What do we do if Medicaid won't pay for my mom in a nursing home and none of us can afford it?

Generally, the money to pay for her care while she awaits Medicaid assistance would come from any assets that she has. Is she living in a home she owns? That could be considered an asset.
If she has no money at all other than Social Security, the chances of her getting Medicaid help are good, but the waiting period is challenging. Each state is different, so you need to ask your contact at the Medicaid office where the application is being processed what you are to do in the meantime. It's likely that her home could be used as collateral. You may want to talk with an elder law attorney who knows your state Medicaid rules well.
Good luck,
Carol

Thank you. No, she has no home and we have already spent all she had for the nursing home.

Your mother's situation is what Medicaid is meant for. She has no assets and she needs skilled nursing home care. I assume that the NH she is at accepts Medicaid? Mom is probably in the status now of Medicaid Pending, right?

If it happens that this NH does Not accept Medicaid, start looking for one that does immediately!

Thank you. Yes, the nursing home does take Medicaid.

It sounds like she is already in the nursing home. So do an internet google search for the words "medicaid pending while in nursing home" and you will find some helpful info. Hopefully you did not sign that you will guarantee payment. If she has no money then wouldn't the only issue be she doesn't meet nursing home starndard of care but it seems like she does from your description. If denied, then look into appealilng it but it would be the nursing home's responsiblity to find an appropriate placement for her since they already admitted her. Contact your state ombudsman if there is one to find out what you can do in the event nursing home medicaid is denied. If the state claims she only needs assisted living, then ask them if they are going to find her a place and fund it under the medicaid program for community care. You can also try to contact an attorney at legal services for free help if she has no money.

some people envision a NH as a utopia of safety, good care and fun activities. i didnt see that in the rather upscale AL that my mother spent a couple of months in. it was more like old people sitting in their rooms surrounded by a pack of money and drug thieves waiting to go eat another horrid meal. after a few weeks the families stopped visiting altogether. im not trying to influence anyones decision but my mom isnt going back into one if we have to live in a van down by the river.

3 months ago, we received a phone call one night that the relative who was taking care of my disabled mother in law was going to jail, so come pick her up (she was in another state). So, we did. My father in law who was in the hospital passed away last month. She has no assets at all - nothing, except a small social security and pension. What a shame to live all these years (68) and not have a single thing to show for it. Assisted Living, I was told is a "luxury" so that was out of the question. She couldn't even afford a nursing home. What are we going to do? We have a two story house. I've made an "apartment" for her in one room, however, being in a wheelchair means she cannot come downstairs, and she needs assistance to use the restroom. Anyway, we have decided to dip into the 401K and make a handicap accessible addition onto our home downstairs. This has all happened so fast, but what else can we do when no one else will step in. She has a much better life with us, that's for sure, however, it is very stressful having to be a caregiver and work a full time job too. Thank goodness my husband and immediate family are here to help too. I know I'm not alone in this situation. This forum has helped me tremendously. Best of luck to you.

1daughterin law, apply (on her behalf) for Medicaid Global Options. It will pay for home care or Assisted Living Care. It is a beast of an application and process but is a wonderful alternative to helping an individual who does not yet require a higher level of care. I've done so on behalf of my aunt as I'm her POA. It's been 8 months now and it still hasn't gone through but I'm hoping that it pays off in the end. If your father in law was a veteran, look into that option as well. They don't advertise it but my aunt is now getting a pension from the VA even though my uncle only served 4 years. If you have any questions feel free to email me.

A side note on Medicaid- after my mom was financially exploited by my only sibling and left penniless, I was in a panic. My mom was evicted from her assisited living facility and like what you all have commented, had only a small SS benefit for her care. She needs 24/7 care at 95 and has advanced dementia.
When I was investigating putting her on MediCal (CAMedicaid) I learned that some states are using an old law to collect the costs to the state after the recipient dies- called estate recovery under filial law. Be very careful if you are the DPOA and seek advice for your protection. There are articles on the Internet of adult children being served with $50,000 and up bills. Look up filial law.
In my case I will make the state go after my sibling if I have to put my mom on mediCal.
I wish everyone the best. Being a full time caregiver and holding down a job is rough. Don't take on more than you can do. Reach out for help. Call your county's Council on Aging for assistance. Like the person above said, speak to an a ombudsman. There are requirements that need to be met physically to qualify fir SNF.
I know we all want the best fAOR our parents, but be careful about dipping into your own funds that you will need one day. Check out small board and cares around you. They are better environments than nursing homes.

I do not see any mention of an Adult Foster Home in any of the answers. Check to see if your state has them. This is an alternative to a nursing home and some of the homes do specialize in alzhiemers patients and all will take them till end of life so once they are placed it is for good(unless they want to move)These homes are licensed through the state. Check with your local DHS for a list of curreng foster homes in your area.

Didn't know about adult foster homes. Be sure to check your state's regulation board to view complaints against nursing homes. Elder abuse us unfortunately rampant in some skilled nursing facilities. Some practice convenience drugging and pay little attention to residents. I know this from personal experience. The Ombudsman knows every facility in their jurisdiction. It's good to get to know them as they also can act as an advocate and be another set of eyes.
Also, some colleges have graduate programs where the student is required to earn credit for their social work masters. I have a someone that visits my mom weekly. Great program.
Alzheimer's Assiciation help line staff is very helpful. Go to the National Coincil on Aging website and look for benefits check up and fill out that form for additional help.

Some nursing homes that accept medicaid patients postpone billing private patients while the medicaid application is pending. So, speak to the nursing home director in that regard.

Capnhardass - I understand that in your situation you want to keep your mom at home. Please don't act like those of us who choose not to do that are less kind/compassionate/whatever you think than you are. It's not always an option. We're all doing the best we can for our loved ones or we wouldn't be on this website!

Thank you Leedee, I have ordered an alarmed pill box!!!! This will prevent much hand-wringing at home.

LovingMom,

I went through the same process with Medicaid as you are. A couple of things of note:

1) Medicaid will not pick your mother up to pay her bills unless she has outstanding medical bills. And with the nursing home costing what it does she will have no problems qualifying based upon that.

2) As long as you are completely honest and ethical on the application then you will not have a problem getting accepted for Medicaid. If she has no home and no assets...which was my mother's situation...she will be accepted.

Now, it might take months for the final acceptance to come and also you better be prepared for the application process because it will drive you crazy, but I have not heard of an instance where Medicaid denied someone who was open and honest on the application.

You can read about my personal experiences in this article I wrote for AgingCare.com...

https://www.agingcare.com/articles/applying-for-medicaid-for-parent-155854.htm

And if you need any assistance do not hesitate to contact me.

God bless and good luck.

I filed for Medicaid for mom in October. Never heard anything from them until late in January. I lost my mom January 7th so she was gone before I got any information then it was more questions s o it would have been another couple of months. but I live in Maine and everything here is so messed up now, thanks to the government. I could have put her I n one I found but it was dark, smelly, and dirty, No one smiled all patients were in there rooms and the rooms were so small they couldn't have anything of there own. She would have had just 2 drawers for her clothes. NO WAY was my mom going to be used like a prisoner! The inmates in prison better care than the elderly in Nursing Homes. There are very few that are really good. I know of three in our area and it was just to late. I'm still waiting to hear from Medicaid. and it's now the last of march.

Skilled nursing facilities do more harm than good IMO w/ the harm coming from those doctors who love to keep the residents just sick enough by prescribing their toxic drugs that keep the residents suffering from the side effects. Apparently these facilities don't get paid by the insurance companies unless they follow a toxic drug protocol. My mom, who also suffers from dementia, was in a skilled nursing facility recently for 2 months where the doctor seemed to love experimenting with different HBP drugs and doses. One drug and dose was so high that it caused my mom to develop a bad cough and difficulty breathing. I had to ask him to wean her off of it. He never consulted us (the POAs) before he switched the drugs and the last straw was when he gave her an ace inhibitor called Lisinopril that caused her to end up in the ER due to a severely swollen tongue that kept her from eating anything for 3 days. We have our mom home now and she is doing much better after we stopped ALL her medication and put her on a diet and supplements to help with her HBP and high heart rate. So far, so good. What a hard lesson we learned.

What do all of you who don't think NH's aren't an answer suggest for those of us who can't take a loved one into our home and don't have $ to pay for private pay skilled help suggest? I feel like we're being condemned in some way - like we're not as loving as you are - b/c we don't have the same options. I'm open to suggestions if you have them, but in 6 years of trying to provide the best care possible for my mom w/ALZ, nothing better that's affordable has presented itself.

Every state has different rules and programs so it is smart to talk to someone who knows the answers....Sometimes there is someone at the nursing home who can help you find the answers or lead you to the right source....You don't always have to hire an attorney....Good luck to you! Things work out in time, it just takes a lot of patience....

My husband went to a NH on October 12 (Florida). The insurance paid for the period October 12-31, and I paid $300 co-pay. In January when he was approved Medicaid (the insurance terminated in December) I returned his SS payments for Nov & December to the NH. Every month on the 3rd I receive his SS direct deposit and make a payment to the NH. I am not too clear in this, but it is my understanding that Medicaid only covers the part that the SS of the resident does not cover. If the NH charges $3,000 and the resident only receive $2,500, Medicaid pays $500. Again, this is in Florida.

Just for other's information, I contacted the Area on Agency in my mother's area for legal assistance. I was told they really didn't do anything legal except give advise.
It has been one unpleasant surprise after another in this situation. A lawyer I contacted charged $350 for the first phone call ( as I live out of state from my mom) !
After that, something like $300 per hour. I don't know what the average American is going to do as baby boomers age and we struggle more and more to take care of our elderly. The cost for care is out of reach for most of us. We all need to start inundating our representatives with phone calls and letters about these concerns.

I'm proud of you all for adding your wisdom. What an honor to be part of this forum!

I did want add to the idea of looking for an ombudsman. By going online to www.ltcombudsman.org and typing in the nursing home Zip code, you'll get the contact number or email. This person is your representative in the system. They are well trained to give advice even if they can't personally help.
Take care, all of you,
Carol

I have to add a note here. We were displaced by Hurricane Sandy and are still dealing with issues in our home, needing to relocate again. When Mom was in the Atria living center, we were asked to remove her. e were waiting like thousands of others to receive payment for housing . They refused to wait, and told us that she had to be removed, 48 hours before her 60 day contract was up. They had no interest in our plight, or mom's personal safety. I say this because while she was there, an open bottle of Ensure was left on her nightstand for nearly 7 days. When I came back to visit her, I dscovered this and brought it to their attention. I continue to recieve bills, but no documentation regarding this incident. Only rhetoric regarding how they have financial responsibilities that must be met.
PLEASE be careful. I never dreamed that not only would we be caught up in this situation with mom alone ( no family will take her in even temporarily, even AFTER the hurricane,) but be displaced form our home as well.
Keeping all in our prayers.
Nancy

Couldn't area on aging refer you to local legal services for free and low cost if you qualify? go to this site to see if any in your area and if they help in this type of situation

http://www.lsc.gov/

Fact Sheet on the Legal Services Corporation

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What is the Legal Services Corporation?

LSC is the single largest funder of civil legal aid for low-income Americans in the nation. Established in 1974, LSC operates as an independent 501(c)(3) nonprofit corporation that promotes equal access to justice and provides grants for high-quality civil legal assistance to low-income Americans. LSC distributes more than 90 percent of its total funding to 134 independent nonprofit legal aid programs with more than 800 offices.

LSC promotes equal access to justice by awarding grants to legal services providers through a competitive grants process; conducting compliance reviews and program visits to oversee program quality and compliance with statutory and regulatory requirements as well as restrictions that accompany LSC funding, and by providing training and technical assistance to programs. LSC encourages programs to leverage limited resources by partnering and collaborating with other funders of civil legal aid, including state and local governments, Interest on Lawyers’ Trust Accounts (IOLTA), access to justice commissions, the private bar, philanthropic foundations, and the business community.

The Corporation is headed by a bipartisan board of directors whose 11 members are appointed by the President and confirmed by the Senate.

Who is helped by LSC-funded programs?

LSC-funded programs help people who live in households with annual incomes at or below 125% of the federal poverty guidelines – in 2013, $14,363 for an individual, $29,438 for a family of four. Clients come from every ethnic group and every age group and live in rural, suburban, and urban areas. They are the working poor, veterans, homeowners and renters, families with children, farmers, people with disabilities, and the elderly. Women—many of whom are struggling to keep their children safe and their families together—comprise 70 percent of clients.

What kinds of legal issues do low-income people need help with?

Legal assistance is necessary to address many issues that affect low-income individuals and families. The most frequent cases involve:
•Family law: LSC grantees help victims of domestic violence by obtaining protective and restraining orders, help parents obtain and keep custody of their children, assist family members in obtaining guardianship for children without parents, and other family law matters. More than a third of all cases closed by local LSC programs are family law cases.
•Housing and Foreclosure Cases: As the second largest category of all cases closed, these matters involve helping to resolve landlord-tenant disputes, helping homeowners prevent foreclosures or renegotiate their loans, assisting renters with eviction notices whose landlords are being foreclosed on, and helping people maintain federal housing subsidies when appropriate.
•Consumer Issues: Nearly twelve percent of cases involve protecting the elderly and other vulnerable groups from being victimized by unscrupulous lenders, helping people file for bankruptcy when appropriate and helping people manage their debts.
•Income Maintenance: More than 12 percent of cases involve helping working Americans obtain promised compensation from private employers, helping people obtain and retain government benefits such as disability benefits to which they are entitled.
•Helping Military Families: StatesideLegal.org—the first website in the nation to focus exclusively on federal legal rights and legal resources important to veterans – is funded by an LSC Technology Initiatives Grant. This free service enables military families and veterans to access a wide array of legal information and assistance. The Department of Veterans Affairs, in a directive, encourages use of the website in connection with service to homeless veterans.
•Responding to Disasters: LSC has a long history with helping victims of natural disasters. LSC has built a national network of experience and expertise—including legal services providers and national organizations such as the American Red Cross and Federal Emergency Management Agency (FEMA)—to help programs better serve victims when disasters strike.

Contact your local department of Aging and Disability. They have social workers to help with the Medicaid process. I know here in NV, Medicaid will pay for her "levels of care" but not room and board, so SSI or any VA benefits would have to pay for that. They usually pay retroactively from the date of the application, so facilities will usually let it slide knowing they will be able to recoup their money. They also have a short term loan that you can apply for that will pay in the meantime and be paid back by the lump sum when medicaid goes through. Google the deparment of Aging and Disability, or the Health and Human Services Agency in your state they can probably help. Good luck, I'm going through the same thing.

SheriR: I never thought, like most of us, that I would ever be in this predicament. Every one of us has a unique situation and we deal with it in myriad ways. Undoubtedly though, we all are doing what we think is best for our loved ones and, hopefully, ourselves. We are all here to support one another and not to judge because no one has the right to do that. Hugs!

We are going thru the process of reviewing my parents financial status (they are both at home.) Mom is an invalid and dad is not in good health. There funds are dwindling because we have to have a live-in. It took months for us to find a good EldareCare Attorney whom we met with for almost 2 hours (no charge consult). The bottom line is to qualify for medicaid for one person they must be impoverished (2700 in assets). Medicaid is not a guarantee and to try and qualify on your own could take awhile. If there are more than 2700 in assets (plus a home) there has to be a legitimate spend down. My recommendation to you is to search for an eldercare attorney and setup oa meeting. Reputable attorneys will fight for the Medicaid rights and help build all the proper documents for you (POA, health, financial, etc... AND advise on how to use existnig assets to your mothers advantage.) As long as you tell a nursing home that you are pending Medicaid, if they have her in a medicaid bed, then they will accept Medicaid once approved. The problem is that after medicaid reviews her accounts from the past 5 years, there may be a period of time that she will be required to pay out of pocket. This is where having a qualified attorney will help. Reputable attorneys have many payment structures, using your mothers assets and most will do a flat rate fee rather than time and materials. If they start talking about charging by the hour -- look around. Hope this helps. For those that have two parents in not good health and they have a home, the one that does not have to go to a facility right away has the right to keep the home and up to $110K in assets for their care, plus the 2700+ for the one that has to go to a facility (NH). Anything above that level, you need to be careful on how the funds are spent. If repairs are needed to the house, then some of that excess amount (over the $110K) can be used for repairs. -- Again I caution and urge you to speak with an attorney to find out all options.

@caphardass you are so right, sadly, so right. I was laid off from my full time employment so i see my mom multiple times a day every day and take her with me to my home or out regularly. i intend to call medicaid to get the info about what it would entail to bring her home. i am living on a small retirement from my 30 years with an airline so medicaid would have to cover all of my mom's expenses and i don't know if they do that..i want her here with me. Benefits of the NH; when I am exhuased or sick i know she is being fed meals and snacks. When her behavior changes the order a urinalysis its done (no doctor appt). They coordinate all the meds so i am not making multiple trips to the pharmacy...the things that tired me out when mom lived with me were the small things like pharmacy and doctor trips, grocery shopping then cooking. Otherwise, she was quite easy to care for. When she was here i worked full time coupled with the above i became exhausted quickly (plus many other things including surgeries, tests, ER visits, ambulances etc etc). Now that I have no income I would not be able t afford respite care for myself and that scares me...there is no family just me and mom. If nursing homes could use child care centers as a model we might see improvements in nursing home living.

Lovingmom: Based on your description, your Mom should end up qualifying for Medicaid, it's just a frustratingly long process. After 9 months waiting for a decision (while Mom was already in NH as "MedicarePending"), I started hounding Medicaid and also the NH Finance Administrator to hound them also. Anonymous made avery good point regarding your POA. ANY documents you sign on behalf of your Mom should include the initials POA after your signature. This protects you from getting personally tagged as the responsible party for her debts. I believe every state has legal aide services. Check with your county legal aide services and see if YOU financially qualify for free legal services. They can help you regarding any questions you have about your POA, and also to make sure you get both legal and medical rep authorizations for her if you don't already have them. What about your Dad? If he was a Veteran, there may be some aid available to the surviving spouse that you can tap into. Please check the Money and Legal tab on this website for tons of helpful information.

@momhouseme ... you need to apply for Medicaid Global Options. It gives you ... well, options! It will pay for your mom to have all of the physical care that she requires and she can stay in her home ... or yours ... or assisted living. The application process, as is the case with all things Medicaid ... is a beast ... Was she every in the military or married to a veteran? Because there are unadvertised benefits that she would qualify for that would give her some assitance. Have you checked with the office on aging in your county? They might be a good resource for programs that she might qualify for. Some counties have state funded day programs with free transportation or perhaps they can help you to apply for PAAD to get her drugs at a lower cost.