Medicaid for nursing home resident. Mom has a balance owing that accrued while awaiting Medicaid approval. Anyone have experience with this?

I just signed paperwork for my mother to go into NH on Rehab. In the paperwork there is a statement that says if for any reason she needs to be sent to the hospital she would be responsible for a daily charge to hold her room until she returns from the hospital. I told them she doesn't have the funds to pay a daily hold fee for a room. They said in that case I would need to take all her belongings out of the room and she would have to wait for another rehab bed when discharged from the hospital. They also said that when she changes from rehab to SNF and I put in the paperwork for Medicaid she would have to pay whatever she can afford each month toward her stay until Medicaid comes through. I take it that they mean whatever amount she will need to pay from her income less the $50 allowance when Medicaid starts paying. I'm just hoping that she doesn't need another hospital stay while in rehab. Her problem right now is most of her income is going to pay for her ALP placement. They will hold her room while she is in Rehab but that must continue to be paid for. I have still to learn how this affects her insurance once going on Medicaid. I don't know if MLTC takes over and her Medicare and supplement goes away. Very confusing and I work in the field!

Zelda,

You need to contact the Medicaid caseworker. Mom cannot pay for something she cannot afford and you are not responsible. You shouldn't even be getting a bill. Mom contributes her SS and pension. Medicaid does the rest.

This is a billing error by the NH or its something Medicaid picks up. Whatever, its not ur responsibility. Once my Mom was on Medicaid, the NH became her payees and I never saw a bill.

Was your mom officially discharged from the NH?
Was there any prior notification of this charge?

We had to hire an elder care attorney to figure out what we needed to do to get Dad to stay at the nursing home. After all was said and done, after several months, the nursing home paid the attorney’s bill. Since we were getting the attorney for Dad, I think that Medicaid made the nursing home pay. But my brother talked to a Medicaid person and got it started.

Zelda - for more fun something else to deal with could be on the horizon..... since your mom’s approval for LTC Medicaid is fairly fresh, her being on Medicaid may not have caught up with BCBS yet...... Most BCBS policy’s have it that IF another entity can be the secondary insurance then the BCBS has to be either suspended or cancelled. BCBS will retro back to date Medicaid started and premiums will be repaid. Any providers paid by BCBS during this period will get a clawback of payments paid. So they will have to rebill in a timely manner to Medicaid and get paid whatever Medicaids reimbursement rate is. It probably will be much much lower than what BCBS pays.

If your moms Blues has this system, please send a letter to the NH clearly stating that BCBS will be suspended (as she is now on Medicaid) and that all providers need to be notified by the NH as it’s the NH who hires or contracts the various providers for the NH. It will be the outside vendors - like podiatrist, Mobile X-ray co - who are affected the most. They will not be happy when the clawback finally surfaces.

Wow! I’d find an elder care attorney!! They’re robbing you. My mom was in AL. They took all but $40 of her SS & applied for Medicaid for her. She kept getting bills with a balance due each month but we were told to ignore that, they have to send bills out. Once Medicaid went through, no more bills

I'm a nurse that has worked in NH's and this just doesn't make sense to me.
In my state, when patients were waiting for Medicaid to kick in the NH just billed the state for the back payment. It seems they only care about the money if they charge you a late fee every month.
If it were me I would call the state and have them check out their billing policy.
The NH will have the 800 number to the state agency visible when you enter the billing along with the survey.

Money maker for the NH. They're using hospital admission to justify this charge. Take a look at the contract. It should state out if the resident is charged if he/she is admitted to the hospital. Readmit fee. does not make sense since she has not been discharged from the NH. If that was the case, then you would be able to move her somewhere else and get a final bill from NH

i don’t know if this is the right answer . But even if mom goes into the hospital your still paying rent at the NH for thirty days even if she’s there or not. It all depends on how your agreement was worded that you signed. Some things aren’t covered by Medicaid also. And maybe her other insurance doesn’t pay if she’s not there. I’d ask for an itemized statement of charges and read the lease on the nursing home sometimes there is a one year or two year spend down your paying for before Medicaid kicks in. I was told by Medicaid not to pay for mom’s placement while she was in the hospital. They closed my claim because of this. Now reopening. I don’t understand a lot of this either and image there are a lot of people out there that don’t. Medicaid is such a hush hush thing and they don’t give families much information. People also need to be careful of what they sign before signing these agreements. I had my attorneys look mine over and there were some things I would have been stuck. Paying for if I hadn’t had them look it over . Best to contact someone before signing these NH contracts

I'm assuming, hoping all of the financial commitments you have made to NH have been made in mom's name, you simply signing as her POA/agent meaning she is the one responsible financially. I thought the usual practice when a NH resident went on Medicaid was that the NH required that patients income to be assigned to them, setting aside the allotted personal account amount for the pt and then they and Medicaid worked out the balance payment, that remove the need for you to do anything with the finances but maybe it varies state to state.

It sounds to me like there has been a miss-communication or something within the business office or perhaps Medicare/Medicaid but that shouldn't be costing your mom. Again some of this may vary a little state to state, Medicaid is run by each state and actual dates may come into play but once Medicaid has kicked in there shouldn't be any back bills left. That's the point they don't kick in until she meets the income and asset requirement, sometimes even back paying a little but she shouldn't have any funds available to pay back rent. Still if I'm understanding this correctly;
Mom entered NH under Medicaid rehab/hospital stay status in Sep. say Sep 1 for these purposes (100 days max) did she enter from a hospital stay that might have started the 100 days prior to entering rehab or another rehab prior to this? Also that 100 days I believe include a lifetime benefit, has mom had any hospital stays in the past that lasted more than 30 days?

She became a long term NH resident at the same facility after being considered a rehab patient when those 100 days ran out around Nov 29. Her BC/BS was paying the co-pay up until this point and may have still kicked in to cover a portion of the cost maybe in conjunction with a different part of Medicare but leaving her with an out of pocket co-pay.

Medicaid approved and kicked in March 1 so she had at least a partial if not full pay for 3 mos. In March she had a trip to and was admitted to another hospital for 4 days or was she a skilled nursing patient there at the same facility? I believe there has to be 30 days of not being a "skilled nursing" or admitted to the hospital patient before a new occurrence starts, otherwise it's considered part of the original admittance but it looks like that should have been met easily. Now it may be that she no longer had the BC/BS policy in effect for that March occurrence so NH is charging for that portion but Medicaid should have then covered it since you didn't drop BC/BS until she was being covered by Medicaid.

I would urge you to talk to a Medicare counselor and a Medicaid counselor before paying another dime out of pocket to the NH, you might even find you need to talk to BC/BS depending on what the other two say and then once armed with info from the payer representatives go back and talk to the NH. You obviously aren't trying to get away with anything or not pay a bill mom is responsible for, no one can accuse you of that and the facility you have chosen made the choice to accept all of these insurances and the rules or parameters that come along with that so you aren't trying to get away with anything by holding them to that.

I don't know anything about the co op shares or how they are considered and passed on but I agree with JoAnn29 you might want to do some investigating about where they fit in when Medicaid was looking at moms financial profile, the last thing you want to do is put your mom and sister in a worse position unintentionally.

Good luck, these insurance, coverage, financial details are rarely simple especially dealing with Medicare and take a lot of time and energy to work out, your mom and your sister are so lucky to have you taking care of these details, watching out for Mom.

I looked up co op shares. So my question is, how did Medicaid look at this? Like a house she is allowed to have? If so, you may not be able to turn over the shares. This is a question for Medicaid.

Another question would be how the NH is billing Mom. Once she is on Medicaid there should be no extra billings. She has no money and you are not responsible for the debt. I would ask her Medicaid caseworker about this. Also, putting late charges on a balance owed.