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    Old 09-29-2009, 07:06 PM   #1
    polina
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    Medicaid Application Denied

    I am so sick with worry I just received a letter from Medicaid saying my mom's application was denied. Most of it is paperwork that we gave the Lawyer but I guess he did not submit it with the application. Not sure what he did?? I just got the letter tonight when I got home from work. I will be calling the lawyer first thing tomorrow morning. The biggest concern I have is next Thursday her Medicare runs out. Which means self pay or I imagine she will have to leave. We cannot bring her home she is wheel chair bound. The application says we have the right to a hearing but all that takes time or submit the needed paperwork and they will go by the date the needed paperwork is submitted. Most of is minor paperwork bank statements etc. I just cannot believe it I feel we are under the gun here and time is ticking. I just cannot believe it got denied. The money they are questioning is $9,000 that was in both my dad's and her name that we took out her name and just put in an account with my father's name. Just simple little things like that. It doesn't help that we got tied up with a lawyer that has no knowledge of the medicaid application at all. So he is useless. I have done most of the leg work and all he does is ask for more money. There is no way we can bring her home and I just don't know

    pauline

    Last edited by polina; 09-29-2009 at 07:07 PM.

     
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    Old 09-29-2009, 11:04 PM   #2
    Gabriel
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    Re: Medicaid Application Denied

    Pauline, they will not kick her out and send her home. Let them know what is going on with the Medicaid and that you are getting the paperwork and reapplying. It will be fine. I understand that a large percentage of medicare claims are denied the first time so it's not an unusual situation. Now take a deep breath and shut your eyes for a moment. It will be ok. Just a few more hoops to jump through and it will be done Some of the other's here have had a lag between the medicare/medicaid or between private pay/ medicaid. It will work out!!

    Love, deb

     
    Old 09-30-2009, 03:35 AM   #3
    polina
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    Re: Medicaid Application Denied

    My first phone call this morning will be to the facility to let them know where we stand. The second call is to the lawyer. Everything I read on the letter as to why it was denied (there is a list of things about 7 of them)I had given the lawyer so I know he has them. If I had more time to devote to this whole process I would never have hired this lawyer. I think I could of done it myself for goodness sakes. He is driving me crazy. I give him paperwork he looses it. Asks for this twice then in the end half of the things I gave him he didn't submit. Oh well, you are right deb after sleeping on all of this I said to myself all we can do is resubmit everything again and start the reapplication.
    What else can you do. I am sure the end result will work out it's just everything with this whole process IS a PROCESS!!!

    love pauline

     
    Old 09-30-2009, 04:05 AM   #4
    Martha H
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    Re: Medicaid Application Denied

    I agree. Resubmit. The lawyer should do this without further charges, or am I livng in a dream world?

    Sirry about this hassle. do not despair, your Mom can certainly stay there while it is being rehashed. My Mom had a joint account with my brother, and half of it was counted as her assett, the other half was counted as his. Her half had to be spent down before medicaid kicked in.

    Good luck!

    Love,

    Martha

     
    Old 09-30-2009, 08:19 AM   #5
    caringsister54
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    Re: Medicaid Application Denied

    Polina

    Get thee to the lawyer's office, stand there with hands on hips and just say that you find him inept and wouldn't recommend him to anyone else EVER

    then ask for the dang paperwork you gave him and march to eitehr the medicaid office or the NH and give it to them.

    My sister was going through a divorce and the lawyers just took large retainers and when they felt they worked through the money (real fast) they'd tell her what needed to still be done and she went and walked through everything herself!, they wouldn't lift a finger. Of course, we made sure the judge and everyone knew this.

    So tell the lawyer off AFTER you get the paperwork.

    I also know my sister is also trying to navigate something with Nj taxes and has to duplicate things at least 3 times because everyone kept "loosing" the paperwork after submissions! (conveniently lost?)

    Take Care and hang in there.

    Caring

     
    Old 09-30-2009, 09:57 AM   #6
    marypar
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    Re: Medicaid Application Denied

    Hi Polina,
    Maybe it's the $9,000 - there is a five year lookback and if that done within five years, there would be a problem.
    I am dreading going through that process but I feel my records are perfectly detailed and I have copies of everything; I think I will go with a Medicaid consultant rather than my lawyer. I think they give more time and go down to Medicaid in person rather than the lawyer mailing in the paperwork.
    good luck and keep us posted.
    maryann

     
    Old 09-30-2009, 10:19 AM   #7
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    Re: Medicaid Application Denied

    i know there is a 5 year look back. what i would like to know is what exactly is the poverty level? at one time i heard it was $3,000. your mom has no other assets but the money. the nh will or should work with you on this. good luck.

     
    Old 09-30-2009, 10:57 AM   #8
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    Re: Medicaid Application Denied

    We used a very expensive lawyer who specializes in Eldercare cases. We thought he would drive us nuts because he never seemed satisifed and kept bugging us for more and more info. I spent hours on the phone with the IRS and with Social Security. Eventually (it took 3 months) we got all the paperwork in, and Mom was accepted on the first try. The money spent on the lawyer would have gone to the NH instead, since it was part of the money that had to be spent down. It was worth every cent. He also gave us the idea of prepaying her funeral out of spend down money, which is allowed. Everything from the flowers to the food afterwards was prepaid, and 2.5 years later it was a beautiful funeral. Meanwhile Medicaid paid for her NH care for over 2 years.

    Hope it works out for you. I have been told that in certain states they are so short of money that they are trying hard to find reasons NOLoT to accept new Medicaid patients. I wish they would look elsewhere, not at Alzheimer victims ... they can't help it. Hopefully when Health Insurance Reform goes though, all these things will be easier and more affordable. It just isn't fair that a heart transplant can be paid for by Medicare, but not a nursing home when they are in the final stage of AD.

    It is possible to be acceped on a second try, especially if they listed the reasons why she was not accepted, and you can take care of all those issues. Good luck!

    Love,

    Martha

    Last edited by Martha H; 09-30-2009 at 10:58 AM.

     
    Old 09-30-2009, 11:00 AM   #9
    polina
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    Re: Medicaid Application Denied

    mom and dad had joint accounts on everything savings checking and cd's. plus, mom had her own little seperate checking account that she would put her own little amt of money in. Her social security check which only was 500.00 a month as she never worked outside the home after she got married.
    The lawyer advised my dad to close all the accounts with her name on them and just open up new accounts with his name only and me as beneficiary. So my dad did that. Mom has no bank accounts now at all. I think as spouse with joint accounts as part of the marriage he could of just left them as is.

    debbie I would definately go with a medicaid consultant as opposed to a lawyer. We only went back to the lawyer because he is the one who put the house in a family trust and we figured we would use him boy was that the biggest mistake we ever made

    Today the facility told me her Medicaire benefits stopped on Sept 6th. I was shocked. I asked who they informed this to. They said my dad. It is a big mess. Dad thought because facility had told us that if Medicaid application was in then not to worry once in and filed and pending we did not have to worry. Now it appears I may have some worrying to do. Unless, Medicaid once approved goes back retro active which I heard they do 3months. I have a big headache from this. I cannot wait till this part is over

    It just appears to me nothing is black and white when dealing with medicare and medicaid thats what scares me!!!

    love pauline

    Last edited by polina; 09-30-2009 at 11:02 AM.

     
    Old 09-30-2009, 04:36 PM   #10
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    Re: Medicaid Application Denied

    Pauline, nothing is black and white with medicaid! Martha is right in what she said about the states running out of money. Medicaid is paid for by a combination of federal and local money. States in particular are cutting what they are putting into the system because of budget constraints. Here medicare is in competition with prisons and schools for the tax dollar. I saw something just yesterday about Medicaid. It was unrelated to our situation but again it was related. It was in reference to the new Heath Care legislation. Medicaid is the largest single payer of medical expenses. They have at times a 160 day lag in payments and their denial rate is between 20 and 25 percent and that does not include pending cases (which is most of them). BCBS.. that evil institution that we need a government agency to replace.. has a turn around rate of less than 20 days and a denial rate of less than 4 percent. So that 160 day lag and denial rate of 20 to 25 percent is the loop you are in. I have also read that most applications for medicaid assistance are accepted on the third try. So don't give up. I think the hoop jumping is part of the system to spread out cost as much as possible.

    As for the lawyer... he would know of my displease in his ineptness. There is a bar association that is always willing to take your complaints!

    Just take a deep breath occasionally and keep wading through the muck and mire of government red tape Yes you can do this and in the mean time I will keep you in my thoughts and prayers that a quick resolution will be forthcoming

    Love, deb

     
    Old 10-03-2009, 06:57 AM   #11
    polina
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    Re: Medicaid Application Denied

    Dad and I are going directly to the Medicaid/Mass Health office on Tuesday. I am taking the day off from work to go right to the horses mouth. (I think that is an old expression my mom used to use.) LOL
    I am not going to play around with this any longer and keep submitting paperwork and they keep asking for more and more. I went to the Lawyers office told him I want the paperwork and I am going to hand deliver it in person. So tomorrow on my day off I am going to sort through everything and make sure I have it all organized so when she asks for this or that I can produce it.
    We do not have time to play with anymore. Mom's Medicare benefits stopped on Sept 6th. Which I never knew about till I called the facility after I found out medicaid application was denied I called to see how much Medicare time was left. She said that had ended on sept 6th. I asked her why we were led to believe we had nothing to worry about??? Everyone at the facility social services said as long as the medicaid/mass health application was in and pending nothing to worry about. Well, Medicaid denied and I have a bill on my kitchen table for 17,000 dollars. Ok so nothing to worry about I guess.

    Mom and dad had no big money just Social Security and a small pension. So I know the Medicaid should go through. It is just a paperwork process and trail of banks accounts they want to look at.
    I do not like dealing with the State at all. Sometimes I think it comes down to a matter of what type of mood the case manager is in that day as to the outcome of your case.

    love p

    Last edited by polina; 10-03-2009 at 07:30 AM.

     
    Old 10-03-2009, 10:47 AM   #12
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    Re: Medicaid Application Denied

    I really hope it works out for you, Pauline. I remember the anxiety when Mom was out of Medcare (Dec 05) and not yet in Medicaid (April 06). My siblings had more or less decided that I would take her here if the NH threw her out, because I have no stairs, and live alone (can't quite figure it out, but that's what they thought.) I was terrified. I did not know how I would manage with her in a wheelchair. I can't lift anything, even as light she was as she lost weight. I didn't know if I would qualify to get any kind of home help. What a relief when Medicaid accepted her and the NH did NOT demand money for the 4 months it was ''pending."

    Love,

    Martha

     
    Old 10-03-2009, 11:52 AM   #13
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    Re: Medicaid Application Denied

    good luck to you. i think you have a great plan. i will never understand our insurance. i also think the nh should have let you know about medicare stopping.

     
    Old 10-03-2009, 12:14 PM   #14
    polina
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    Re: Medicaid Application Denied

    Yes, deb that is exactly what I said to the NH WHO and WHEN did you notify that Medicare had ended?? She said she told my dad. I said to her The only way it was ever said to my dad or me was that we had nothing to worry about as long as we have the application in for Medicaid. I reassured them it was filed on August 13th so they said oh don't worry. That must of been why the social worker started to hyperventilate when I told her we were denied the Medicaid. It was alwyas her that said: "nothing to worry about". She also moved mom down to long term floor from the TCU floor on August 2 knowing quite well in 9 days her Medicare would end. I would never have moved her down I would of taken a leave of absence from my job and taken her home till Medicaid went through. I would never have kept her there not being on Medicare. I knew it could be a gamble of getting approved vs a big hefty nursing home bill. I would NEVER have risked it. Yet maybe you could say well, you would be risking your mom's safety taking her home. So I guess either way we are in a jam either fiancially owing or risk mom's safety.
    Till Tuesday she will remain in good hands where she is. However if after this meeting on Tueday with Medicaid if I get any feeling in the least that medicaid may not approve us then she will come home. I cannot rack up any more of a bill. We do not even have the $17,000 due right now never mind anymore.

    I cannot wait till Tuesday when I am leaving the apt. I Hope I will have a better indication of how this is going to turn out. I am optimistic it will turn out. It alwyas seems we have to sweat some things out for awhile but in the end it turns out ok. It just makes your hair turn grey faster.

    love pauline

     
    Old 10-03-2009, 06:41 PM   #15
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    Re: Medicaid Application Denied

    Pauline

    DO NOT TAKE YOUR MOTHER OUT. If you do -- everything is over and you have to start all over again.

    What we had to do is technically abandon my mother -- we did not visit her for 4 days. it was the hardest 4 days for my sister but she also took the time to recharge her batteries and slept almost all 4 days.

    Once she was classified 'abandoned' by us, they moved heavens and earth to get her into a nursing home. Yes, they knew she only had weeks to live so they knew she'd die on the 100 days of Medicare but they moved her so fast, where before that they were just spending each day calling my sister and I and screaming at us that we were horrible daughters, that my mother must have money somewhere that we're not giving them -- we should be calling up all our family and friends and asking them for monetary help in caring for our mother if we didn't truly have it.

    That is why its really important that no one sign that they would be financially responsible because my sister thought she was signing that she understood what they were saying. The be-otch would say something and then say "do you understand? good, sign here" or blah blah blah, you understand "okay good, initial here". The lawyer was freaking out when he saw what it was that my sister signed.

    That is why he said we needed to abandon my mother.

    Caring

     
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