Dad hit by car. Medicaid just denied. Now what?

Igloo has it right. I had to do a Medicaid appeal for my Dad once. Mom couldn't get the paperwork together as requirements had become tighter since over the years since she had done it before, and neither she nor I initally realized she was having enough cognitive decline she couldn't cope without chewing out all the people who would have helped her. It sounds like you are on your way to having your ducks in a row for this, and Medicaid just needs some i's dotted and t's crossed with documentation of his level of disability that either someone didn't send or someone there lost. Keep dated copies of EVERYTHING and make friends with your fax machine. My dad's nursing home made a try to get his Social Security rep payee rather than wait on us to sort it all out, which would have immediately impoverished my Mom, but I got it instead. They did just need to wait, and then they got all they were owed when the dust settled, as they knew they would...they never even considered trying to give him the boot. Glad things are looking up.

Hello, all. I finally got answers from the nursing home and with your help in knowing what to ask, they know that I know that I'm not responsible for his bill. That is taken care of. --I've called the Medicaid caseworker and repeatedly left messages the last two days. Hopefully, she'll call me back tomorrow. I did receive a letter in the mail from Medicaid stating that he was denied because he didn't meet the eligibility requirements for "disabled." WHAT??? He is on a g-tube, difficulty with speech, doesn't know his name most days, has limited use of his right arm/hand, cannot walk, and half of his brain is dead. He also does not have his left skull flap. This just doesn't make sense. Hopefully the caseworker will call and help me figure this out and appeal.

What a nightmare, this could happen to any of us. I feel for you.

For me, the central question is WHY was he declined by Medicaid? You need to find that out to determine what to do to get him qualified.

Medicaid has 2 tracks that have to be done - financial & medical. Now the financial will deal with all his assets & income and each state sets their own cap or ceiling on what those amounts are. Like Texas Medicaid for NH has assets @ 2K and monthly income at $ 2,094.00, so if you get $ 2,095.00 in SS & retirement a month, you are $ 1.00 over and will be declined Medicaid (there are things you may be able to do if this is the situation too). His having a home & a car is OK as their home & a car are an exempt assets for Medicaid (except if the home is over your state's limit or if they are viewed as unable to do a "right of return") - the home or car does not have to be sold, the state will not seize it but someone other than dad will have to pay for everything on the house. If dad has items that have a cash value - like a whole life policy or a term policy with a cash build up or a funeral policy that can be cashed in - or if dad has any other assets like a boat, rental property, 401K, CD's, investments, etc, then he will be declined until those items are cashed in and all those funds used for his care. You don't mention his wife, but if there is one Medicaid will look at all their assets & income to determine acceptance. So could there be $ that has to be cashed in or spent down?

Another thought is that since there appears to be a "secondary payer" & a lawsuit or other legal that could be involved (like the hit & run is found and their insurer will end up paying), that Medicaid is declining until they know that no one else could be out there to pay. There is a whole set of federal regulations on "Secondary Payer" that went into effect in 2012 and basically if Medicare or Medicaid pays for something which later on is paid by another (like via a insurance claim or lawsuit) then before you can get any of the money, the M & M's have to be reimbursed for whatever they paid. The settlement can be held in an escrow like account until all that is worked out by the attorneys, then the balance is released. Maybe Medicaid assumes that since he is young and this was due to an accident that there will be insurance &/or litigation and won't pay until the insurance &/or litigation is resolved. You need to find out just what is keeping him from being accepted.

If he does eventually get a settlement, it will likely suspend him from Medicaid as it will be an asset that will have to be spent-down.

About the medical - that has to be done by the facility. Maybe he is being declined as the facility he is in does not provide what the state will reimburse for. Like some trauma rehab places are very VERY specialized and expensive and Medicaid although they will pay for skilled nursing will not pay for the higher level of intense care at that type of facility. If he moved to a regular NH, then they might pay. I would speak with the social worker where he is to see if this is the case and if so, where else he could get into.

Really speak with the actual state Medicaid caseworker to find out what is causing the decline of his application. Whatever the case, you need to file an appeal and within whatever timeframe is on the letter from the state stating the decline. If he was admitted Medicaid Pending and you are documented to be in the appeal stage, the facility cannot force you to move as per Medicaid regulations. They can however do 30-day notices to you during the appeal process. they will probably also try to get you to sign off to be financially responsible so hold firm on not doing that. Best of luck and let us know what you find out.

apassmore, it is a difficult situation. I have been trying to think of things you can do and realize that what others said about bringing the state in may be the best option. It could take time to liquidate his estate and he needs help faster than that. You need to get a state caseworker going through this with you. The NH your father is in may know a caseworker who would be dependable. It would be nice if you could get a referral to one. When you cold-call, you never know what you're going to get. All state workers were not created equal when it comes to being helpful. The good thing about social workers is they know how things work, and they know what resources are available.

I hope that you are able to find someone to walk through this with you and your dad. You are both victims of this crime. I am mad at and feel sorry for the person that hit your dad and fled. I wonder if he/she lives daily with what they did and not having the courage to face up to it.

Champagne Charlie - it's a kind of frozen syllabub with crushed ratafias blended through it - highly recommended. Don't know about the gas, was probably too merry to notice.

Your father is a victim of a crime, hit and run...... Not sure what state you are in, there might be some assistance that way. Is there a remote chance while he worked, he had some kind of insurance plan that might cover expenses... AFLAC or whatever. Just a thought. I agree he should be eligable for disability. Be careful when you mix wine and icecream..... gives you gas!

A hit and run would complicate things with Medicaid. If the car has been identified, the auto insurance company would pay all of his care plus lost wages and then some. A good personal injury attorney should have filed a lawsuit. If dad has a lawyer, call him Monday morning. Dad shouldn't need any kind of Medicaid, the person who hit him PAYS ALL OF IT.

Well, yes, the insurers would have to pay up - unless it was a hit-and run. Is insurance, or a police investigation, complicating things with Medicaid, could that happen?

Awful timing to learn this - late on a Friday, with no one to call. Try to get some sleep, it may be a cliché but it's true that things always look better in the morning. Tomorrow do some homework, including on guardianship - you're not going to be able to set up POA, by the sound of your father's injuries. Terrible thing, I'm so sorry.

Thanks, gang! It was a hit and run situation...big mess unto itself. I will try to catch my snap with a big bowl of ice cream and a glass of wine! Ha! Veronica, I needed that! ;) I'm feeling calmer. Monday won't be here soon enough and it's rare that I say that about Monday!

Someone suggested a website where you can get free legal advice. There is much involved here that can't be solved over the weekend. The website is AVVO. Signing up is easy... find the category for personal injury. You can be lead to an attorney in your area who may answer your questions. I know this is very stressful and sorry to hear about your father.

If he was hit by a car, the drivers car insurance should be in play!! You shouldn't need Medicaid at all.

Has your dad applied for disability? He is only 60 and clearly will never be able to support himself. Stop worrying yourself silly about all this. If he owns his home it will have to be sold and the proceeds used to pay for his care. Medicaid usually comes in and takes house and contents and sells everything. the social worker at this current NH should be helping you with this or go to social services and they should help. Don't worry your dad with this he has enough on his plate even if he can understand anything. if he is taken to a hospital they can't just throw him out and you should be prepared to refuse to take him even for one night. You may loose the right to direct his care but you can still be a loving daughter. It is the weekend so try and relax, have an adult beverage if that is your thing. Meet up with a trusted friend and have a good cry if that helps. Come back here, people really care for each other and have faced equally challenging situations in their caregiving lives

My first question is if the person who hit your dad was at fault for the accident. If the person was at fault, what is happening with the insurance claim? If it is relevant, you may want to get your lawyer to pursue that. Insurance companies have caps on how much they cover, but I've heard of incidents where they will pay more. I am so sorry that you are having to deal with this. I am always so scared for bicyclists, because I know that many people don't drive so safely around them and accident can be so deadly.

Thank you. This really helps. I appreciate your time :)

Know too the nursing home wont just but him on the curb. They may transport him to the hospital and a social worker at the hospital may be able to help too.

The house is a huge asset and if he is going to qualify for Medicaid it well have to be sold. Talk to the social worker at the nursing home and see if some type of plan can be put in place. Get that attorney in place to protect you and your dad.

It sounds really awful to do but you may have to just walk away and abandon him in order for the state to come in to get him care but know if you do that you wont have any say on your dads care or where he ends up. So get that lawyer on the phone

All he has in assets is his home. And I did not sign any paperwork saying I was responsible for his bill. I skimmed it all and the social worker repeatedly told me I would not be help responsible. --Dad will get kicked out of nursing home during the appeals process? Where will he go? I cannot provide the intense care he needs. UGH. Thanks for all you help!

Does he have his own money or assets that have a value more than $2500? If he does he will continue to be denied. Does the nursing home accept Medicaid residents? Not all do in fact it can be very hard to find.

Did you sign paperwork that stipulated you were responsible for your dad's bill if he can't pay? They would have told you at the time that "...by signing this you are guaranteeing payment in the even your father cannot pay" or something to that effect. You can't accidently sign this paperwork. For instance, when my dad went into a nursing home I signed paperwork stating that I was his emergency contact person, his POA, and his closest living relative. However I did not sign paperwork stating that I would be responsible for his bills at the nursing home. Once my dad died with a small outstanding balance owed at his NH I contacted them and they told me pretty much what I just told you.

However, if you are a responsible party the NH can try to collect the outstanding bill from you.

Medicaid has an appeals process. Call your caseworker and see about starting that appeals process. From what I remember with my dad I don't think your dad can stay at the NH during the appeals process but I'm sure someone smarter than I can tell you for sure.

And P.S. Get the POA as soon as possible for the future.