How on earth do elderly adults with pensions above the Medicaid limit afford nursing homes?

My 91 year old grandmother is living in an independent senior living facility but needs a higher level of care. She has a generous federal OPM1 pension and SS benefits totaling $4500 a month, but no assets. Her total income after medicare costs is about ~4000/month, and she’s also paying down prior debts and life insurance, bringing her down further to about $3500. I applied for Medicaid for her and was immediately denied. Every nursing home costs $7000+/month, including the state-run facilities. How on earth am I supposed to get her into a higher level of care?

Edit: Her current income is $4500/month. Her expenses:

Rent: $2400/month

Medicare A/B and D: $400/month

Prescriptions: $200/month

Groceries/personal care: $200/month

Utilities (cable, phone): $85/month

Nursing care: $440/month right now (this is currently added onto her rent and could be increased to bring down her income – would that work to put her in medicaid range???)

Debts: $600/month (we had no idea about these until her dementia worsened – too late to do anything about them besides either pay or default)

Life insurance: $150/month

Net: $325

Medicaid limit in my state is $2300/month so despite her net income she did not qualify, unless we add $1000 in nursing costs and re-apply. (She really could use more nursing care.) Would that work?

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