It would probably be helpful if you contact at least one of these agencies before you "figure everything out".
What you learn from them could greatly affext your planning.
RM
As several posters have said, the hospital, nursing home, or rehab center where your mom was being treated should not have discharged her directly to her home with no support. As an example of the services available in this situation, should it arise again: my late husband was hospitalised with a mobility and cognition crisis and before he was discharged, a hospital social worker came to his room, interviewed us in detail about the layout at our home and the amount of care I could provide. She had orders for home health care, and presented me with a list of agencies from which to select a provider. I selected a highly-regarded agency; she made all the arrangements and filed all the paperwork. The agency called me and set up an appointment for a nurse to come to our home the next day and evaluate my husband and our home situation and develop a treatment plan. The nurse came, spent about an hour with us, and recommended physical therapy at home twice a week, occupational therapy at home twice a week, and speech therapy at home twice a week. We could have asked for home health aides for bathing and other tasks of daily living, but at that point they were not necessary. The recommended therapists came and were terrific. Medicare paid for all of this. Medicare required periodic re-authorization, but the services continued for 5 months (until my husband's condition had declined to the point that he needed full-time care. And this is not applicable to OP's situation, but at the end of 5 months, when I filed a claim on his LTC insurance, the 90-day exclusion requirement of his LTC policy was met by the time he received these Medicare-provided services. That was a surprise.)
Silentnight wrote: ↑Wed May 17, 2023 10:32 pm https://www.flmedicaidmanagedcare.com/h ... ealthplans
In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. People on Medicaid will get services using one or more of these plan types:
• Managed Medical Assistance (MMA): Provides Medicaid covered medical services like doctor visits, hospital care, prescribed drugs, mental health care, and transportation to these services. Most people on Medicaid will receive their care from a plan that covers MMA services.
• Long-Term Care (LTC): Provides Medicaid LTC services like care in a nursing facility, assisted living, or at home. To get LTC you must be at least 18 years old and meet nursing home level of care (or meet hospital level of care if you have Cystic Fibrosis).
For which health plan services are you eligible?
Please enter your zip code or select your county of residence:
https://www.medicaidplanningassistance. ... y-florida/
Medicaid is a health care program for low-income individuals of any age. While there are various coverage groups, this page is focused on long-term care Medicaid eligibility for Florida senior residents (aged 65 and over). In addition to care services in nursing homes, adult family care homes (adult foster care homes), and assisted living facilities, FL Medicaid pays for non-medical services and supports to help frail seniors remain living in their homes. There are three categories of Medicaid long-term care programs for which FL seniors may be eligible.
1) Institutional / Nursing Home Medicaid – This is an entitlement program; anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.
2) Medicaid Waiver / Home and Community Based Services (HCBS) – These services are not an entitlement; the number of persons who can receive these services is limited and waiting lists for some services may exist. Intended to delay nursing home admissions, long-term care benefits are provided at home, adult day care, in adult foster care homes, and in assisted living residences via a managed care system. (snip)
.....The three categories of Medicaid long-term care programs have varying financial and medical eligibility criteria. Financial requirements change annually, vary based on marital status, and is further complicated by the fact that Florida offers alternative pathways toward eligibility.
...The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from a Florida Medicaid program. Alternatively, one may take the Medicaid Eligibility Test. IMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Florida. More.
https://www.medicaidplanningassistance. ... -smmc-ltc/
Florida’s Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) Waiver Program provides a variety of long-term care services and supports for Florida residents who are elderly or disabled and require a Nursing Home Level of Care. While nursing home care is a benefit available via this program, a variety of home and community-based services (HCBS) are also available to program beneficiaries in their home, the home of a loved one, an adult family care home, or an assisted living residence to prevent and delay the need for institutionalization (nursing home admission).......
These 3 sites should help you get started on your research.
You should not do that by yourself. It's complicated. Do it wrong, and you might have to wait months before you can submit another one. You need a professional such as an elder law attorney.
You have gotten great advice on this thread. Please, please follow it!
Don't do that until you have spoken with a Medicaid caseworker and thoroughly understand the eligibility requirements. Medicaid can severely frown on people who deplete their assets in order to make themselves eligible. From Medicaid's point of view, Medicaid is similar to the "last resort" and Medicaid views it as "you need to help yourself first" b/f relying on them. If you take money out of her account the wrong way, there could be bad repercussions. They can look at is a "cheating" if you don't do everything to help yourself first. Talk to the experts b/f you do anything. (Using her money to pay her bills is not transferring money--that would be helping yourself first)
You need to contact at least one of these agencies before you do anything. You're getting some good advice here. But you need to sit down with someone who can discuss the whole picture together with you, rather than bits and pieces as we respond to your questions.ResearchMed wrote: ↑Thu May 18, 2023 9:53 pm ...It would probably be helpful if you contact at least one of these agencies before you "figure everything out".
What you learn from them could greatly affext your planning...
In Fl and i believe this is how it works in most states if someone is already enrolled in an MA plan and later gets approved for a medicare savings program ( medicaid) they remain on the MA plan and copayments of MA plan can be billed to Fl medicaid but this is not ideal. In this case if person has full medicaid or QMB level medicare savings program and wants to remain on a MA plan it is better for the person to switch to a Dual Special Needs MA Plan (DSNP) that is designed to be seamless with Medicaid or they could revert back to original Medicare and choose one of the Managed Medical Assistance( MMA) they want as secondary to MedicareShackleton wrote: ↑Thu May 18, 2023 8:26 am First off, you’re doing a good job trying to figure this out. It is overwhelming. I’m not 100% certain since it varies by state, but my understanding is that Medicaid would replace Medicare and her Humana Gold plan. But I really suggest you read the links posted by Silentnight above (viewtopic.php?p=7272473#p7272473)
Also, the “case worker” at the doctor office is probably not a trained “social worker” which is what you need. The case worker may just be the billing person assigned to your moms account at the doctors office. Again, start by rereading and looking at the three links posted by Silentnight above.
no, but you could use excess resources above $2000 on an irrevocable burial reserve to spend down assets. Because it's irrevocable, she can't get the money back and the monies in the burial are excluded in countable resources. This is assuming she hasn't already prepaid for her funeral expenses.
You can also use the money to pay for in-home nursing care for her while you’re getting this all sorted out.arcticpineapplecorp. wrote: ↑Sat May 20, 2023 12:45 pmno, but you could use excess resources above $2000 on an irrevocable burial reserve to spend down assets. Because it's irrevocable, she can't get the money back and the monies in the burial are excluded in countable resources. This is assuming she hasn't already prepaid for her funeral expenses.
I would really hesitate to work on spending money down without a comprehensive plan. Mom doesn't have many financial resources, which means she doesn't have many options and she has a lot of needs. It may take a while to get things organized for her, there may be waiting lists, etc, etc.quantAndHold wrote: ↑Sat May 20, 2023 2:51 pmYou can also use the money to pay for in-home nursing care for her while you’re getting this all sorted out.arcticpineapplecorp. wrote: ↑Sat May 20, 2023 12:45 pmno, but you could use excess resources above $2000 on an irrevocable burial reserve to spend down assets. Because it's irrevocable, she can't get the money back and the monies in the burial are excluded in countable resources. This is assuming she hasn't already prepaid for her funeral expenses.
that's true too. any medical bills and really any bills for your mom are fine since her coverage for in home care wouldn't start until resources were spent down anyway. So she could pay credit card bills, car payment, insurance, utilities, rent, but coverage wouldn't start until her resources were spent down to $2000 (and she can't give the money away to qualify, the money has to be spent on her).quantAndHold wrote: ↑Sat May 20, 2023 2:51 pmYou can also use the money to pay for in-home nursing care for her while you’re getting this all sorted out.arcticpineapplecorp. wrote: ↑Sat May 20, 2023 12:45 pmno, but you could use excess resources above $2000 on an irrevocable burial reserve to spend down assets. Because it's irrevocable, she can't get the money back and the monies in the burial are excluded in countable resources. This is assuming she hasn't already prepaid for her funeral expenses.
From my experience, this is the worst thing you could do. I handled my MIL's Medicaid application and acceptance for the four years she was on it prior to her death. My wife and I handled her existing bills and her bank accounts. She exhausted her 145k retirement savings entirely while in her facility then transitioned immediately to Medicaid.
My dad was in the Air Force. He's still alive. My parents are divorced.WolfgangPauli wrote: ↑Sun May 21, 2023 7:21 am This is a long shot but were either your mother or father (I assume he is deceased as you have not discussed him) in the military? My parents are in their 90's and in LTC in Florida. While they can afford it (for now) there is still a lot of care you will need to provide and, believe me, you will have to check and follow up over and over again.
So, we took a shot and applied to the VA for care giving services. Initially we thought they would contribute to funding the LTC as it is clear my parents will run out of money (Due to longevity) but the VA actually provides a care giver to come in for 26 hours per week! The care giver does everything for them including just sitting and making small talk. It has been a God send for us.
Just an idea in case it may work for you.
Sorry to hear, speaks to the urgency of getting things in place. Unfortunately, living alone isn't going to work.
I agree with henry. Hospital social workers can be very helpful. What happened to a member of my family was when the rehab facility asked him if he wanted home health care (which would have been covered by Medicare or insurance, I'm not sure which), he declined it. Once they decline that offer, they cannot change their mind. We then had to pay a home health care worker. I cannot stress this enough: do not let them discharge her without home health care.henry wrote: ↑Thu May 25, 2023 11:30 am Sorry to hear that. Make sure to engage with the hospital social worker and/or case manager on your Mom's case. They will be focused on getting her to the rehab facility, but they may also be able to assist with navigating the process to qualify her for Medicaid and with your goal of eventually getting her to an assisted living facility. The rehab facility where she eventually goes should have a social worker and/or case manager that might be able to assist, but I would definitely discuss your concerns with the social worker/case manager on you Mom's case at the hospital as soon as possible.
Sorry to hear this. I agree with the others above to work with the hospital social worker to work on longer term planning for your mom.
And the HIPAA was already mentioned, but make sure of that too.
Please take the above advice VERY seriously: Home health care OR a residential facility.LilyFleur wrote: ↑Thu May 25, 2023 11:54 amI agree with henry. Hospital social workers can be very helpful. What happened to a member of my family was when the rehab facility asked him if he wanted home health care (which would have been covered by Medicare or insurance, I'm not sure which), he declined it. Once they decline that offer, they cannot change their mind. We then had to pay a home health care worker. I cannot stress this enough: do not let them discharge her without home health care.henry wrote: ↑Thu May 25, 2023 11:30 am Sorry to hear that. Make sure to engage with the hospital social worker and/or case manager on your Mom's case. They will be focused on getting her to the rehab facility, but they may also be able to assist with navigating the process to qualify her for Medicaid and with your goal of eventually getting her to an assisted living facility. The rehab facility where she eventually goes should have a social worker and/or case manager that might be able to assist, but I would definitely discuss your concerns with the social worker/case manager on you Mom's case at the hospital as soon as possible.
Does your mom have a retinologist? Is she a candidate for laser therapy or the shots to help her vision?
You are doing the right thing, managing your mom's care. This is a season of life, and I know it's stressful for you, but it will not be forever.
I mentioned in another post on this thread: you have the right to a review and appeal before discharge, whether that's from the hospital or from the rehab. As mentioned in that post - it sounds like your mother is in a MedAdvantage program. Be sure to follow the appeal process set up for MA programs. Senior Medicare Patrol may be able to help with that.clip651 wrote: ↑Thu May 25, 2023 1:47 pmI also agree, don't let them discharge her without proper plans in place (from the hospital, or later from rehab). When they start talking about discharge, if it seems to soon, or if plans are not in place, you can often appeal the discharge. This can allow extra time to get the plans in place, and it sort of forces the hospital or rehab to get the plans together. Usually on admission there is some paperwork in there explaining the rights to appeal discharge. If not, the social worker should be able to get you the info.
She was seeing a retinologist. She had laser done once and many shots in each eye. She changed her primary care physician and she was against my mom getting the shots in her eyes. She asked my mom if they helped her and she said no and that her vision was getting worse; so we cancelled one of the shot appointments (She wouldn't have been able to go anyways). They take images of the back of my mom's eyes each time she goes for the shots, so I would assume they could tell if they are working or not. I don't understand why the primary care was against the injections.
I'm not intending to be hurtful in this time of you mother's injury, but you have got to become more proactive in managing her care. When a doctors do something you don't understand, ask them why. And don't stop asking until they explain it in terms you understand.
Right, so very unfortunately, the OP is probably now in the situation where he needs to be managing mom's care the same as he manages (hopefully!) his own care. This is one of the things that happens when caretaking, even if you are not doing the hands on daily care. The patient is not really up to managing their own care. And the doctor offices are unlikely to coordinate in a useful manner. Thus .. you have to.cheese_breath wrote: ↑Thu May 25, 2023 10:40 pmI'm not intending to be hurtful in this time of you mother's injury, but you have got to become more proactive in managing her care. When a doctors do something you don't understand, ask them why. And don't stop asking until they explain it in terms you understand.
Yes, I should have done that. I asked my mom if she wanted to keep the appointment for the injection and she told me no. I feel like she doesn't have much desire to be alive (Her doctor sensed this as well and prescribed her an antidepressant).cheese_breath wrote: ↑Thu May 25, 2023 10:40 pmI'm not intending to be hurtful in this time of you mother's injury, but you have got to become more proactive in managing her care. When a doctors do something you don't understand, ask them why. And don't stop asking until they explain it in terms you understand.
Giving medical advice is against forum rules, so I'll make no remark about a prescription being written for an anti-depressant in an elderly person without any other management of possible depression.ralphboy wrote: ↑Fri May 26, 2023 10:27 amYes, I should have done that. I asked my mom if she wanted to keep the appointment for the injection and she told me no. I feel like she doesn't have much desire to be alive (Her doctor sensed this as well and prescribed her an antidepressant).cheese_breath wrote: ↑Thu May 25, 2023 10:40 pmI'm not intending to be hurtful in this time of you mother's injury, but you have got to become more proactive in managing her care. When a doctors do something you don't understand, ask them why. And don't stop asking until they explain it in terms you understand.
Wow. Again.ralphboy wrote: ↑Thu May 25, 2023 10:32 pm She was seeing a retinologist. She had laser done once and many shots in each eye. She changed her primary care physician and she was against my mom getting the shots in her eyes. She asked my mom if they helped her and she said no and that her vision was getting worse; so we cancelled one of the shot appointments (She wouldn't have been able to go anyways). They take images of the back of my mom's eyes each time she goes for the shots, so I would assume they could tell if they are working or not. I don't understand why the primary care was against the injections.
Lots of good advice from TN_Boy, a real voice of experience (who gave me good advice when I posted a question here about managing my late husband's care a couple years ago).TN_Boy wrote: ↑Fri May 26, 2023 10:59 am
I can say that you probably want to understand the total list of your mom's prescriptions. You might find, as many of us have, that the list is amazingly long. I spent a lot of time trying to get relatives off medications that were no longer needed, inappropriate for their age (dosage required for a 30 year old versus a 70 year old) actually interacted badly with other medications, etc. The problem is specialist one writing a prescription for condition A, then specialist two writing a prescription for condition B, repeat five or six times and the medications themselves start becoming a significant issue (e.g. if you are taking three or four medications, all with a possible side effect of dizziness, you can put your money on falls happening often).
No she does not. How does she go about doing this?Several people have asked if your mom has Power of Attorney and Healthcare Power of Attorney documents.
Your conversation with the case manager sounds promising. I believe that with the right discharge orders, Medicare will cover these services for several months, so do ask about that.ralphboy wrote: ↑Sat May 27, 2023 10:39 pmNo she does not. How does she go about doing this?Several people have asked if your mom has Power of Attorney and Healthcare Power of Attorney documents.
I spoke to the case manager at the hospital today and she gave me a phone number to get help about assisted living from a place called Care Patrol. I'll call Tuesday morning.