The official Medi-Cal letter came today. Mom was denied Medi-Cal. What can we do?

Just adding, in my State you are only allowed 90 days to apply, spend down and find a place for the person. If not done within that time, u have to start all over. Hopefully your proof of spend down now will get her medicaid.

https://www.medicaidplanningassistance.org/medicaid-eligibility-california/

Scroll down and there is a chart saying there is no limit. In my state ur allowed just over $2300. Are you sure that the money she had set aside for her AL was not considered part of her assets.

My Mom was in an AL running out of money. I placed her in LTC when she had 20k left, which covered 2 months of private care. During that time, I applied for Medicaid, got Medicaid info needed and showed them I had spent down Moms money and the 3rd month Medicaid started. You have to have her money spent down before Medicaid will pay. She can't be over the 2k allowed.

You should have the ability to appeal but u only allowed so much time. If there is an overage, see if your state allows Miller Trusts.

That she is in AL poses an issue as technically if they are a resident in AL they are supposed to be able to provide for themselves with some assistance on occasion. The requirements to have to provide for a safe lateral transfer of care that NH are required to do by Medicare are not in place for AL.

note: this is why it’s so very very important to have them evaluated for level of care needed periodically.

An AL can do a discharge to the community…. Which if no family comes to get them usually means they get sent to a shelter. That really rarely happens as it’s lousy PR, bad optics. Instead what an AL will do is ahem….. find that the resident appears or “presents” with some sort of medical issue that warrants having EMS come and take them to the ER / ED. The often used one is they look like they may have had a TIA ( transient ischemic attack) as TIAs are really super subjective as to how you look. Anyways EMS come and whisks them off to the ER where they are either held for observation or admitted. Either way the old AL will now state that they cannot have her return as she requires a level of care higher than what this AL can do. Mom now becomes a problem for the discharge planner at the hospital to find her a bed in a NH. This tends to be what happens. An ER dump.
Now the discharge planner will do whatever to clear the case & that tends to mean lean heavily on family to come & get them, so prepare at to letting planner know clearly that you will absolutely not be coming over and taking her home; that they need to find a NH for her.
BUT & perhaps…
as she is in hospice, I’d speak with the hospice group as to her getting eligible & fast tracked for placement in an in-unit / in-facility hospice within a LTAC. It’s totally different than a standard hospitalization. It’s long term acute care. It is a Medicare benefit but not easily accessible as you cannot on your own get admitted. But often some hospice groups have their own free standing LTACs or are affiliated with one adjacent to a hospital.

Both my MIL and an Aunt were in ones. For Mil, she was in a NH and got pneumonia and off to ER & admitted. LSS she was placed on hospice as she became real septic. Hospital moved her from hospital bed to the LTaC next door. It was separate but connected via air bridge to the hospital. From the outside, it looked like part of the hospital, but actually was an LTAC with different levels of care. Hers was real end of life care as she was having cascading organ failure but others were lots of younger cancer patients on serious black box drugs and why they were there and long term. For my Aunt, she was in an IL that was part of a tiered facility (it was a sister facility to the IL where my mom was), Aunt had a sudden stroke and off to the ER/ED, it was determined she “needed 24/7 clinical care” and went into a totally free standing LTAC facility, that in its past was a womens & children hospital, and then became an LTAC. The hospice group at the old IL/AL/NH ran this LTAC. My mom went to see her and noticed that it had a lot of younger patients who seemed kinda ok but was told they had a cancer, End stage AIDS so needed 24 hr clinical care.

Kindred Hospital group is the big player in LTACs. They don’t have an ER / ED, so you cannot come off the street and get admitted. It’s all via a referral from the hospital or hospice. MediCARE will cover the stay if your eligible and Medicare beds available. Really speak with her hospice to see if her chart can be freshened to show this type of need for “24/7 clinical care”. In theory you could get better while in the LTAC and get discharged to “skilled nursing care” aka a NH.

then you use this time to get her CA Medicaid straighten out so that she can get discharged and then go into a NH as a dual aka on MediCARE and Medicaid. & yeah I’m with Bill & Alva that there was a snafu in the correct data used in her determination. Get an appeal filed.
Good luck.

As you mention in an answer to another answering this query, she was not denied because of her Social Security. That complete amount, whatever it is, would go to the facility with medical picking up the remainder. She was denied because she had too much in an account over the allowed amount. I am afraid you are up against having to refile, making certain that there is not too much in her account, and that it was properly spent down. Speak with the Medi-cal prepresentative about how to proceed. Consider seeing an Elder Law Attorney to expedite this, as Mom's 700.00 may be eaten up right there. Also speak with the nursing home as to how you are proceeding. They will not be allowed to throw an elder out into the street. Do not take her into your home. That will make all of this ever so much more onerous moving forward.

I found this: Share of Cost Medi-Cal
If you are "over-income" for Medi-Cal but have high health care expenses like nursing home fees, then you might qualify for a program called Share of Cost (SOC) Medi-Cal. SOC Medi-Cal allows recipients to pay a certain portion of their income every month towards their medical expenses, and Medi-Cal pays all of the expenses incurred afterward. The portion that the Medi-Cal recipient pays is called his or her share of cost.
SOC Medi-Cal is an important resource for individuals who might have higher incomes but who find that they cannot afford the cost of long-term care. However, Medi-Cal only lets long-term care residents keep a very small personal needs allowance ($35-$50/month) when they have nursing home fees paid by SOC Medi-Cal. Any non-exempt income above that personal needs allowance has to be paid to the long-term care facility before Medi-Cal will cover additional costs each month. In essence, Medi-Cal pays the difference between the monthly cost of the nursing home and the monthly income of the Medicaid recipient (minus $35).

https://www.nolo.com/legal-encyclopedia/when-californias-medi-cal-will-pay-nursing-home-assisted-living-home-health-care.htm
Besides this, I would definitely contact your congress critter and "7 on your side" or whatever TV station. This lady's on hospice, she has nowhere to go, and our state allegedly has a surplus and is not helping her?

Good luck

You need to call APS and tell them the situation. The State social worker will know what to do in situations like this, as it is very common. You do not have to take her home with you nor pay any of your own money either. By the way I think the Medi-Cal application may not have been done properly, if your mom needs NH care and only gets $1567 a month, she absolutely would qualify for Medicaid. Call APS, also the ombudsman let them know the situation. They will not let mom just be kicked to the curb.