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My father entered a nursing home last year., while my mother still lives independently in their home. We were in the process of getting him qualified for Medicaid since his income (SS+Pension) is below the income limit. We were denied. We appealed with the state (Ohio) and were denied. Has anyone appealed beyond that? Can we reapply?
Also, does her monthly income or 403B count towards the asset limit? Her income is much higher than his and he has no retirement account.
Finally, does anyone know if she sells her house and buys a new one (smaller one closer to me), does this negatively impact a Medicaid application?

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Lily, what was the reason that Medicaid states they denied the claim?

From what I understand from reading Igloo's posts are, mom's income is countable towards the monthly income, ALL of their assets are 50/50, barring an inheritance that was never comingled in any way.

If you were using an attorney, I have to say, if they were truly an elder law attorney, they would be better able to help you.

I recommend going to www.nelf.org and look for a CELA level attorney. We found the elder law attorneys to be crooks without the knowledge I have, scary business. We found a very competent and super knowledgeable attorney using this route.

A good attorney will know how to do the asset split, the spend down and ALL of the intricacies of your stated Medicaid program.

I have read many posts here about how tough and ridiculous Ohio Medicaid is.

Best of luck. I found out that I didn't know what I didn't know until I started the elder care journey, listen and learn to every professional you can, it really helps you to navigate the system.
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lily78 Jul 22, 2024
Thx for the reply. Just curious - what did you experience to call them crooks? Because that's close to what I feel about our lawyer right now.
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I live in Ohio too I am 83 my wife has dementia and is diabetic one. We only live on social secruity . We applied for Medicade and was turned down. We applied through what they called a Passport Waiver. We got the passport wavier which got us avalible for that which is like Medicade had for one year now. Has really helped you might call them and say you want to apply for passport. What ever they ask you to do . Do it. Even take all papers to there office don't mail. Fill them out then take in. Deal directly with a case worker. I hope this may help you
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igloo572 Jul 28, 2024
Bakerman, just in case it somehow was not made clear by the caseworker to you / your wife, PASSPORT as a stay in your home waiver - a shifting by Ohio of some of the dedicated $ from LTC Medicaid funding to PASSPORT - has it that all costs paid are subject to Ohio’s Medicaid Estate Recovery system aka MERP.

If you own a home, there will be MERP to deal with due to $ owed for your wife being on OH Passport.

If OH does a capitation by enrollee payment system, it could be several thousands every month as a flat base rate that becomes an after death tally paid by Passport. Right now she already has a years worth of future liens or claims if y’all own a home. All States are required to attempt a recovery or recoup of all costs paid. But each State does this uniquely as its subject to State probate and property laws. It’s something to take into consideration.

fwiw my State has PACE programs, which too involved waiver $ shifting. It’s does a base enrolled rate, which is abt $5800 a month. So the base rate alone would be 70K per year subject to MERP.
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It’s strange that posts who ask about appealing ‘medicaid was turned down’ usually DON’T say why. If you don't know, surely it makes sense to ask 'on what grounds'?
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cover9339 Jul 29, 2024
They send a notice, either electronically, by mail or both, that explains an approval or denial.

The OP should have if not already have a benefits.ohio,gov account or can create one.
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Did Mom and Dad split their assets? Was your Mom mentioned as the Community spouse? Did Mom sign a form saying she would not support Dad to maybe protect her pension or 403B?
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What specifically were the reasons for the denial?

Mom last year transferred her car with Blue Book Value of 18K to a grandson and gifted 50K to you or a sibling 3 years ago is a way WAY different problem than Dad does not have the deep medcial chart to show he is “at need” for skilled nursing care,

so what - in detail- did the State list as the reasons for denial???
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Please consult with an eldercare attorney.
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bakerman757 Jul 27, 2024
I hope this can help you. We live in Ohio and my wife has dementia. We applied for Medicade through what they called a Passport Waiver that is what the case worker suggested.We were turned down on Medicade but received Passport. Basically the same thing .That was over a year ago. We live off of social secruity . A limited checking account. This has worked out for us. You might want to try for Passport. I hope this helps.
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lily78, welcome to the forum. Please note that Medicaid is individual to each State. Therefore, each State has their own rules, regulations, and programs.


Sometimes one would need to talk with an Elder Law Attorney as they specialize in that field, and knows the ins and outs of Medicaid.
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lily78 Jul 22, 2024
Thanks but we were using a lawyer.
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lily78: Retain an attorney.
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The Passport program that others have mentioned is a Medicaid waiver program in Ohio designed to help older adults receive care at home rather than in a nursing facility. It provides services such as personal care, home delivered meals, and medical equipment. To be eligible for Passport, individuals must meet certain financial and medical criteria. Even if someone is initially turned down for Medicaid, they may still qualify for Passport if they meet the specific requirements of the waiver program. This can be a good option for those needing long term care services at home.

The Passport program in Ohio is similar to the PACE (Program of All-Inclusive Care for the Elderly) program which is available in multiple states, including California where I live. Both programs provide a wide range of healthcare and support services, including medical care, personal care and social services. Both programs are designed to help seniors to remain in their homes or community settings as long as possible. Both programs serve older adults who meet certain medical and financial criteria.

PACE is a federal program available in multiple states, while Passport is a state specific Medicaid waiver program in Ohio.
PACE often operates through specific PACE centers that provide day care services and medical care, whereas Passport coordinates services through various home and community based providers. PACE is jointly funded by Medicare and Medicaid, while Passport is primarily funded by Medicaid.

Both programs aim to enhance the quality of life for seniors by providing them with the necessary support to live independently.

For more information about Passport, visit Ohio.gov. For more information about PACE, visit Medicare.gov.
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Martindale-Hubbell is a long standing directory that allows users to search for attorneys by specialty and location. It also includes peer reviews and ratings. (martindale.com).

Read reviews, check credentials, and possibly meet with a few attorneys to find someone you’re comfortable with.

Wishing you the best of luck.
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