A Rock and a Hard Place?

If you are going to bring your mom home, please gather a group of people to help you with her care - now. Ask family members, friends, members of your faith community, and any paid help she can get with her finances. Coordinate them so you have enough "time off" to meet your essential needs: sleep, health and hygiene, run errands, and a little for fun/relaxation. You'll need this help not just for the short time while everybody adjusts to her coming home, but for the entire course.

BernerMom: Imho, perhaps you need to retain an elder law attorney.

Get an attorney or contact special services via Medicaid. These institutions are always looking for more money, especially the ones that state they're 'non-profit'. There has to be social workers in your area especially at Senior Centers...

There is always a way to qualify for LTC Medicaid or get placed in a nursing facility if medically needed. It doesn't matter what the income is or what State you live in. What differs is how you go about it in each State. There seems to be a lot of misinformation out there, but the state will always pick up the cost of medically needed NH care after the patients funds have been exhausted. Different states have different ways to go about it, but there is always a way. BernerMom, you do not have to bring your mom home. In fact I would strongly advise you not do it. I'm not sure why you feel "resigned" to bring her home, because you absolutely do not have to.

Please pay attention to your gut instinct and do NOT bring her home. You have no control over what happens to her and with COVID but you are playing with fire if you bring her home. It is worrying you now so God help you if you take her home. Then what. Are you going to lose your life because of the burdens coming? No, find a way to keep her safe outside of your home by whatever means. Trust me on this one. You can't fix them - they will get worse - and so will you.

Iggie, QITs and Miller Trust are not allowed in VA. But see below for a quote from a law firm in VA that says that if all income is paid to NH and there are no other assets, the state, via Medicaid will make up the difference.

Contact an atty who does elder work or estate work. If the price to pursue Miller Trust via private atty, call your local legal aid and see if they can help you. Talk to social worker again at the facility - many of them have become very knowledgeable about Medicaid and Medicare because that's how they make money. Find out if hospice care in a facility would change the outcome of Medicaid or Medicare paying.

You can get nursing services in the home for hospice care as well. This might also help you out with her daily care.

Find out if your state does Miller Trusts or another type of income trust.
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.

Berner, was mom in the NH section when she applied for Medicaid? Or was it assumed that she woukd return home, and thus was applying for Community Medicaid?

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 she can no longer afford the copay, can you reapply for Medicaid? Perhaps if you refuse to take her they will find alternatives to getting the care she needs.

Is she a veteran or a spouse to a veteran? Because if she is there is help out there for us. I learned this when looking for a place for my BIL found out that. I also would look into long term assistance from medicaid even with your mother's income there is a spend down program that may help. Prayers that you find the right way for your mother.

This is from the Hook Law Center:

"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."

Medicare pays for hospice care. Whatever her secondary insurance is pays for the 20% that Medicare doesn't pay. They also pay for up to 100 days of skilled nursing care in a nursing home. If your mom gets downgraded to custodial care (room and board care), Medicare does not pay for that.
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.

Berner, was mom's Medicaid application for Long Term Care Medicaid or Community Medicaid?

Was she assessed as being medically in need of skilled nursing (you have to be medically at need as well as qualify financially),

You either need to talk to an eldercare lawyer, a Medicaid planner or the business office at the NH to straighten this out.

Exactly. Her room & board at the NH is currently $180/day while she is getting rehab/PT for broken ankle. Once we stop (ankle has healed) and move her to long term care, her room & board jumps to $380/day. Medicare does cover all hospice services and necessary supplies but not room and board at the NH.

Have you explored creating a "Miller Trust" to take care of the excess income mom has?

See a Medicaid planner or eldercare attorney.

Have you met with the business manager of the NH and also an elder law attorney to go over the situation and possible options? Seems there needs to be a plan other than bringing her home, your health is worth exploring this more

Medicare covers the cost of hospice so that might be a reason to leave her where she is, along with your concern about being able to deal with her immobility. Exposure to Covid may be inevitable. Some people bounce back from qualifying for hospice, but not many. Consider the stress on you in making a decision to bring her home.