Medicaid question from WV

DawnKJ

I received a letter saying my father was denied "Medicaid and/or WVCHIP" and below that is says "Medicare premium assistance" due to his income. It says he is $380 over the limit. I don't remember applying for that. My application said "Application for long term care Medicaid and Children with Disabilities Community Service Program."  But the WV State Medicaid website says the limit for long-term nursing home care is $2,199 as of 2015. Dad only gets $1,817 a month. So We're confused.

Does anyone here understand this and can you explain it to me, please?

Thank you.

Dawn

DBC

Could be supplemental income from pension or other retirement.  What about assets?  Does he have any in his name?  My suggestion is contact an elder law attorney.  May be a little late for this though if care is needed now.

DawnKJ

He doesn't have ssi and all his income (military pension, social security, and two smaller pensions) are included in the total of his income. If the limit is one thing and his total falls below it, I'm confused by the letter. But I'll ask the case worker on Monday.

Thank you for your reply.

Dawn

Cynbar

Is it possible this letter is just saying he was denied the help paying his Medicare premiums? Here in Massachusetts, a Medicaid application includes an application to stop the Medicare Part B premium. For someone who is low income and getting community Medicaid, this can be a big help. For a person in a facility who is getting long term care Medicaid, it doesn't really matter to them, it's a bookkeeping issue re who will pay that premium. You may get a separate letter saying whether he has been accepted or denied for Medicaid. Just a thought.  Also, when you quote that figure for his total income, is that before or after automatic deductions for Medicare and anything else he gets?

Quilting brings calm

I don’t understand the low  income limit to help payfor a nursing home.  Nursing homes cost 8 thousand a month.  What are people who make $4000 a month without any savings supposed to do?

DawnKJ

My sister and I thought it might be something like you described. As for after deductions, my quote is just what shows up in his bank account, so I guess after deductions?

Dawn

Cynbar

The amount he gets deposited is his net income. His gross income is almost definitely higher, he should have his Medicare Part B premium automatically deducted from his SS check and maybe other deductions as well from his various checks. The gross income figure is usually the "official" income you are dealing with for benefits.

DawnKJ

I finally figured that out. Luckily, the documents I sent included the auto deduction for Medicare, and nothing is removed from his pensions, so he's still below the limit. 

I heard from the facility that has room for him that he just needs to pass his COVID test for admittance, because his Medicaid for long-term care has been approved, though I haven't gotten the official letter from Medicaid yet. We also have a hospital bed coming, home health aide, a lift to move him from the bed to his wheelchair. 

Having said that, he developed some pneumonia and had to go to the ER today. We have all these things coming, but he won't be here.

I just spoke with the doctor treating him and we discussed all his ailments: broken scapula, urinary tract infection, shearing wound on his bottom, and we discussed the facility we'd like him to go to. The doctor said they could do the COVID test, and there shouldn't be any problem with transferring him from the hospital (when he feels better) to the nursing home. I put her in touch with the nursing home coordinator and the VA social worker to get the COVID test settled between the three of them.

The facility is an hour and a half away, but I just want him to get better care than we can give him. We barely managed for five days, and today, we couldn't get him up and clear his lungs, so to the ER he went.

I'm the hub in the family that disseminates all the details to everyone else. Thank you all for your help and encouragement in this.

Dawn