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My Dad is in long term care and on hospice. I am his guardian and am learning as I go along. I missed his Medicaid redetermination deadline after he was only on it for 5 months. I quickly sent in paperwork and documents because we have a 90 day grace period to submit but his coverage was dropped due to the lateness. I’m so scared. I call them often and the first few told me it was processing but then I was told I was missing something and 2weeks later I was told it was the wrong application. I actually had some one tell me it was denied due to being over income limit which can’t be the case because nothing has changed about his income. Then the next person couldn’t tell and that it was processing. His nursing home has been harassing me. I’m terrified! I can’t sleep or eat. Would they actually kick a man in hospice out until the decision comes through?
Thank you so much for this valuable information. I will take all of this and get started on it. It’s so intimidating!
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Reply to Heypaula
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What state does he live in? Medicaid rules vary by state. This info is important.

Request a meeting with the nursing-home administrator or business-office manager, not just whoever is calling about the unpaid balance. Tell them:

“His Medicaid redetermination/reinstatement is pending. I need you to document his account as Medicaid pending and work with me to resolve the eligibility issue.”

If the facility actually threatens an involuntary discharge while Medicaid is pending, that's the point where you should contact the state Long-Term Care Ombudsman immediately. CMS's guidance on this particular issue is unusually clear.

If Dad's Medicaid eligibility determination is actually pending, a Medicaid-certified nursing home cannot simply discharge him for nonpayment while Medicaid is deciding his eligibility. CMS specifically addresses this situation in its nursing-home regulations and guidance.

That said, stop relying on repeated telephone conversations with different Medicaid workers. You've already been told several contradictory things—processing, missing information, wrong application, over income, etc. You need to establish in writing exactly what the status of his case is, what was submitted, what (if anything) is missing, and whether his case is being treated as a late renewal/reconsideration or as a new application.

Keep copies of absolutely everything you submit and proof of when it was submitted. As his guardian, I'd also ask the nursing home's business office/social worker to help you straighten this out. Medicaid-certified nursing homes routinely deal with residents whose Medicaid applications are pending.

If his income and assets truly haven't changed and he qualified only five months ago, an alleged “over-income” denial deserves investigation. There may be an administrative/documentation problem rather than an actual change in eligibility.
And don't let the nursing home intimidate you into personally agreeing to pay his bill. You are his guardian; that doesn't make his nursing-home debt your personal debt. His funds are used according to the Medicaid rules, but don't sign anything accepting personal financial responsibility.

[ Info aggregated by ChatGPT5.5 ]
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Reply to Geaton777
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