Does my mother have to stay in a NH where she is being mistreated while awaiting Medicaid approval since Medicare has been exhausted?

If she has filed for “Medicaid” and is in a facility, the Medicaid program that was done was for Long Term Care Medicaid. & was in one of the 2 tiers of of LTC Medicaid program: for custodial care in a skilled nursing facility OR for a waiver for care in an Assisted living (if your State does these waivers). The application & eligibility requirements are specific . So it won’t be the same application for a Medicaid program for In Home Healthcare which is done through Community Based Medicaid programs, which has its own requirements.

Current Nursing Home - for better or worse - is tied into her application filed as they have her there under “Medicaid Pending” status. NH has filed invoices to your State LTC Medicaid program alongside the application done for your mom. NH paid whatever State set daily $ custodial care / room&board rate paid 2 them ALONG WITH moms REQUIRED Share Of Cost (SOC) / resident responsibility $ to be paid by your mom to the NH as well. Her SOC is due to the NH starting the date she sequewayed from a rehabilitation patient (paid by Medicare as it’s a health insurance benefit) to being a custodial care resident. SOC would be almost all of whatever mo income she gets paid…. eg her SSA $, a pension, an annuity in payout mode. SOC can be somewhat sticky in that some States cannot require it to be paid to the NH till the LTC Application determination has been finalized while others have the resident SOC due from day 1 of being “Medicaid Pending” status….. but either way her income $ will be due to the NH.

All your mom gets to keep as $ each month will be whatever your State has set as its Personal Needs Allowance for those on LTC Medicaid. Most States do $50 or $75 a mo. That PNA $ is it for her flexible spending $ and it is restricted spending. By & large what it gets used for is to pay for on site beauty shoppe or maybe in room cable or in room old school landline type of phone. As these are costs not covered under custodial care costs.

I have been on this forum a long long time and over & over again the POA / families are surprised and gobsmacked that the SOC exists and what it means financially. If u are in any way needing moms $ to support your household or she has kept her home (which she is allowed to retain as an exempt asset while alive) and can’t cover the property’s costs entirely on your own for possibly years, then her being in a facility on LTC Medicaid and it’s required SOC will not work out.

If somehow all this is freshy fresh news to you, and you are your moms POA, that attorney hired imho did not do their job as they should have gone over this and explained all this and in detail to you as moms POA.

if you decide to pull mom out of the NH B4 her application is fully processed, the NH can’t be paid the day rate by the State. They will do whatever to seek payment from mom, POA. whoever else they can. And it will NOT be the lower LTC Medicaid reimbursement rate. It will be full tilt private pay rate. That the debt is there will go to collections….. which in turn becomes problematic if she should leave and family ignore the bill…. then she gets to be too much to deal with at home and now family have to move her into a NH…. as no decent NH will let her move in without someone doing a serious financial responsibility contract to private pay as she went into collections prior.

Personally imo you have to ride it out till her application is finalized and she is determined eligible. Then a couple of months after all this, then you look for a NH better to your liking. Moving NH2NH can be done but it will be a real ballet to accomplish. If somehow mom signed to allowed the current NH to be her representative payee for her SSA (or for any other retirement), it will be seriously daunting to get these switched back.
Good luck in all this.

What exactly is this facility doing that you feel is bad? If her application is Medicaid pending, they can't make her leave, if I'm correct.

You say you have the help of an attorney.
I would put this question to that attorney.
It is what he/she is getting paid for.
Do not invest your OWN money in your mother's care. It takes a lifetime of savings to be ready for your own old age which will sneak up quicker than you can imagine (as I can guarantee at age 82).

You can move her back home as long as safe caregiving responsibilities are put in place, but it may be very difficult to place her in a nursing home again. You will have to seek out other facilities that have open beds that will accept her. It sometimes is not an easy task.