Does anyone have experience with Texas Medicaid?

Princess - please please realize that Medicaid requires eligibility for BOTH financial and medical. There is so much emphasis on $ as there’s scurrying abt on getting financials statements...tracking down just wtf mom was doing with $110 cash each mo.... deciphering names on old checks, etc. BUT having mom show to be “at need” medically is equally important and in many ways is much more the challenge as you are gonna have to work with & schedule appts within health care system to get mom to clearly show “at need” and if this is for a NH placement, that means needing skilled nursing care. Just being old or falling or unable to manage her meds or iffy on her ADLs, well, it won’t cut it for needing “skilled”. Those at that point are good for AL and AL by & large for TX is private pay.

Most NH admits nationwide (I’ve read up to 80%) are coming in post hospitalization; usual scenario...fell, broke hip, hospitalization and surgery then discharged for rehab at a NH. All these are payable by mediCARE benefits. Medicare NOT Medicaid. The rehab is pretty well 100% covered by Medicare first 21 days then go up to 100 days (@ 80%) if they are still “progressing”. For the facility, they are happy as Medicare pays oodles more. But eventually the elder either goes home or stays in the NH & segueways from being on Medicare rehab benefits to applying for Medicaid LTC if not private pay. They have this nice fat medical file that shows need. For those in an AL, they too probably have a regular updated medical file and if the AL has an affiliated NH they know how to bridge their chart to qualify for Medicaid. But for those of us whose parent is still at home or in IL, no fat file. So you or your bro are gonna have to figure out how to build moms health chart to clearly show the need for skilled nursing care. Her doc can write orders that skilled needed but it has to also be clearly backed up within her health chart over time. As a first step in this, to me, you need to have a sit-to with her primary doc to see where she is on her status. Depending on what’s mom is like now, this could take months or a year of health monitoring. I did the jump to hyperspace & got my mom, in TX., from IL to a NH & Medicaid Pending; totally bypassing the AL phase and it took about 6 mos of every 3-4 week visits to moms gerontologist. The visit mom had a 10% weight loss, bad H&H labs and a couple of other things, doc wrote orders for skilled nursing needed and I got her moved into a NH within 40 days.(Needed to time to cleared 30 day notice to IL.) State sent a 2 person assessment team to NH to do a multi page determination of need. & there was an issue as NH left off RXs from moms chart. So medical appeal had to be filed. Staff at NH takes the lead in medical appeals and it’s kinda all on them to get thier game together. Updated medication and co-morbidity info sent by NH to state before appeal hearing date (like 6 mos out), so all good.

My point in this is that you cannot overlook the medical requirement of Medicaid.

Katie, the lawyer suggested FIL scan the individual receipts since most people have smart phone or scan on printers. If a check is for a bunch of different items, you might scan the receipt and mark check # paid. As the money pot gets smaller, reasons for exclusion will increase and the path to getting help will have more roadblocks. Since the tax bill passed, the next items to be reviewed will be entitlements, which means Medicare and medicaid will be on the chopping block. Good records now will prevent crises later.

Princess- now financial, here’s my take regarding financials..... it’s my belief that the state uses a formula (an algorithm probably proprietary) that the caseworker enters data into and then consecutively an auto search is done based on SS# of applicant and spouse (even if deceased) within state database on real property (all tax assessor info dovetails to overall state database in Austin). The formula has a basic monthly cost of living & insurance that is deducted. (Lots in TX are FEIB and that’s a set $amt each month). And within application caseworker also looks for a pattern of spending, like $75 each month to Dillard’s, $45 to life insurance. If something seems amiss from what the formula & pattern show, the application is red flagged for further review. Whether it’s local caseworker or regional review I believe depends on what’s amiss. Caseworker- at least when I did my moms - was by zip code. So they kinda know the area and where more affluent, like those in 78209 probably more $$/more savvy than 78201, so they do the evaluation of reasonable local costs. Regional or Lubbock does the review on ones with more high-cotton financials (like LBDs, O&G or ranch-lands); they seem to do the appeals too.

Like say mom is a widow, who has 3 sources of income. Now her “awards letters”, show $1000 SS, $700 dads pension, $300 her teacher pension paid to her each mo. Awards letters mailed usually Nov for what is being paid monthly for the incoming year. Her awards letters are a required document for Medicaid application. So Medicaid know to the penny what income is & was. Mom lives with you with no caregiver contract done. Mom sold home with no mortgage 3 yrs ago for 300k. Mom now 3 yrs later is applying for Medicaid. Application gonna be red flagged cause no way mom down to 2k in assets.

Mom makes 24k a yr plus 300k. So where did 370k go to? Mom is not expected to live on air, but her share of housing costs are probably expected to be under $200 a mo per item. If she’s paying for caregivers, that needs to be shown. Caregiving would be within her “pattern” of spending. I’ve found the caseworkers and upper staff of TX Medicaid within the application process to be very fair and sensible, but you as dpoa have to provide documentation to show why & where funds were spent that is plausible and get it via fax or mail over to caseworker or regional within the tight timeframe the state legislature has set for them. Everything seems to be date stamped & it’s outta thier hands if your late on getting an item to them.

As an aside on the latter, for my moms annual renewal, I did not know renewals were even done. I packed up all medicaid paperwork into storage once she became eligible. Renewal Letter came and due within 14 days. For even more fun, interior letter dated several days before mailed date stamped on envelope. Flew back to TX to get paperwork and submitted it (over 30 pages which was less than the 100+ pages in initial application) along with a detailed extremely terse cover letter to DHHS regarding their timeframe requirements. I got a call back from staffer in Lubbock that all ok and sorry for lagtime between letter & mailing. I’ve found it is important to pay attention to the details as it can be used to your favor.

Good luck with Medicaid, especially if your mother had some assests the past five
years. They want records for everything. My mother was approved the first time I applied without any problem, but since I have reapplied for her, they now want
records from 2012 up to current date including all bank statements, invoices, receipts, deposits, withdrawals from her accounts. I'm at a loss, I can't even imagine gathering
so much information, plus all the receipts! I don't have all the receipts. And I have not had any help from the Reps at Medicaid whatsoever. It's been soooooo stressful and frustrating for me. I don't know what I am going to do next. We can not bring her home, nor pay for private care. All her savings were spent on her nursing home prior to applying for Medicaid.

If you come across someone that can actually be of assistance, please let me know. Good luck.

Check Texas state website for how to apply as each state has its own requirements.

Princess, LONG POST but you asked.
My Favorite Quote from igloo who is the Medicaid Guru:
Remember when you do a Medicaid application, you sign off full access to the state system to get data on you wherever.... IRS, retirement, banks, etc. You also have to provide all information on life insurance, so they will know if mom has a term 100K policy and who is the beneficiary.The brokerage houses send 1099's on all accounts so that will show up too.
In my own experience, my Father-in-Law went to a lawyer experienced with Medicaid before he applied for mother-in-law (married will allow some asset movement within 5 years, but theory is same). Medicaid wanted FIL and MIL to sign off that they could review IRS tax filings for up to 5 years to see how much they made vs what they presented in bank statements and expenses. Medicaid wanted the award letters for the current year from Social Security, statements from any pension plan showing the balance and monthly payments due to MIL, copies of any 401K or stock investment accounts or IRA accounts, copies of all pages of any life insurance term or whole and value, any prepaid funeral plan or burial plot asset, and any long term care insurance plan. Lawyer made sure that when my MIL applied for Texas Medicaid this summer, FIL had detailed bank statements for 5 years (they asked for 2 for initial application, but Medicaid folks said they'd probably want 5 years when MIL renewed). Since bank statements included copies of checks, Medicaid was less interested in individual receipts if it was obvious what check was for (car payment, property taxes, utilities). Any cash withdrawals over $200 they wanted to know what it was used for. Any check written to a person they wanted to know what it was used for. If it was stated for health care or caregiving, they were interested to know if there was a W2 or 1099 filed for it or it might be considered gifting (especially if paid to family member or friend and over $600 for year total). If it was to some odd company or charity, they wanted to know. MIL sold her car; Medicaid wanted to know what the money was used for and whether it was for market value or a family transfer below market that would cause a penalty for gifting (it was to an independent big name car lot and used to pay down a credit card held in both names). Credit card payments - Medicaid was interested to see what was bought on the credit card if it was large or unusual purchase (like plane tickets or furniture).The good side is that credit card supported the medical expenses and doctor co-pays that were crippling in-laws. Medicaid wanted to see records of any property transfers (these are public record and the state will post them, Medicaid will find them, and any unrecorded transfers can be invalidated later with liens on property). Yes, it can be a huge task to get someone on Medicaid, but you are asking for thousands of dollars of care be paid with public dollars. Especially in Texas, the money available is getting less and less and the need is more and more. We were told that the biggest problems with medicaid is folks that didn't understand annual renewal, that didn't have records that supported expenses or explanations, that didn't report assets or transfers like ladybird deeds within family without documentation at original application, or that moved money after application without providing proof it was for patient benefit and not someone else.

It's my understanding they want receipts for anything over $200 from her accounts.

Caregiverhelp - what are they asking receipts for? The only asset my mom has is her home. We sold her car last year after she had an accident.

I know Medicaid looks back 5 years, but I’m unclear what they look for. Since taking over her finances, it never occurred to me to keep receipts because, honestly, I never expected to have to apply for government assistance.

Thanks for all the good info on this thread. I live in Texas with both my parents in memory care. They are anywhere from 5 to 7 years (depending on expenses) from needing to apply for Medicaid (if they outlive their assets). I need to proceed with record keeping etc. as if that will happen.

Question about receipts.. do all receipts need to be saved? Like if I pick something up for them at Walgreens and pay with a credit card. Is the credit card detail enough? Is check detail enough? Most of their expenses have some kind of electronic trail. I never use cash for anything for them.

Thank you so much, Igloo. Your info is extremely helpful!!