Medicaid - Culling the Rolls

[Anonymous]

My mom is on Medicaid for her nursing home. She has dementia, MS. She cannot feed herself and has multiple seizures a day. Basically, she had to go on Medicaid to cover the costs of round the clock care. The nursing home recently got her hospice services to help the understaffed nurses help care for her.

Our healthcare system is not set up for this scenario. She is in a red state that is currently reducing the expanded Covid Medicaid services. I had to resubmit all her paperwork showing she can’t get a job and has no assets. Because of the massive backlog, it may be another 6 months. Because of this “renewal,” they have kicked her off Medicare Plan B. I’m worried the nursing home will kick her out. I’m just livid. What do they think they will accomplish by all this? She has been unable to work, feed herself, walk, function for the past 8 years. She isn’t going to be able to work.

Thanks for listening to my rant. If you have any experience with Medicaid renewals for nursing homes or know who I should talk with the change our nightmare system, please let me know.

[Anonymous]

Lawyer or the Congressman. Contact in the geographic area of the nursing home. Contact them about specific services denied - not about fears.

[Anonymous]

Anonymous wrote:Lawyer or the Congressman. Contact in the geographic area of the nursing home. Contact them about specific services denied - not about fears.

State Senator or US Senator?

[Anonymous]

They cannot discharge her without a safe plan. So she won’t end up on the street. But she could get transferred. Just don’t agree to take her.

[Anonymous]

Anonymous wrote:My mom is on Medicaid for her nursing home. She has dementia, MS. She cannot feed herself and has multiple seizures a day. Basically, she had to go on Medicaid to cover the costs of round the clock care. The nursing home recently got her hospice services to help the understaffed nurses help care for her.

Our healthcare system is not set up for this scenario. She is in a red state that is currently reducing the expanded Covid Medicaid services. I had to resubmit all her paperwork showing she can’t get a job and has no assets. Because of the massive backlog, it may be another 6 months. Because of this “renewal,” they have kicked her off Medicare Plan B. I’m worried the nursing home will kick her out. I’m just livid. What do they think they will accomplish by all this? She has been unable to work, feed herself, walk, function for the past 8 years. She isn’t going to be able to work.

Thanks for listening to my rant. If you have any experience with Medicaid renewals for nursing homes or know who I should talk with the change our nightmare system, please let me know.

This makes no sense what so ever. Your mom is not on regular medicaid she is on a specific long term medicaid that pays for nursing homes. As long as you submit the paperwork it should be fine. They will not kick her out. Are they threatening?

Hospice is paid for via medicare and different situation.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Lawyer or the Congressman. Contact in the geographic area of the nursing home. Contact them about specific services denied - not about fears.

State Senator or US Senator?

Not pp, but US Senator. Let those GOP folks know the consequences of their actions. And then, vote Dem, get your friends to vote Dem, and organize as many people as you can to vote those right wing GOP members out

[Anonymous]

I’m so very sorry OP. That is a heavy burden for you to bear.

Our politicians at the state and federal level and our profit driven system is undeniably cruel. Every other developed country offers minimum health care and most have affordable and or sr care more readily available.

[Anonymous]

They cannot kick her off Medicare. Medicare is a completely different program. If this is what you heard someone tell you, there was a miscommunication and you need to ask for the information again.
The good news for you is that your mom is in. Medicaid population that will be least likely to lose coverage during this process. It is good you submitted her paperwork, and she should be fine. Again, the idea that someone has kicked her out of Medicare does not make sense.
Good luck.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Lawyer or the Congressman. Contact in the geographic area of the nursing home. Contact them about specific services denied - not about fears.

State Senator or US Senator?

OP, before you contact elected officials, I would make sure that you understand every step you described in your post and that they are accurate. If you incorrectly describe the situation and the state senate staff (or whomever) find that out when they are following up with the nursing home/state Medicaid office/etc, then they may not advocate as vigorously for your mom.

When I was in a somewhat similar situation with my mom, I contacted the state rep, the state senator, and the county ombuds office for senior services. I also found a nonprofit legal team based in the state capital, who lobby for seniors, including on nursing home conditions, Medicaid, etc. I also reached out to the press, but my mom's situation was not individual, but involved the whole wing where she resided in the retirement home. If it were just her, I would have probably not done so, but the story involved one of the leading non profit institutions in the city. Finally, when on the phone with nursing home staff, I shared that I was based in DC, knew folks at CMS, etc. That helped break the logjam - they were already getting bad press with lots of comments from the Dem state rep and the GOP state senator - and the home reversed their decision. Sadly too late for one resident who was transferred out and ended up dying from transfer trauma soon after.

If it were me, I would probably ask to speak with the home's social worker and ask them to explain the situation to you point by point. Perhaps reach out to the ombuds rep first and see what their understanding is of the circumstances. After that, approach the elected officials. If you can find any other residents similarly affected, then try to engage them/their relatives/friends too.

My thoughts are with you. Please keep us posted as this unfolds.

[Anonymous]

Anonymous wrote:I’m so very sorry OP. That is a heavy burden for you to bear.

Our politicians at the state and federal level and our profit driven system is undeniably cruel. Every other developed country offers minimum health care and most have affordable and or sr care more readily available.

To be fair, there is one party that is completely against Medicaid and will do anything to undermine the program's efficacy as well as the benefits for any of the recipients. And they exist at the state and federal level.

[Anonymous]

Health care ombudsman for long term care. Most likely this is state level

[Anonymous]

OP - You have gotten good advice and I would find the Ombudsman person at the state level and start there. You might also contact your local Office or Aging or if there is a Senior Center in your area and ask them on the local level, too, how to proceed. It is likely they are hearing from others in your area about similar questions and concerns. Keep a copy of all forms that you submit no matter how long they are.

[Anonymous]

Anonymous wrote:They cannot kick her off Medicare. Medicare is a completely different program. If this is what you heard someone tell you, there was a miscommunication and you need to ask for the information again.
The good news for you is that your mom is in. Medicaid population that will be least likely to lose coverage during this process. It is good you submitted her paperwork, and she should be fine. Again, the idea that someone has kicked her out of Medicare does not make sense.
Good luck.

OP here. She was kicked off *Medicaid* and Medicare *plan b*. Medicaid was covering the cost of Plan B. The way that Medicaid works for nursing homes is recipients must spend down all assets the government allows them on $60 a month. Now that she has to pay her Plan B coverage (taken directly from her monthly social security check), it complicates her very tight budget and she will run a deficit now. The nursing home has been taking the previous Medicaid amount even though she has been suspended until reassessed.

TL;DR: our healthcare system is a complex nightmare.

[Anonymous]

Anonymous wrote:

Anonymous wrote:They cannot kick her off Medicare. Medicare is a completely different program. If this is what you heard someone tell you, there was a miscommunication and you need to ask for the information again.
The good news for you is that your mom is in. Medicaid population that will be least likely to lose coverage during this process. It is good you submitted her paperwork, and she should be fine. Again, the idea that someone has kicked her out of Medicare does not make sense.
Good luck.

OP here. She was kicked off *Medicaid* and Medicare *plan b*. Medicaid was covering the cost of Plan B. The way that Medicaid works for nursing homes is recipients must spend down all assets the government allows them on $60 a month. Now that she has to pay her Plan B coverage (taken directly from her monthly social security check), it complicates her very tight budget and she will run a deficit now. The nursing home has been taking the previous Medicaid amount even though she has been suspended until reassessed.

TL;DR: our healthcare system is a complex nightmare.

It sounds like what you are saying is that her Part B was suspended/terminated for non-payment when Medicaid stopped, and then reinstated when she began paying personally via a Social Security deduction. Is that correct?

Can you share the stated grounds for the Medicaid termination?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:They cannot kick her off Medicare. Medicare is a completely different program. If this is what you heard someone tell you, there was a miscommunication and you need to ask for the information again.
The good news for you is that your mom is in. Medicaid population that will be least likely to lose coverage during this process. It is good you submitted her paperwork, and she should be fine. Again, the idea that someone has kicked her out of Medicare does not make sense.
Good luck.

OP here. She was kicked off *Medicaid* and Medicare *plan b*. Medicaid was covering the cost of Plan B. The way that Medicaid works for nursing homes is recipients must spend down all assets the government allows them on $60 a month. Now that she has to pay her Plan B coverage (taken directly from her monthly social security check), it complicates her very tight budget and she will run a deficit now. The nursing home has been taking the previous Medicaid amount even though she has been suspended until reassessed.

TL;DR: our healthcare system is a complex nightmare.

It sounds like what you are saying is that her Part B was suspended/terminated for non-payment when Medicaid stopped, and then reinstated when she began paying personally via a Social Security deduction. Is that correct?

Can you share the stated grounds for the Medicaid termination?

The state is reviewing eligibility and has a huge backlog due to Covid. She has had zero changes in her life. The entire review paperwork is geared to people living in a house on their own or with kids. It isn’t set up for nursing home residents with power of attorney. I was told she will likely be fine and they will back pay all the nursing home charges but it is on me to recoup the Medicare Plan B coverage from the insurance company (in her case Aetna). Infuriating!!