy) AND has property in New Mexico.

A LTC Medicaid applicant, aka in a SNF or NH, is allowed to continue to have their home if it is their homestead or principal residence as an exempt asset for Medicaid & for their lifetime.
BUT
the property MUST be in the state. It needs to be their residence & has homestead exemption. Home in NM cannot be her homestead so it is not an exempt asset. It is a non-exempt asset and it’s value is considered as part of her overall asset tally for Medicaid. And it will take her over the 2k maximum that is allowed for nonexempt assets for LTC Medicaid in TX. If tax assessor, say in Ruidoso, has it at $167,890 then she is $167,888 over the allowed non exempt for Medicaid

This, I’m pretty sure, is what is making her ineligible. Comprende?

Now medicaid understands that elders move in & out from other states.
Like when H. Katrina hit, my mil NH moved enmasse from New Orleans to a hotel in Houston and then into facilities in Harris & Galveston Co. Now Mil did not own a home back in Louisiana, but some of the ladies did. What happened is that for the first six mo all was ok, then those w homes, well those properties got considered nonexempt asset and their property value (lol) made them ineligible as it took them over the 2k. So they had a choice either to move back to LA (like Monroe, Shreveport as too much chaos elsewhere) or they put the house on the market with a Realtor and MLS listing or went private pay. The rules are pretty strict.

That was 15+ yrs ago but it still holds true. Your mom needs to do something to establish herself as TX resident and that the house is on the market to sell or that she had defaulted on the terms of her mortgage and it has been take over by the RM. If she has just left it to twist in the wind with the RM company that doesn’t do it. She needs to do some sort of defined paperwork to show Medicaid the current status on the house and that it is no longer her asset. Remember Medicaid does not give a rats butt about debts, Medicaid only cares abt assets even if the RM is abt to seize the asset.

I did TX Medicaid for my mom. The system was different than for JoAnn up in NJ. All the Nh we looked at had a list of documents that needed to accompany the LTC application which the facility did. The list varied slightly in descriptions but basically the same. I turned all over the day in advance of mom moving in as I sat with admissions to go over their filling in the application. It was slightly over 100 pages mainly due to moms very old legal size muktipaige life insurance policy. NH reviewed the documents. I realized that they were looking for stuff that would be glaring issues, like big checks written. Stuff that could red flag for a transfer penalty. Then NH turn my 100+ page document drop along with their bill and the application to the caseworker assigned to this NH. The caseworker (male) was pretty sharp. Mom had couple of issues & I needed to respond to them within like a day or two. CW cannot let things drag on, it’s a tiny window to get stuff in and get processed. It’s really important that whatever the CW needs you are able to get on it.

Id suggest that you find out from the CW exactly what the hurdle is and what type of document from the RM is needed. If the Nh has NOT yet submitted the entire packet to the State, that’s a different issue. Find out what the Nh thinks they need ASAP to send app to CW.

it will work out. Remember you make it your mantra that you cannot take her into your home, “I do not have the level of safety and security needed for her oversight”. Some facility will take her & her SS.

The worst that happens is that she becomes a ward of the State.

Just want to clarify for you. Her Dr. probably placed her in Rehab if Medicare was paying. If she was not progressing, Medicare will not pay so she is discharged from Rehab. If Rehab could not do a "safe discharge"* then she was transferred to Skilled Nursing.

Your problem is her SS is only offsetting the cost of her care leaving a balanced owed. I personnally would not allow the business office to do her Medicaid application. Especially with a reversed mortgage involved. In my State you are given only 90 days to apply, spend down, get info needed and get the applicant placed. If not done in that time, the application has to start all over. I think you need to talk to Medicaid and ask what they need for proof that Mom no longer owns the home. Maybe you need something from the Reversed mortgage showing that there is no equity in the home. That even if sold, Mom would get nothing. Were her and step-dad on the deed? You may want to consider letting the State take over her care. Maybe filing as a hardship case. Someone just mentioned that on the forum.

You need to keep up with everything the NH is doing in reference to the application. I started Moms application in April. Placed her May 1st. She private paid May and June. June I called her caseworker, sent proof she was spent down and confirmed he had all info needed. July 1st Medicaid started. I would have never left that in the hands of someone who works in the NH. Get help yes, but I would be making sure everything was being done in a timely manner. Especially when in your case its not all cut and dry.

And her husband. He abandoned her without telling someone there was a vulnerable adult in the house. I blame his son too since he knew about it. And how can step-Dad afford an assisted living and not Mom? Their assets should be split. Then her 50% gets spent down on her care. He is really legally responsible for her care. I may eventually pursue that.

Hopefully Igloo will chime in. And she will correct anything wrong I have said. (She does it nicely😊) I really think you need a lawyer.

*Safe Discharge comes about when its found a patient need 24/7 care and there is no one who can or is willing to do it. The Rehab/Nursing home then cannot release the person back to their home. If no family, and no one even willing to be a guardian then the State steps in an appts a guardian.

This illustrates one problem with a reverse mortgage. The home often has a "loan" that must be paid when they leave the home, which necessitates sale of the home before the senior can collect medicaid. There will be repayment of the "loan" with its often high interest, then there will be the assets in Mom's name that will make her self pay. If you are her POA you would be left handling all this if she has dementia; I did POA for my bro and I would find this daunting, myself.
One of the people who frequently answers on Forum is called "Igloo". Often has good information regarding medicare/medicaid, etc. I hope she sees your post. If you are POA I would consider using some of her assets to get an elder law attorney to guide me, perhaps a fiduciary to handle this, as I wouldn't know what I was doing with all of this myself. You said your relationship is "toxic". I would consider letting her handle what she is able, and be under the guardianship of the State she is in when she is not capable of it; they will appoint a fiduciary through the court to handle these sales, transfers of money, payments and placements. In a real sense I am sorry she got transferred to TX which I assume is to be nearer you. Had she remained in her own state she would have been dealing with at least the rules and laws under State medicaid in the same state. This seems to have made it still more complicated, and at present I think you are left with lawyers, or rather SHE is, as I cling onto hope you aren't her POA, and won't become one. Nothing like having to do a tremendous amount of work on something you don't understand for little to no pay and certainly no thanks in a toxic relationship. I hope you'll update us how you are doing and hope Igloo weighs in.

They'll apply SS to her bill, carrying over a balance. If approved for Medicaid, not sure if they will pay off any balance, before taking over paying the whole cost.

Great answers below. The only thing I would add is some emphasis to the advice to not accept her "temporarily" into your home. Do not believe them if they say they will "work with you" or "help you" to find another solution. Once she is in your home, they will consider the problem solved. YOU will be the solution.

Do you believe stepdad that there is nothing? Or did he leave after emptying joint bank accounts? And, like Barb said, the nursing home should be given his contact information.

It sounds as though she has been admitted to the NH as "Medicaid Pending". The NH may seek for the State to gain guardianship.

Do not sign ANYTHING that says "responible party".

I don't know if they will try to give her a 30 day notice of eviction if Medicaid is denied (I would give the NH stepdad's contact information) and do not pick her up or accept her into your home "temporarily" if they do.

You just told reverse mortgage to take the house? Did mom have any equity remaining in it? How was income from reverse mortgage spent?

Arline
It sounds like you are doing all you can. Just don’t sign anything. Mom must sign for herself. It sounds like you have found a NH that will work with her. If you sign for her, the concern is that they can come after you to pay her bill if Medicaid doesn’t cover.
It really doesn’t matter so much what you told them, what matters is what you signed and under what capacity.
good luck and let us know how it goes.