Could use some help and guidance. My 89 y/o mother only receives $1254.00 / month income as Social Security Income. She recently qualified for the Medically Needy Medical Assistance program in Florida. Her monthly cost of share was determined to be $762.00 / month. Any chance someone has knowledge of this program and how my mother's share cost is determined. The numbers seem unrealistic.
In addition, I help provide additional money to help my mother pay her monthly bills, about $900.00 monthly. This money is used to pay her bills from my banking accounts. Is there any impact because of this? Thanks.
Id suggest you try not to get lost in the maze that is Medicaid. But always try to narrow your searches down to Community based Medicaid Medically Needy Program. Like don’t get caught up in long term care Medicaid stuff. Read & reread then go to see a staffer at the AoA aka Area on Aging for your county / region to see what’s available in your area and just what the criteria is for them. Your mom / you as Dpoa is still going to need to deal with the Medicaid caseworker who evaluates her eligibility & compliance for the exact one she’s on. But AoA should be able to help you find what else is out there and who (like clinics, universities, local groups) participates in your area.
AoA is a division of the Council of Governments aka COG. Cogs are regional policy planning and clearinghouse bodies (they funnel federal & grant $ within their footprint & partnership up to do this). All states have them, maybe 1 statewide (like NM) or dz plus (like TX). It’s your tax $ at work. The Aging Area has been part of COGs since forever (1970’s) and some are so big & well funded that they are their own freestanding buildings (like Houston area COG has 3 AoA buildings seperate from their COG “parent”). Often ombudsman program is within AoA section of your COG. COGs do other stuff, like regional transportation planning; ACA navigators might get based at the COG.
one thing that occurred to me is that you don’t want the $ 900 of yours to ever, like never ever, get placed as “income” for mom. If it was the $900 paid for bills in moms name directly out of a bank account solely in your name, that should be ok. You kinda don’t want it that you pay mom $ which she then uses to pay her bills. It looks like “income” & can muddy up her financials.
also try to find out if moms health care & RXs would be easier to manage if she was to go into a MCO (managed care organization) that participates in the FL Medicaid Medically Needy program. advantage could be that if it’s a MCO they know to set up health care costs to be dated/billed first few days of the month, so Mom hits her $762 (or whatever you hopefully get it lowered too) early so then MCO can bill FL Medicaid the second it’s at $763 in costs. I can just see if you have to track & submit moms bills here & there from oodles of vendors to get to the sweet spot of $762, it’s gonna be exhausting unless she has a regular single big RX of $ 762 each month. (Don’t confuse MCOs with Medicare Advantage plans.... it’s confusing as a lot of the same insurers do both plus regular health insurance; yeah it’s a ton of acronyms to know, but it is what it is & thank goodness Medicaid is out there). Some states community based Medicaid require enrollees to go onto a MCO if there’s ones available (Tx does this). Good luck, stay organized.
BUT I’m wondering if, possibly if, when mom was applying, that the $ you personally pay (that $900) for moms cost of living, was NOT factored in for determining what her co-share needed to be. So yeah your on the right track that there is an impact due to this.
Like Medicaid looked at her “bills” (aka Economic Self Sufficiency in Medicaidspeak) that she actually pays and in her bank statements and it appears moms ok on $500 a mo outside of her health / medical bills. So it ends up being $762 coshare.
She should have gotten a Notice of Case Action document on the $762. “Notice of Case Action” is Medicaidspeak, & she / you as Dpoa need to file an appeal ASAP. I bet it’s time limited
My guess is if some her bills get paid directly from your $, it probably didn’t get into her Medicaid spread sheet, that was used to determined “Economic Self Sufficiency”. If it had she’d be $900 negative income each month ($1254 income, $2154 expenses). I’d suggest you ASAP do an eExcell like document on all her living expenses. You want to be have it so that you & caseworker / appeal hearing all looking at the documentation simultaneously. Comprende?
You know that Medicaid program is some kinda sticky (eyes glaze over). It seems, to me at least, is that her share of cost is based on the sum of her health care costs for the month; BUT it’s only until she hits a full $762 in self pay will state Medicaid pay her health care expenses. (I’m guessing that your mom has significant medical issues and their costs and that’s why she’s needing Medicaid.). If this is actually how it pays (clearly ask caseworker & what counts towards the tally), then imo mom / you need to do couple of things....
- have reoccurring bills get dated to early early in the month. Mom needs to hit her $762 as soon as possible into the month so Medicaid can take over.
- her health insurance premiums, I’m pretty sure, are monthly health related costs. So those can get deducted from her $762 ceiling.
- her prescriptions too need to get refilled and paid by her early into the month, so they too get deducted from the $762. If her meds just on their own are $762, get them refilled on the 1st of the month.
- if she has monthly MD visits get those too early in the month.
You want her at the sweet spot of $762 the first days or week of the month if at all feasible. So Medicaid picks up the rest. Also it will make it much easier to do the reporting/ bookkeeping with Medicaid.
if you would let us know what exactly you find out on getting moms Economic Self Sufficiency redone. We do all learn from each other. Good luck too.