My Mom is Medicaid Pending, receiving A&A, and needs to

Discussion in 'General Discussion' started by MJ, Jul 27, 2011.

  1. MJ

    MJ 85 year old mother is surviving spouse of veteran

    be transferred from rehab facility to assisted living facility.
    The state is North Carolina
    Question: Will she lose her A&A benefit once she is on Medicaid?

    Question: She has a house with approx 80K equity- will Medicaid 'recovery of assets' place a lien on her house?

    Question: If Mom is in Assisted Living and the facility gets her social security and Medicaid (assuming that A&A is terminated) who takes care of the bills associated with keeping the house up? If Medicare is going to take it - why would the family spend $$ paying her insurance, and property taxes and upkeep to keep the home in shape if it is to be lost to Medicaid for recovery of the ALF expenses that Medicaid paid?

    Question: I have been reading for hours and CANNOT find information on this issue that is clear and concise. I am the POA, I do not want to sign any docs with the ALF that would make me personally responsible for any payment shortfalls. I did read that Medicaid will pay some, but not all, ALF expenses- do I assume the balance is met with her SS check? This is so daunting... resources (hers and her children's) are limited. Does anyone out there have experience or know the real deal on this situation?
    Is there any difference in Medicaid payments to Nursing Home vs ALF?
    ALL INPUT GREATLY APPRECIATED. SHE HAS BEEN IN REHAB OVER A WEEK- SHE CANNOT GO HOME AGAIN she is so frail and unable to take care of herself even with the home health caretakers we had coming in thanks to the A&A benefit.
    THANKS, MJ
     
  2. nananorma

    nananorma Jr. Member

    MJ - we are in Texas and our experience was that Medicaid would only pay for nursing home, not ALF. I left my Mom at the same facility that provided rehab and nursing home and moved her out of her ALF because of her frail condition. ALF didn't really want to take her back after rehab. A&A dropped from $1056 to $90 monthly because Medicaid paid for most of nursing home + I paid 95% of her SS to them also. Cannot use the $90 A&A for medical, just personal expenses. Don't know how it will look at EVR time.
     
  3. KarenO

    KarenO Jr. Member

    What will Medicaid be paying for at the ALF? I do not believe that Medicaid covers any part of the ALF cost except for perhaps her medication, medicare insurance premium, etc. unless the state has specific program such as Florida's Diversion Program. Have you talked to the social worker at the rehab facility. The one where my Mom was was a great help and explained it all. My Mom went on Medicaid when she was in rehab also, thought she might return to the ALF but ended up in a nursing home for several months which was totally paid by Medicaid and her SS until she passed.
     
  4. MJ

    MJ 85 year old mother is surviving spouse of veteran

    Thanks for your responses.... it is soooo confusing.. each state does things differently though. I have a 52 page contract from the ALF to read when I get home from work.
    I have learned:
    1.) not to sign as responsible party- the ALF will come back to me for any money owed.
    2.) make sure the ALF lists all the things that medicaid does not pay for and that won't be covered by
    the social security... then see what the deficit is. That will be the kicker I think.
    3.) Go ahead and prepay for burial expenses.....

    what are some things I haven't learned yet.... please give me your thoughts.
    Thanks.
     
  5. gt57

    gt57 Newbie

    Ohio has an Assisted Living Waiver Program that I am currently seeking and received verbal approval in the jsut a few days ago. My mother is currently in an ALF and receiving Aid & Attendance of $1,056. Once she is on Medicaid, my understand is that the A&A will drop to $90 / month and this will not be counted as income for Medicaid calculations. Medicaid will leave her $50 so she will have a total of $140 per month for personal expenses and co-pays for prescriptions.

    I will be updating another post regarding my experience with Medicaid as it has not been as smooth as Veterans A&A. My county Medicaid office is not agreeing that the Aid and Attendance should go to $90 and not be counted as income. They want to count the entire $1,056/month as income even though this will be reduced to $90/month once I file the adjustment paper work with the Veteran's office.
     
  6. MJ

    MJ 85 year old mother is surviving spouse of veteran

    Isn't it AMAZING the amount of disinformation that is out there. NO ONE seems to really have a grip on how all this works. My mother was utimately DENIED Medicaid because with what Medicaid was counting as A&A income (basic portion of $661.00) plus her Social Security put her over the limit of what a Medicaid bed in the ALF costs:

    974.00 social security (income)
    +661.00 countable portion of VA Aid & Attendance (basic allowance) (also income) Wanda says she does not lose this benefit going into an ALF but call Philadelphia and ask (per Michelle @ VA office in Union County)
    $1635.00 total income. This is OVER the Medicaid income limit of $1182.00 (cost of Medicaid bed in ALF facility) so she does not qualify for Medicaid for ALF. Private pay is about $2600/month and there is no money for the difference. So... we are out of the rehab hospital back at home with caretakers at $16/hr for 4 hrs per day 5 days a week.... better than nothing I guess. But not really safe for her. I guess we have to wait for her to be bad enough to need skilled nursing care. Then I think Medicaid may pay? This whole process is sooooo confusing .............
     
  7. magnumpi28

    magnumpi28 Jr. Member

    Ive been through this, im in oklahoma so may be some minor differences but listen to what i say, ive been down the exact road you are going down now......also this was four years ago that i dealt woth this so the laws may have changed but this should at least give you some ideas that may or may not work now....

    be transferred from rehab facility to assisted living facility.
    The state is North Carolina
    Question: Will she lose her A&A benefit once she is on Medicaid? She will lose her A&A once she enters a medicaid nursing home. Medicaid does not pay for Assisted living centers

    Question: She has a house with approx 80K equity- will Medicaid 'recovery of assets' place a lien on her house? YES, If she enters a medicaid nursing home they can come after the house in most circumstances.

    Question: If Mom is in Assisted Living and the facility gets her social security and Medicaid (assuming that A&A is terminated) who takes care of the bills associated with keeping the house up? If Medicare is going to take it - why would the family spend $$ paying her insurance, and property taxes and upkeep to keep the home in shape if it is to be lost to Medicaid for recovery of the ALF expenses that Medicaid paid? OK, Are you getting nursing home and assisted living cenetr mixed up? If she is in an assisted living center and not a nursing home the you will pay for that, not medicaid. This is teh best option as YOU get to pick a nice assisted living center. Most nursing homes are understaffed and not fit for a dog.
    In that case, give them the 1056 dollars and also give them the social security check, sell the home and use the proceeds to pay any other money you owe the assisted living center. If your mom dies before you use the 80,000 then the family will get to keep it.
    If you mean Nursing home then medicaid will pay for that and give your mom 50 dollars(90 dollars if on a&a) . The nursing home gets ALL her social security and the A&A 1056 check stops. Dont put any of your money in the home, just stop paying the mortgage, if by chance your mom dies in just a few months, catch teh mortgage up and sell teh home, medicaid will get about 5000 a month so they may get 10,000 dollars but you would get teh rest, if she lives longer than a year or so then medicaids lien would be so much then you wouldt get anything but your not out any money because you never paid the mortgage


    Question: I have been reading for hours and CANNOT find information on this issue that is clear and concise. I am the POA, I do not want to sign any docs with the ALF that would make me personally responsible for any payment shortfalls. I did read that Medicaid will pay some, but not all, ALF expenses- do I assume the balance is met with her SS check? This is so daunting... resources (hers and her children's) are limited. Does anyone out there have experience or know the real deal on this situation?
    Is there any difference in Medicaid payments to Nursing Home vs ALF? AVOID NURSING HOMES AT ALL COST if possible, MOST ARE NOT FIT FOR A DOGS. Go assisted living centers that provide full time care.
    ALL INPUT GREATLY APPRECIATED. SHE HAS BEEN IN REHAB OVER A WEEK- SHE CANNOT GO HOME AGAIN she is so frail and unable to take care of herself even with the home health caretakers we had coming in thanks to the A&A benefit.
    THANKS, MJ


    Logged
     
  8. vbcoder

    vbcoder Jr. Member

    Obviously Medicaid rules vary by county as well as by state.In Davidson county NC, Medicaid pays part of the room cost
    in an AFL. The resident pays the ALF his/her SS check minus $66 and Medicaid pays the rest for a semi-private room.

    A family member of mine has been in an AFL for 3 yrs. and Medicaid pays all of the room cost except for SS-$66 and the
    SS-$66 is about 1/2 of the total cost. If they won't pay now, then the rules have changed in the last 3 yrs. and my family member was grandfathered in. A&A is not involved.THIS IS AN ASSISTED LIVING FACILTY not a NURSING HOME.

    MJ, it may behoove you to check with another social worker and determine if you were given the correct info. Medicaid benefits are based on the state and county of her residency.

    I hope this doesn't muddy the water any more than it already is.

    P.S. The social worker said that A&A did not count as income but if left in a banking account for more than a month it will be counted as an asset and cannot go over $2000.
     
  9. magnumpi28

    magnumpi28 Jr. Member

    VB coder is correct,even for oklahoma now, I did some research and the laws were changed in Oklahoma in 2009 to allow medicaid to pay for ALF. Like i said, i dealt with this over 4 years ago and apparently some things have recently changed. If you can find a nice asisted living center that takes medicaid then go for it however things dont look good concerning the home. Most people would probably say just get her in an medicaid assisted living center and be done with it. Just do your homework and hopefully find a descent one. Its important to find a good one, It will be one of the families last major decision in your mothers life.

    If for some reason medicaid wont pay, just pay the ALF your moms ss check, her 1056 A&A, sell the home and use that 80,000 to pay the difference. I dont know, tough call and since ive been out it for 4 years and the laws have changed i dont feel comfortable telling you what to do.

    But here is one thing im sure of, Most people dont understand that you can get Hospice even while they are in a nursing home or assisted living center. DIFENTLY get on hospice if she qualifys! They are an extra set of eyes when they see your mother at the nursing home or assisted living center. They also help and encourage the family and at this point in your life, weather you know it or not, you need that encouragement.

    The hopsice staff even went to my dads funeral. They know how to be your friend and was with my dad when he passed away.

    "Oklahoma Assisted Living Medicaid Policy - A Medicaid waiver certification program for assisted living centers was initiated in Oklahoma in 2009..."
     

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