Medicaid was denied. Anything in particular I should write in my appeal to Medicaid?
My moms long term care Medicaid was denied because they say she doesn't meet the medical level of care to get nursing home care. Has anyone gone through the appeal process that could give me some advice? I'll explain my moms and my background a bit.
My mom is 68 years old with Multiple sclerosis. She cannot walk or stand. She needs assistance with all transfers, to toilet, bed and her mobility scooter. She is cognitively alert and can feed herself, but cannot prepare meals. She also needs someone to dress her and wash her and her hair. She broke her hip in February of 2015, before then she could transfer herself so I was able to help with meals and shopping and anything else really. Now that she cannot transfer herself she needs someone around always incase she needs to use the bathroom. She can hold both urine and fecal for 5-10 minutes, after then she goes in her pull-ups or pad and needs someone to change her.
We just moved to Tennessee and I was sure that she would be accepted for ltc Medicaid because she was without question in our last state. I guess Tennessee has harder rules. They write that she can receive 8 hours of help at home a day and she will need to use free help from friends or family members. I'm the only family around and I cannot take care of her for those other 16 hours of the day. I have three young children, 5 year old, 3 year old and 10 month old and my husband is going overseas for the next 9 months. My mom gets up 2-3 times every night. I cannot mentally or physically handle the demands of her plus my children.
Is there anything in particular I should write in my appeal to Medicaid? I don't know what we would do if she is denied it fully. :/
The DON sounds like we knows her stuff so medically this is all fabulous. But the billing thats all controlled by the owners or the corp HQ and outside of her intervention. Ok worst case scenario......after 2 mo or so, they send mom & you a 30 day notice in which mom or you have to come to some sort of binding contract with the Nh on moms past due bill OR the NH contact the court to get mom made an emergency ward of the state. So mom becomes a ward of the state of TN.
Actually this could be a good - no actually great - thing for you. Ward of the state is done all the time often for those who have family who cannot fulfill the duties of a DPOA or guardian. Usually it would be done cause worthless son went & spent moms $ from the sale of her hiuse so mom cannot be eligible for medicaid as mom has a huge transfer penalty. Thats not you.....You kinda have both hands full & then some with 3 kids & a deployment hubs. A state appointed guardian for her means they take over getting her care done & often they can part the Red Sea as the are essentially an arm of the state. I would asap ask if any of the folks in the MS support groups have family who are wards and ask for the contact info for their guardian. Family can request a guardian if they have expertise in something beneficial & the judge will be sensitive to this. MS has it own unique issues I would think.
Guardian does not need to be permanent either. Your mom is still competent so it could be she's a ward for finances only. So the guardian deals with health issues. Or you seek the guardian till hubs comes home permanently from deployment or military service.
I've been an executor now 3times and guardianships were also heard in probate court. I can recall temporary guardianship being placed for a lady who's only child was going off for duty (very emotional & he came in full uniform) & being lifted for a daughter who was finally finished with her chemo so now good to resume being a DPOA.
I'd guess that most of the time hearing turn mom over to ward of the state is viewed as a threat but it could be the solution if TN has a good open system for wards.
In the interim, I'd suggest you call the MS group in TN to find a local support group. There are going to be others who have had to find a NH for a family member and can give you all sorts of insight as to the nuances of TN Medicaid. It's not the usual elderly with mid stage dementia who broke a hip and now needs a NH situation which is kinda numero uno for the move to a NH. Your mom is still young.
Now about the residency, in theory I think all states have a 30 day rule, but I think you will find that mom will need to show that she is doing whatever to establish residency. If she continues to keep the old states ID to verify who she is, has her banking showing an address in old state, Medicare has the old address, then the state of TN could declare that she is not a resident. If mom has anything that a could be considered real property - land, home, car - anything that ties into tax assessor records, those will be considered non-exempt assets for the new state and their value take her over the Medicaid asset limit (2K).
It may end up being that mom will need to switch to a another facility that will take her as "medicaid pending" and more geared to a younger resident. Good luck and let us know what happens.
Igloo, that is a fantastic idea to stay on the DONs good side! Those are good ideas you gave me, thank you :)
Your moms young so you have a long history ahead of you with this facility.
Again so happy for you. I'm sure there will be some issue but it sounds like its all going to work out.
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