Any suggestions on what to do after hitting a roadblock with Medicaid application?

The nursing home can petition for guardianship for her (you could too, but I’m not sure you want that responsibility).

The NH can get emergency guardianship and cut through all of the red tape. Consider this seriously. It might be your best option.

In my home state of MN the applicant can designate an Authorized Representative (it's at the end of the app where there applicant signs):

"Assistance with Completing this Application 

You can choose an authorized representative

You can give a trusted person permission to talk about this application with us, see your information and act for you on matters related to this application, including getting information about your application and signing your application on your behalf. This person is called an 'authorized representative.'

Authorized Representative Signature
By signing, I agree to be an authorized representative for this household. I understand my responsibilities including keeping information about the people applying on this application private."

This is all that is required but the app differs by state.

If you are their *legal* guardian or PoA filling out their app (as opposed to just being the authorized rep), they ask for proof along with the submission of the app.

It's not unusual for facilities to strongarm families; but they can't discharge a patient if the patient's not safe alone at home. A decent social worker would help with the POA.

Call (717-783-8975) or email (LTC-ombudsman@pa.gov) to contact the ombudsman assigned to the facility. Their purpose is to help resolve conflicts with a facility.

Did you try the Area Agencies on Aging (pa.gov) for help with home care options? They should be able to point you to everything needed.

If mom is lucid, the POA just requires her signature, two witnesses, and a notary. You can find one who can come to the facility on notary911.org or notarylocator.com.

If mom is not lucid, you're past the POA point and need emergency guardianship unless you're okay with the facility or State doing that.

Best wishes for clarity and resolution.

Although the authorized representative can fill out and complete the Medicaid application, the problem for a representative who does not have POA is getting hold of the needed records--5 years of bank records; pension and ss statements; statements about other assets; etc. Is there any way to go through paperwork where this person had been living to find out as much as possible? My huisband was POA for his brother for 4 years before they had to aply for nursing home Medicaid coverage, and we had taken all the paperwork we could find when we cleared out brother's house. In our state, they asked for copies of bank and brokerage statements for one month each year for 4 years (the same month as the application, in his case, March), and for 12 months of statements for the year preceding the application. Had to provide copies of annual pension, social security, copies of documents showing value of the house (tax statement from the town). Had to document whether any assets were sold or given away in the 5 year period and why--in this case, my husband had to sell off $$ in his brother's retirement account, use his savings, etc. to private pay and spend down. I can't imagine how one could do the initial application without having POA and/or access to all these records. Wishing you lots of luck!

The NH is afraid you are stonewalling them and that they will not get paid for Mom's care. It is the reason so many NH now refuse to admit someone who is not pay private and has proof of their Medicaid application in hand. If for some reason, Mom has to leave the NH and is admitted to hospital, the NH at that point can refuse to accept her back (in spite of the recent ruling in California) because she does not have a payment source. An eldercare attorney who specializes in Medicaid will be able to assist you. The social worker at the NH will be somewhat limited in their ability to assist you since you don't have DPoA. You could have them go for guardianship of Mom but you will lose control over her. In NJ, the state, not the nursing home, goes for guardianship but again you lose control.

Blessings on you and please keep us updated on this journey.

Are you using the NH to help with the application? If so, you may want to talk to a Medicaid caseworker to see if they can help.

In my State you have 90days to apply, spend down and get them info needed. If not done within that time, you have to start over.

Is there a reason you can't get this person to authorize one of you to be the POA (and Med POA at this point too).

Where are all of her documents? Can someone go to her home and gather the actual documents? Your name may not be on the bank accounts, but you know where she had bank accounts, right?

I'm sure the atty is going to be able to direct you, so that conversation will be well worth the expense.

Most NH will have a Medicaid specialist on staff either full or part time to navigate the complex and time-consuming application process. I had to apply twice since my mother moved from one county to another. In both cases, there was someone on NH staff to assist. Also touch base with the Finance Director at the NH as this person typically oversees the specialist and could help expedite the process. Sounds like you are on the right road with the attorney (Elder Law I assume). In the meantime, I agree with others that you need pursue getting the POA (legal and medical) to facilitate moving forward. The NH should then continue her care and when Medicaid is approved, you will then be responsible for her fair share from the monthly SS payment. There should be a small amount left over for her each month to spend (e.g. snacks, clothes, hair appointments, etc.)

The NH cannot just release her to the street, so don't let them scare you. They must release her to a safe environment. The only thing that may happen is they send her to the hospital and then refuse to take her back, then it is on the hospital staff to find another facility. State APS can also be called to assist. It doesn't have to be your job to figure it out as you are saying the NH is telling you, but you can call the state Medicaid office and see if you can get more info as to what the problem is, as a concerned relative. If you are consulting an attorney, I hope you are not paying out of your pocket, that is completely unnecessary.

I used to be a Financial Worker whose load inlcluded NH - I would call the local County agency and sxplain the problem - they may have an Intake worker who can helo.

I handled this situation for my brother on a ventilator. Don't rely on NH to handle this for you. Assuming she is competent, immediately have her sign the Medicaid, Medicare AND Social Security forms which designates an "Authorized Representative" and allows that person to handle things on her behalf. You can download the forms from the websites. A Durable POA can be done by having a notary come in to document signatures. You need witnesses to also sign that are not nursing home employees, (friends are best) then file it with deeds office in her county. Her bank will want a copy which will allow the designated individual to handle finances, sign checks, etc. The nursing home will want a copy of the POA. For her to qualify for Medicaid, she can't have personal assets that total over $2,000. That includes life insurance with cash value, checking and savings, real estate, etc. It took insurance carrier 3 months to pay out my brother's policy (his only asset) to prepay funeral costs as part of pay down for him to qualify, and I had full authority. Once qualified, the nursing home attaches her social security check, minus a small "allowance" (usually $30 to $60) for the time she is admitted. Do NOT sign a form for you to be personally responsible for costs not paid by her coverage unless you have money to burn. If she needs to be transferred to a hospital for treatment, the NH will charge a "hold bed" fee (not covered by insurance) so she has one to come back to. Try to not let the stress and frustration of the process get to you, getting authority to do what is necessary will make it go smoother.

I can only speak from experience in CT, each state has their own process and each pair of eyes looking at a case is different too but the basics are the same I think. It is definitely a challenge even when you do have POA and access to accounts so I can appreciate the extra roadblocks you might hit. As far as the application itself anyone could fill it out as an agent for the primary (your LO) the only time my POA really came into play was after she was approved and suddenly no one could talk to me without verifying I was her DPOA. We were assigned a case worker for the Medicaid application and every time they needed something they sent it in writing along with copies in the portal and to a degree she was helpful. When it comes to getting the bank account and income information that is a bit more difficult without the authority, as it should be but if you or another family member has been helping her with that stuff, which I imagine is likely given her health needs and they have on-line banking set up for her you can often order the statements you need that way. She would have gotten SS statements and that sort of thing at the end of last year and again if there is an on-line account it can be accessed that way but the state also has easy access to that info. In our case they wanted copies of her divorce decrees, Mom has been divorced twice and the one from my Dad was so long ago it wasn’t on the computer system and they had to put in a request for someone to dig through the older files…it took 3-4 months! While some of theses things were harder to get than others the way CT works as long as you give them something from the list of needs the clock starts again or continues so I saved a few easy things like copies of her insurance cards and proof of who she is to send periodically, a tip the CW (case worker) gave me. What I’m saying is be creative think outside of the box when it comes to obtaining some of these things as long as you don’t lie they do understand that you aren’t your mother and she may not be able to help you. They system wants to make it difficult it seems, something no elder going into a NH can navigate but the real people want to help you, for the most part and there are various resources you can use to help guide you. The NH should be first and foremost on that list and it’s a shame they don’t seem to be but maybe it was simply a poor choice of words and approach, bad day maybe, on the part of that person and approaching them for help rather than now fear they are an adversary in this will help. At the very least keeping in touch with what you are doing, where you are in the process if they aren’t an active participant. The case worker as I mentioned earlier and most states department on aging have or can guide you to knowledgeable people to help guide you too. All of these people I have found are so happy to know the elder has family involved and willing to do the work they will help anyway they can. Not all elders have family doing this and they become the NH and or states responsibility which is a heavier burden on them. I would absolutely ask someone about the best approach at this point however to legal standing moving forward since you don’t have DPOA and it doesn’t sound like mom is able to give it now, remember for the most part they should welcome your involvement as long as you aren’t overly demanding or needy because otherwise they need to do the work.

Good luck and hang in there this process seems designed to be a marathon by they system rather than a spring, though they do expect you to sprint…

Yes it is the game they play meaning the states. It is like disability. Even though it is obvious you are entitled you need to put up a lengthy fight. I think they hope you will die before the have to pay. I have been told now they will even try to go after survivors even though there is no legal link. I just hope the people in these positions find themselves in having to care for someone.

Contact your local agency on aging. In our case, the person assigned to us there could see where the hang-ups were so they could be addressed. Mom and I never received that information directly. The help of the agency on aging was invaluable. She walked through the entire process with us.

Given the situation, I would think very carefully about becoming her POA for finance or health. You have done what you can.
Ask the local area on aging and a qualified elder law attorney about allowing the state to take guardianship may be a better route. The court appoints a guardian and gives the person authority to access all sorts of bank and Social security records, etc. They may find she has funds...or report to the court that she doesn't.
That satisfies the Medicaid requirement for documentation for sure.
The nursing homes often try to push for discharge home so they do not have to wait for Medicaid to 'catch up" with the overdue amount once Medicaid kicks in.
"Unsafe discharge" are the key words. Not able to provide for her needs, no other family members available either.
Good luck.

Maine127: Prayers sent for a positive response from your attorney.