My mom recently qualified for Medi-Cal in CA. How does one initiate long-term care/facility placement and how long does it typically take?

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Janine2020 Asked February 2023

My mom recently qualified for Medi-Cal in CA. How does one initiate long-term care/facility placement and how long does it typically take?

My mom has dementia and has had a number of recent falls (has not been hospitalized but seen at her doctor's office). She lives alone next door to us and it is becoming a safety issue for all as we cannot provide 24 hour care, safely lift her without straining muscles etc. Her doctor has agreed to sign off on long term placement but says she has never done so before through the doctor's office and asked for me to contact the county to find out how. However, when I previously called the county they told me that this must be initiated by the doctor's office or is usually done by a hospital. I have durable POA and feel like I am stuck in the middle getting bounced back between the county and the doctor. My mom's doctor is not encouraging an "ER dump" and says she will help with any necessary paperwork. An APS social worker was also previously involved several months ago last year after a neighbor called since my mom kept wandering outside to the neighbors but no longer does this due to her recent mobility issues. The APS Social Worker encouraged us to apply for Medi-Cal at the time which we did and finally just recently got the approval for (even though my mom's premium is very high). What to do? Get the APS Social Worker involved again or just wait for the doctor/county? Hoping to avoid an ER Dump if possible but almost feels like we are running out of options to make this happen sooner rather than later.

Alzheimer's & Dementia Home Safety Medicaid Skilled Nursing Facility

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score 1 · Answer 1

Thank you all for your helpful advice, much appreciated! That's correct about the MediCal premium referring to all her income less a small amount for personal needs going towards the facility cost.

Totally agree about her doctor not knowing about placement/where to send her.

I since spoke with a caseworker who said the best options to make placement happen sooner are either calling an ambulance after her next fall so she can get placed through the hospital or reopening her APS case and have another APS SW come out to reevaluate/possibly expedite placement by getting placed on the Assisted Living Waiver list since APS cases have priority on the list.

I told the caseworker the hospital is the better option for us so she can also get properly medically evaluated for placement rather than just another brief doctor office visit.

I bet her doctor would want us to go through the APS option to avoid the hospital but I think the hospital is the best choice as others have mentioned.

The support here means so much and always helps me get through these things!

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score 1 · Answer 2

Janine,
MediCal doesn’t have premiums, so I can’t understand how yours are high.

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Possibly what is being referred to as a premium is the the requirement that all of her income, less a small personal needs allowance, goes to the facility for care.

(I’m guessing.)

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score 1 · Answer 3

A Place for Mom owns this site. They have a terrible reputation for being predatory.

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score 2 · Answer 4

I live in California. The fastest way to get MediCal services of any kind is to have the person go from hospital to ltc/snf. From there, you can apply to move her into an al, but the process is competitive and the county chooses the al

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score 0 · Answer 5

I am confused. Mom has been Okd for MediCal. Did you not need a letter from that Dr. during the application process saying 24/7 care was needed? Can only get Medicaid if person is 24/7 care. Is there not a timeline when you have to use MediCal. In my State from date of application you have 90 days to spend down assets, get info needed, and find a facility. My Mom spent down her money by paying privately for 2 months. I verified with the caseworker he had all the info needed and Medicaid started paying the 3rd month.

I would think you first need to find a facility that takes MediCal. That facility may ask for a Dr's letter stating that Mom is 24/7 care.
Mom should have a MediCal caseworker assigned to her, call them and see what they say. Also ask what the time-line is to get Mom placed.

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Miss read, she now qualifies not that she has been accepted, sorry. You will need to apply first and find a place that takes MediCal.

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score 1 · Answer 6

Those who can avail themselves of someone to help with placement such as A Place For Mom are dealing with people who are paid by the facilities, and those facilities want the clients because the clients have assets to spend down. Your Mom will be a difficult placement and while the doctor may discourage ER Dump, what does that particular doctor say about where you CAN go for help, because honestly I know of nothing that works one half so well as the dump. The social workers who know that medical is in force now will quickly find some placement options you cannot find on your own. You certainly can start contacting places on your own, but I wish you luck of it if Mom isn't an "easy" placement.
It is sad that the ER Dump has to be done, but, while your doctor discourages you I bet that same doctor doesn't have a clue how you can otherwise get placement, right?
I sure wish you luck and hope you will update us on what works for you.

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score 0 · Answer 7

Google care advisors, find someone local to work with you . They are realtors of sort… paid by facility placed in. They know what’s available cost , reputation etc… cuts thru the red tape. I worked with a care advisor from a franchise called Carepatrol . I’m in the state of WI …

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Those who work with the facilities are often only working for the big bucks. They are placing seniors with assets in ALF and MC mostly. There is little help for those who need placement for more difficult patients getting only government assistance. I hope some exist somewhere but know of none.

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score 0 · Answer 8

Medicaid differs by state. Have you downloaded the Meds-Cal application from their web page to just look at it? In my state, MN, it was not rocket science to fill it in but you will need to have access to some of her financial info and bills. You can ask the social worker if he/she can fill out the app for her, or ask questions about the process.

If her doc said she'd recommend her for LTC, then I think you have what you need to fill out the app yourself.

To avoid waitlists, you can get her in on private pay (it differs by facility). The existing residents get first dibs on the Medicaid beds. FYI it usually means a shared room. Once submitted, it usually takes 3 months for it to be processed and to get an answer one way or another.

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score 0 · Answer 9

As POA, and with the help of my brother, I did the searches to determine what my mom would like and the "vibe" we felt about the place. Once found, we place her on a wait list, till a bed was open. The application included the doctor's paperwork. You can also do the Medicaid application and she can be placed in the first open bed. Ask about those qualifying questions with the facility marketing staff.
I looked it up and she can have both plans if she is at the qualifying income level. Have you contacted Medicaid yet? If, not, then see an elder law attorney to look at options with trusts

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score 2 · Answer 10

I would start by getting a list of facilities that accept MediCal from the Area Agency on Aging. Then start shopping. I would think that a facility would have staff to help you to get this done. A word of warning, there may be very long wait lists for a MediCal bed.

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My mom recently qualified for Medi-Cal in CA. How does one initiate long-term care/facility placement and how long does it typically take?

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