General Question About Medicaid

Daisie

Hi everyone. I have a general question/curiousity about Medicaid (I'm completely ignorant to this).

I've tried applying for Medicaid for my mom twice now, and both times, her app has been declined almost immediately. She makes less than $1700 in SS and has virtually no savings, no retirement, pension, life insurance, nada. She lives with me, and we share expenses.

However, she also has virtually no medical expenses beyond her Medicare premium and a prescription or two a month (she's 90 and in fairly decent health, albeit the dementia/AZ).

Could THAT be one of the reasons she keeps getting denied? That she has NO medical expenses that would need to be covered at this point, so therefore, Medicaid is moot right now?

If that's it, I'm fine with that. Otherwise, I can't figure out what else it could possibly be!

Thank you!

I should note that I'm applying on her behalf to get assistance from other services at this point and in preparation for memory care. I'm trying to avoid having to move her twice. I anticipate she'll need to go into MC later this year at the rate she's declining cognitively.

M1

Talk to a certified elder law attorney. You can find lists by location at nelf.org.

H1235

I have not gone through the process myself so keep that in mind. Can you just call and ask why she was declined? It’s my understanding they do a look back of her finances (in my state it’s 5 years). They are very concerned with gifts. Did she give any large gifts over the last few years. Maybe there is some kind of problem with the shared expenses. Anything that might give them the impression she is supporting you in any way would be a problem. There is also a medical requirement. If they believe she is still able to take care of herself (probably not if she has dementia) then I think she wouldn’t qualify. I’m shocked you wouldn’t get an explanation with the decline. As M1 suggested a CELA would help. If expenses is an issue maybe the local commission on aging could help you navigate through this.

mpang123

I used to have Medicaid QMB. But I don't qualify anymore because I exceed the income limit. In Texas it is $2000/month. However, my income allowed me to qualify for SLMB. Not as much benefits as traditional Medicaid but better than nothing.

mpang123

Correction…income limit for Medicaid here is $1255/month

mpang123

Sorry for being so vague. There are other factors that come to play. The best thing is to go to the Medicaid office and get the details. Good luck.

livefree2

https://alzconnected.org/discussion/69748/general-question-about-medicaid

A Medicaid approved ALF helped me fill out the form and it was a god send!!! Try talking to an approved facility (your local county wiill have a list.) The admissions director had a list of all necessary info like birth certificate etc that is needed and they submitted it for application fee which I thought was expensive. They also know the ins/outs of Medicaid spend down which may be necessary to get her in. In NYS my mom receives 1400 social security. Her rent is 1300 with Medicaid which is the adjusted rent from 6,000 if person is paying out of pocket. She has less than the 30,000 in savings Every state is different on the amounts they can have. The ASL are the ones with all the knowledge on that. We were lucky there was only a month waiting list. Currently my mom’s facility has a 6 month wait list.

mabelgirl

My mom did not qualify for full Medicaid due to her monthly income ($15 over the limit). However under Medicaid their is the QMB(qualified medical benefit) which basically pays for Medicare cost and then their is long term care assistance which will pay for a portion of cost in AL or for in home services. In FL it’s called statewide Medicaid managed care, not sure what is it in other states. I did all the apps online . The monthly income is a bit higher than full Medicaid but it does limit assets $. I would check around for your elder services who would also be able to help.

mabelgirl

also forgot to mention check into her Medicare plans. I had my moms changed to where they cover $200 a month in grocery or rent or utilities.

towhee

Hello Daisy, it is really confusing right? I cannot really answer your question, partly because I do not have enough info, but I can repeat some general facts.

Qualifications for medicaid programs and to some extent even the programs themselves differ from state to state. So for any medicaid question it helps to put in the state.

That denial you received should contain a reason for the denial. It might be vague or in the fine print but if it is not there your state has an inept application process. There should also be a phone number or address (email or snail mail) which you can contact for info or for an appeal of the denial.

When we are trying to get help in caring for our elderly parents, we are dealing with at least three different medicaid program areas.

One-Medicaid as health insurance, i.e. regular medicaid. This pays hospital and doctor bills, medications, usually vision and dental benefits. When your parent gets Medicare already, medicaid acts as supplemental insurance. Also when you get Medicare there are levels to Medicaid depending on your income and assets. At the first level all that is paid is your Medicare premium, progressing to paying premium and copays, then to paying all of bills and vision and dental. These are the QMB and SLMB programs a previous poster mentioned.

Two-Medicaid that pays for Assisted living, Memory care, day care, or some help in home. Not all states have a program that will cover this, if they do what they cover varies, there is often a waiting list to be covered by the program, income and asset qualifications for this differ from state to state, and are often different from regular medicaid, and there must be a current medical need for that level of care.

Three-Care in a skilled nursing facility or nursing home. Available in every state, no waiting list to be covered, qualifications may differ by state, must be a medical need for that level of care.

All forms of medicaid have income and asset limits. They all also have rules about giving away assets to qualify, and sometimes what you think of a gift is different from what they think. Having a joint account if not done as POA could be considered a gift. Not having a written agreement for rent if your LO is living with you and paying part of rent could be considered a gift, you never know. Check out your state's website, see if you can talk to a social worker, and consult an elder lawyer if you cannot get sufficient help elsewhere.