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I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
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BJM - I was kinda assuming that mom's in a NH..... But if not & living at home & is on hospice fairly recently, it could be that her medical costs are viewed as now totally paid for by Medicare. Hospice is a Medicare benefit, so it should pay for caregivers, equipment, speciality nutionals.......needed. Hospice MD is now her doctor. Only if she needed to see a doctor for something outside of hospice care would she need Medicaid, like she sees her old ophthalmologist for glaucoma. The problem may be related to hospice taking over all care. It's something to put into the letter / fax you send.
Now Medicare does NOT pay for any room & board charges, so if mom was in a NH, she would need Medicaid to pay her daily R&B charge. But your moms at home, so that's not an issue.
As an aside on this,my mom was in a NH for about 3 years and fell (pulling her wheelchair no less!) so became bedfast and went onto hospice. Stayed at NH with Medicare hospice benefit paying all medical costs AND Medicaid paying her R&B for her last 18 months. There was a shift in costs of RXs and supplies from Medicaid to Medicare once on hospice. I mention this as perhaps IF hospice is recent, Medicaid has shifted costs they paid to Medicare.
Also hospice as its Medicare, is self-directed. Which means mom or you as her DPOA can change providers. I did with my mom's within her first 90 day period. First hospice really took the position of its a count down till death approach. My mom was a tough tiny old bird and I knew she wasn't going anywhere soon. Switched hospice providers and it was a big, big, bigly difference. Both got the same rate paid by Medicare but #2 really got on it... Ordered Geri bath & Geri regular chairs, a on variable timer puffing mattress, Twin Cal HC drinks, feeding bibs and met with dietary to get changes done amoung a host of other things. My point is, mom can change hospice if you think she could get better care.
Whomever is moms DPOA needs to file an appeal ASAP. Usually in an ineligibility notice there should be listed the reasons why and a page on appeals process and timeframe. I'd suggest you do this via a certified letter sent uspo with the return registered card (about $8.00 for the duet) AND via fax from a FedExKinkos or other office store that can provide a transmission report on the fax.
Keep it short like under a page and that you need further clarification on documents needed.. Or whatever else sounds appropriate. Hopefully this buys you some time. I'd do both fax & a mailing.
? for you? What is moms Medicaid contact address? If moms in a facility & it's going there that is recipe for problems as the NH cannot open her mail and letters just get buried into a drawer. If mom as dementia, who know what happens.... All needs to go to whomever is moms DPOA at their current address. If moms application was done ages ago, it could be a bad address is still lingering in her state file.
If you just got this notice (like March), I'd bet it's a snafu on 2 things... - awards letters & - annual recertification. That combined caused her to become ineligible.
Awards letters are a trifold that get sent from SSA and most other retirements that state to the penny what the amount mom will be paid for the incoming year. Usually sent in Nov & Dec. Mucho importante as that is the figure used to determine if moms monthly income is under the limit for Medicaid AND the amount of $ mom must pay to the facility as her required co-pay or SOC (share of cost). If mom went from a community based Medicaid program (so she was still at home) to a facility the income limits can change for eligibility. Plus she MUST do the copay to the penny. Pause to think if there could be an issue with the income in her awards letters.
Annual recertification. Some states do these so that it's an actual multipage document that is mailed & must be completed and submits with supporting documentation. Documentation for my moms was both things submitted in inital application (like funeral policy & life insurance) and then updated items like last 4 mos of bank statements (probably to make sure no assets over 2k) and last tax assessor bill (my mom continued to keep her home). I had no idea there was an annual recert done. I'd either boxed up all paperwork on my moms application or shredded stuff..... Then about 16 mos after my mom was in a NH, I got the recert letter as I was on file as her DPOA and it required all to be submitted and within 15 days from date of letter otherwise ineligibility could be placed. FUN! It was about an 8 page questionnaire and with supporting documentation around 30 pages total. For extra fun in this, letter was postmarked about 10 days after date of letter. This pattern of the recert letter being received basically when it was due back....... continued for every recertification for my mom. For year 2 I was totally ready.
It could be if your mom qualified years & years ago, that the state has finally got around to doing a recertification. If the mailing was sent to her or to a bad address, it never got done. So mom became ineligible.
Personally I've found calling the State at the general 800 # just doesn't matter. You need to send things via fax or certified mail as it provides for proof that things were requested or done. It places responsbility upon the state to correctly have the request or documentation go to the right department or section.
Yes I have called them but they just said to apply again. They said nothing about reinstatement. I found out about that on the internet, asking questions. I'm just afraid how long it will take , due to her condition.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
Now Medicare does NOT pay for any room & board charges, so if mom was in a NH, she would need Medicaid to pay her daily R&B charge. But your moms at home, so that's not an issue.
As an aside on this,my mom was in a NH for about 3 years and fell (pulling her wheelchair no less!) so became bedfast and went onto hospice. Stayed at NH with Medicare hospice benefit paying all medical costs AND Medicaid paying her R&B for her last 18 months. There was a shift in costs of RXs and supplies from Medicaid to Medicare once on hospice. I mention this as perhaps IF hospice is recent, Medicaid has shifted costs they paid to Medicare.
Also hospice as its Medicare, is self-directed. Which means mom or you as her DPOA can change providers. I did with my mom's within her first 90 day period. First hospice really took the position of its a count down till death approach. My mom was a tough tiny old bird and I knew she wasn't going anywhere soon. Switched hospice providers and it was a big, big, bigly difference. Both got the same rate paid by Medicare but #2 really got on it... Ordered Geri bath & Geri regular chairs, a on variable timer puffing mattress, Twin Cal HC drinks, feeding bibs and met with dietary to get changes done amoung a host of other things. My point is, mom can change hospice if you think she could get better care.
Keep it short like under a page and that you need further clarification on documents needed.. Or whatever else sounds appropriate. Hopefully this buys you some time. I'd do both fax & a mailing.
? for you? What is moms Medicaid contact address? If moms in a facility & it's going there that is recipe for problems as the NH cannot open her mail and letters just get buried into a drawer. If mom as dementia, who know what happens.... All needs to go to whomever is moms DPOA at their current address. If moms application was done ages ago, it could be a bad address is still lingering in her state file.
If you just got this notice (like March), I'd bet it's a snafu on 2 things...
- awards letters &
- annual recertification. That combined caused her to become ineligible.
Awards letters are a trifold that get sent from SSA and most other retirements that state to the penny what the amount mom will be paid for the incoming year. Usually sent in Nov & Dec. Mucho importante as that is the figure used to determine if moms monthly income is under the limit for Medicaid AND the amount of $ mom must pay to the facility as her required co-pay or SOC (share of cost). If mom went from a community based Medicaid program (so she was still at home) to a facility the income limits can change for eligibility. Plus she MUST do the copay to the penny. Pause to think if there could be an issue with the income in her awards letters.
Annual recertification. Some states do these so that it's an actual multipage document that is mailed & must be completed and submits with supporting documentation. Documentation for my moms was both things submitted in inital application (like funeral policy & life insurance) and then updated items like last 4 mos of bank statements (probably to make sure no assets over 2k) and last tax assessor bill (my mom continued to keep her home). I had no idea there was an annual recert done. I'd either boxed up all paperwork on my moms application or shredded stuff..... Then about 16 mos after my mom was in a NH, I got the recert letter as I was on file as her DPOA and it required all to be submitted and within 15 days from date of letter otherwise ineligibility could be placed. FUN! It was about an 8 page questionnaire and with supporting documentation around 30 pages total. For extra fun in this, letter was postmarked about 10 days after date of letter. This pattern of the recert letter being received basically when it was due back....... continued for every recertification for my mom. For year 2 I was totally ready.
It could be if your mom qualified years & years ago, that the state has finally got around to doing a recertification. If the mailing was sent to her or to a bad address, it never got done. So mom became ineligible.
Personally I've found calling the State at the general 800 # just doesn't matter. You need to send things via fax or certified mail as it provides for proof that things were requested or done. It places responsbility upon the state to correctly have the request or documentation go to the right department or section.