My question is aimed at anyone with knowledge or experience with the Medi-Cal program in California. Assuming a doctor documented that a skilled nursing facility was medically necessary, and if Medi-Cal agreed to that.....if a person had been paying for a facility out of their own pocket, and their funds ran out, prompting them to seek Medi-Cal...would Medi-Cal let them stay where they were or have them moved to a "not so nice" facility? I guess I have heard of some places that I would not want my mother to stay in, and I am not sure how that works with Medi-Cal. My mother is not in any facility at the moment, but she may be soon and has good funding for a year or so before her funds would run out with no other finances available. Anyone have any knowledge about this? Thank you.
#1 She will have to use the services of the ER and then be admitted to the local hospital in Santa Ana, California.
#2 Then she will, more than likely, but not always (here's where your promoting comes in) be sent to a NH when a Medicare bed becomes available.
#3 She will either private pay or apply for Medicaid (Medi-Cal).
#4 If your mother is not in any facility at the moment, I'm not sure why you're asking about changing facilities under the umbrella of Medi-Cal?
#5 Are you over thinking this, as it's not yet a dilemma?
There are also "nicer" and not so "nice" facilities. You might want to check now and get your Mom on a waiting list at one or more of the "nicer" facilities. If her name comes up and you/she are not ready you can tell them that you would like to postpone her residency and to put you back on the list.
Begin the application process for Medicaid now. By that I mean make sure that you have all the documentation that you need and that as far as you can tell she qualifies. Then submit the application, when and if she is denied you can repeat the process and it will go faster. You might be better off with an Elder Lawyer that is familiar with the Medicaid application process so that she does not get denied the first time.