So as the saga continues with the POS Aetna insurance who lets remind everyone will only approve skilled nursing facilities nothing with acute in the name or Sub. They give you a list of approved places that they will send the patient (and again it doesn't matter what a treating doctor, team, physician suggests. Aetna will decide on their own what a person needs or should I say what will pad their pockets even more:) Ok so we got a list of places about 7-10 pages of places. Now most of these places are rated 2 stars or below - places that I wouldn't even send my doggies too let alone my MOTHER. Dad and I sit down and call these places - tell them the full scoop of what mom needs and then hear "oh no we can't accommodate those needs".
Wait! I am a little confused because on the papers it shows that these places have responded with accepting my mother. Well how can that be? I mean it doesn't take a smart person to see right through this crap. Oh, and let's mention here that one of the approved places from the great ol' AETNA states clearly "patients and loved ones must be ok with housing with sex offenders" Are you FREAKING KIDDING ME!!!!!!!
So, we find a place that literally is amazing and wouldn't you know its outside the state. Good cause PA needs a swift kick in the ass with these facilities and what they allow to go on.
Fast forward to last week when the facility gives us a document outlining what would be needed for Medicaid application.
So, Aetna will only approve facilities that give them a good kickback cause why not it's all about the money and not the actual health or wellbeing the people they are to serve. However, Aetna will only approve 5-7 days at a time for that person to stay in that facility. If the patient doesn't improve per I don't some fictitious magic scrolls with requirements listed because I can't find anything to set me straight than Aetna has the right to stop payment. Again, approve to go to facility, get their funds and then can terminate whenever! Regardless, they will ONLY allot for 100 days at most which again turns over to Medicaid or some other organization. Wow AETNA you really should get an award for the most jacked up organization on this planet and with that have every single person that you love have to go through exactly what you put the hard working, bill paying, people here in the real world through.
Ok now lets go down the rabbit hole of Medicaid. Per Medicaid guidelines an individual can only make $2,987 a month to be under the income limit to qualify. If they are over that amount (lets also mention here that they go off gross income that means its not on what you actually get deposited but rather the full amount prior to any deductions) WOW ok so anyone else seeing how we are being screwed from every angle? NO! Just wait it gets better!
So they include retirement, pensions, anything that is considered income. You add all that up and if over that magic number that I don't know Barney came up with (yes the dinosaur), you will have to set up a Qualified Income Trust fund also known as a Miller Trust. This is where all that income is to be deposited into for Medicaid to withdrawal from for my mother's care. Also, let's mention here that mom was no SSA disability and that would have qualified her but once you turn FRA it switches from SSDI to regular SSA which takes that option off the table. While I am on this too why is this the case? I mean if someone is on SSDI and turns full retirement age then ys the amount changes to full retirement but why take them off SSDI and for all purposes put them on SSA as if they were never disabled to begin with or that magically their disability stops at FRA. I don't know seems a little fishy to me! Ok so now her full SSA and the little pension she gets will now have to be sent monthly to this QIT fund. That fund is irrevocable and will only cease upon the death of the grantor. If mom gets better and the trust needs to be closed, then you have to seek legal action to do so. Also, the money that is deposited in there at the beginning of the month is considered Medicaid's regardless so at a trustee of that account you can't pull any money out. So now the household is losing over 3000 a month but oh here is the good news. They let us keep $75 dollars a month for necessities. Wow I mean that's so kind of them cause that will take care of all the bills and everything else that is necessary to survive in this messed up economy.
To set up a QIT you must fill out a form which I retrieved off the Ohio Medicaid website. Now, nowhere on this form does it have a place to be notarized, nor does it have to be witnessed by anyone. So, mom had a great day yesterday and was able to sign the form. Thank you, LORD, for that. By Ohio state law you do not need the QIT form to be notarized however, a bank may require it to open the account. So let me again see if I am getting this. Per state you don't need the form to be notarized and even though the facility is in the state that has that law, they can make up their own requirements. Ok got it! So what do you do when a person is in need of long-term care and I don't know can't walk, can't move out of a bed, can't verbally talk, and is on so much medication because she just went through ANOTHER surgery that could have been avoided that she sleeps most of the time and when awake only for a short time. Yesterday was the first GOOD day we have had in weeks. I mean do you take and fold up a notary and put them in your pocket in the even that another GOOD DAY arrives? Seriously, asking because this is insane.
So if we can't set up a QIT then mom is not eligible for Medicaid which mean that over $111,000+ will fall on us (dad and myself) to pay out of pocket.
Lets also talk about that as moms spouse my father is considered the "Community Spouse" which means that he is also to be included in the application and all assets are to be included. IF those assets are over $35,000 then she is ineligible unless you do what they consider a spend down. So anything over that you have to spend down to that magic number of $35,000. There are various ways to do this with funeral burial arrangement, etc. Most of the "spend down" items are things that either most of us have already or it just adds another monthly payment that is needed. So, you take on another bill to pay, you're losing the full income of the patient, only allotted $75 a month to keep, and that will qualify the person. How does any of this even make sense. As the assets go the person needing Medicaid anything that has their name on it is included. They are allowed to exclude 1 vehicle which is not included in the assets but this should be the vehicle valued the most or cost more. You also have to go off of what the items are valued at. Meaning if it says that your vehicle is worth 10,000 that's what is put down as the amount for the asset it associated with it doesn't matter if you would actually get that or not. If you have an older vehicle, you can purchase a newer one to be included in the spend down but then it gets added to the assets and again the value of that vehicle. I don't know the full scoop on this to be honest because at this point none of this made a lick of sense to me and by brain was like spinning.
Per Medicaid, the patient and the "Community Spouse" must include all assets, banking, savings, documents, burial agreements, and a whole list of items.
I spent 2 full days and nights not sleeping and found around a bout. Which will get mom qualitied and only using her income ONLY and the 2 assets her name is one which puts her under the asset limit. However, now we are trying to find a way to get a QIT established which needs to be done in Ohio since that is where mom is or she will not qualify until that fund is set up. Even with a POA my father is limited as her spouse to do anything for her. Again, depends on the facility if they will accept the POA with 2 witnessed or not.
I am so frustrated that I can't even begin to express the sadness, the hurt, the anger, the rage that is inside me. Thank God I own the house and that is off the table but even still I would sell my home in a heartbeat for my mother to receive the proper care because that's what it's about for me THE CARE, THE LOVE, THE HEALTH of my mother not MONEY! Even if I did, what my house is worth after I pay off the mortgage it wouldn't be enough to even get through 2 months. If we sold everything in this house and outside the house it still would maybe cover 6-8 months. What if mom needs longer than that. If we can't afford her care and she doesn't qualify for Medicaid, then the facility can discharge her, and they have the right to do that. Where? no idea - back to a place like transitions - HELL NO I can't even think about that.
I now fully know the meaning of Welcome to the SHIT Show!
I have no idea why NO ONE is seeing this or hell they are and not doing a dang thing to change it. That's a real problem!!!
So, to sum this up - we pay all our lives for ourselves and others. It means nothing! We try to follow the rules which change like the weather - can't get anything. We all are human and will get sick, injured, go through needing medical assistance, hospital stays, or long-term care yet when it comes down to it what are we paying for? Why? It doesn't mean a jacked-up thing in the end. Our system is broken beyond anything that I could have imagined! This is real life and the more and more I talk about this the more and more I hear stories of things like this happening all the time. It's not just my mom, our family, the insurance we were forced to take, or even the laws and regulations. Its the system that allows this to continue to happen. The system that things this is ok. Its the people in charge of those systems that need to be held accountable for everything. The people that we elect who sit behind a desk collect their paychecks, their benefits, and do absolutely NOTHING. It's the people that hold titles to make and change regulation but refuse to either do so or turn a blind eye to the brokenness. ENOUGH IS ENOUGH!
I have a little over 230 signatures on this petition!
We need to be the change!
We need to make our voices known! We need to change a system that refuses to see us as human beings who's lives matter and to those around us who care for us or are left to navigate this messed up system while the people they are fighting for lay in a bed suffering and dying. Sign the petition or don't the decision is yours but, in the end, we are all going to need a system that is there for us. A system that if in a time of need we don't have to go through the stress and sleepless nights trying to fight a system that will never change on its own. The ONLY thing a family should be worried about is their loved one and them getting better. We all deserve that peace of mind, and it won't happen unless you stop being silent and afraid. Don't sit there and say well the next person will sign or there will be enough signatures. No there won't be and you did not want to take initiative to be a part of the solution means your part of the problem and may God bless you and yours. Help me fight and sign the Petition now