Mom is in the early middle stage of Alzh. she is still able to walk and dress herself ....feed herself etc......mom is private pay now...when she runs out of all of her money ...in a few months...can Medicaid say my mom is not sick enough yet to pay for her nursing home bills...my fear by then she will be out of money....not sick enough ..then what..need help...Thanks
If they are living at home or in IL, and need to move to a NH, you will need to work with their MD to get the criteria in their medical history to show they need skilled nursing care. Just because they are old, or have dementia or incontinent, etc. is not enough. My mom went from IL to NH and bypassed going to AL. She was able to do this as she had a critical weight loss (more than 10% in 30 days), critical H & H and some other conditions. Sometimes the MD will need to change their meds – like go from Exelon pill to Exelon patch (more “skill” to apply); or change a med from a pill (that in theory they can easily take) to medication that needs to be compounded daily which you can’t do at home. Each state has it’s own criteria for admission under Medicaid. They will be evaluated at the NH (by a state Medicaid medical evaluation person - usually a MSRN or MSW) and often are denied because they don’t have enough “critical” conditions because there is no history when living@ home (unlike coming from a hospitalization). You will have to work with NH and your parents MD’s to get whatever done to establish the need for NH if they are coming from being at home or IL. There is a whole Medicaid medical appeals process in each state for this and separate from the financial appeals.
For those still living at home without a huge disease history, becoming a patient of the MD who is the medical director of the NH is good as they will know how to create & write up the health history chart so that it passes Medicaid medical review. For my mom, she went to her gerontologist every 6 weeks and the moment she hit "critical" on her weight loss, he wrote the SNF needed orders so she could get admitted to the NH.
If your mom is still at home and still seeing her old internal medicine doc or family medicine doc, they usually don't know how to do her chart to reflect the history to show the need for skilled nursing care. Understand? That's why a gerontologist or medical director of a NH for her doc can be very important.
Even then there are glitches...I am very OCD on the whole Medicaid process and my mom was initially rejected medically because the idiot aide at the NH did not include every prescription my mom was taking even though it was in her chart. They only put down 1 RX - well that is just not enough. It was an easy fix, but nothing I could do to make sure it was written correctly or even know that it was missing as the medical paperwork is done by the NH. Good luck and keep a sense of humor, you'l need it.
It sounds like your mother has not "failed" enough of these tests, but you may be able to advocate on her behalf, as some of the other posters have suggested, and get her qualified before she completely runs out of funds!
The financial part is easier. The medical qualification could be one person's opinion and they may have never even met your mother! Be an advocate and stay on top of doctors, offices and physical therapists who can help on this.
Remember that Medicaid personnel do not have to meet your mom--only take someone else's word for it!
One more helpful tip. My church had a lady who had worked as a social worker before. She took my application and crossed out several sections that we did not need to fill out. This really helped.
After that, leave no unanswered answers on the application. We were complemented on a nearly perfect application with, what we thought, were complete supporting documents. But you guessed it. We were turned down on our first try. Just keep plugging away and you will Mae it!