Ouch! Mom was sent to the Nursing home from the BH Unit at the hospital with what I thought was Medicaid coverage only to learn today that her Medicaid coverage is provisional until deemed approved or denied. She is 71 with Advanced Stage Dementia. Any thoughts or recommendations????
She’d like be like Section 8 eligible low income to be on community based Medicaid; otherwise she’d need a Medicare gap or advantage plan to pay the 20% Medicare does not cover. Or private pay that 20% or out of Medicare network costs.
BUT and this is important, community based Medicaid is a different program than LTC (long term care) Medicaid. They are both Medicaid but different criteria for eligibility. For individual LTC NH Medicaid, they must be “at need” both financially AND medically. Financials vary by state but by & large Monthly income under fixed max (usually $2k-$2100) & no more than 2k in nonexempt assets; medically it’s “at need” for skilled nursing care. Skilled usually gets limited to care in a NH as NH is a skilled nursing care facility. AL, MC or Behavioral Unit Care may not necessarily be included in your states LTC Medicaid program.
If she was community medicaid, it could be the new place filed a LTC Medicaid application for her... she’s pretty young at 71 so she might have signed off on the application herself. Once application filed, she would go into “Medicaid Pending” status; some places call this Medicaid Provisional. The Medicaid caseworker assigned to her or assigned to the facility will need a bunch of documents to determine if she meets the medical and financial “at need” for LTC. How complicated the paperwork kinda depends on what her prior situation was..... like if living in Section 8 a lot of her info already in system & she’s well established and verified as to being basically impoverished; but if living in a home she owned or had mortgage on its more complicated.
But whatever the above, once Medicaid Pending or fully on LTC Medicaid, BASICALLY ALL your mom’s monthly income must be paid to the facility less a smallish ($35-115) needs allowance. So if she has a home, car, CC debt, etc. she will not have $ to cover those costs anymore. Car & home can remain exempt assets for LTC Medicaid eligibility but if she wants to keep them then family will have to lay all costs and then upon her death deal with Medicaid Estate Recovery.
Yeah its confusing, this site has a series of really good articles on what the M&Ms are or more importantly are not. But ultimately each person situation is unique.
I’d suggest you speak with SW at the facility she is in now to see if the unit she is in is included in IL LTC Medicaid program and if not getting her moved to a traditional NH for skilled nursing care. If she is just needing “medication management” that may not be enough to show at need for skilled nursing so you have to work with her docs to make sure everything possible is in her chart to show “at need” for LTC. Good luck.