My mom’s Medicaid didn’t cover her first two months of nursing home care. I was told they would. Now the nursing home is wanting their money. Any advice?

Speak to Medicare and Medicaid first. Have it confirmed that neither of them paid for your mother's first two months in the nursing home.
It could very well be that they did pay. It is not unusual for a nursing hme to 'double-dip' in the first months a person is placed. This means they get paid from insurance, but want to make sure they also get the cash pay from the family as well.
They will not kick her out because legally they cannot just put her put on the street if they accepted her in.
The nursing home my father was in pulled this on me. They got paid for the first months by Medicare and his secondary insurance. So I forced them to refund the money they fraudulently took in cash. They refunded it. They also threatened about him having to leave. That's all it is. A threat that they cannot make good on. You check with Medicare and Medicaid first to see if they paid it. If they did not, then the nursing home can recover what they're owed from your mother's assets and income.
You DO NOT sign anything about assuming responsibility for any of her bills. If you don't understand what some form is that the nursing home wants you to sign, refuse to. Let a lawyer look it over first.

Is there a cash value the that insurance policy? Normally those need to be cashed in order to qualify for Medicaid, then spent down.

Medicaid penny pinches like crazy. Like any red tape govt run apparatus, military, SSI/Disability etc, one key thing to victory is outlasting them in the fight & keeping them constantly annoyed until they just want to be rid of you. They always so "NO" the first 10 times....
Since they promised you, hope you have that proof, but even if not, keep at em till they give. In the meantime, be real, transparent with the nursing home & don't be so proud as to not play the "Feel sorry for me card!" Offer to pay what you can in the meantime, $25 a month, whatever to buy the necessary time and stay in their good graces.

Just a thought, in the 2 months that Mom was on Medicaid pending, did her Social Security and any pension she received go to the NH? If not, it should have. For my Mom, that would have been $3400 for the two months.

Just read Igloo's last response to you. I did the Medicaid application with the help of the Medicaid caseworker. What I did not supply during our appt I was given a list of what I still needed to provide. One month before Mom received Medicaid, I confirmed everything needed was there. Not sure how Medicaid pending works but there must be something on the application for retro payment.

I'm going through this for my wife. Very stressful experience. Begin Medicade application immediately and, if possible, get expert advice on how to do this. Our local hospice has a new program of counselors, I'll be seeing one next week.

Daphne, personally I’d tread super carefully on going after the NH on “False Representation” “False Advertising” stuff.
If Medicaid is involved the NHs are dependent on elder or elders POA or family to provide in good faith to Medicaid that info & documentation needed to establish that elder is “at need” is accurate. NH don’t really do deep dive into the elders past. If POA leaves out items that would cause a transfer penalty based ineligibility for LTC Medicaid OR if POA is unaware of how asset transfer penalty works and files for LTC Medicaid AND THEN the elder is found to be ineligible for Medicaid, both of these puts NH in a difficult position.

Between my mom and MIL we ended up dealing with 8 different facilities in 2 states (TX & LA) & for MiL some of these were community based Medicaid congregate living facilities. Nothing but fun but quite the learning experience. NH all had a checklist of items needed to accompany LTC Medicaid application & the list varied as to how they described the items even within the same State (super fun!). Some NH did cursory look at the supporting documents needed for LTC Medicaid; others actually did a match up from their list to the document & reviewed in detail; and 1 put all documents - did not check to see if all items there and no review- in a packet along with their bill to Medicaid and sent it over to the caseworker assigned to this NH. The congregate living places were way causal in document review and they did the put it in an envelope / folder and send it off approach.

The problem - imo- becomes that if there is an issue with financially “at need” requirement, it will be weeks till issue surfaces and then causes ineligibility. The residents family has assumed all ok and mentally & maybe physically moved on so may not be responsive to having to provide what’s needed & needed in detail in a couple of days so the resident become ineligible. For a NH, that resident - who at best has had their SS income paid to the NH - now is a private pay resident who owes full tilt private pay rate for possibly months. Medicaid - if they paid the NH -has clawed back all those payments to the NH as the applicant has been found ineligible.

For a NH there’s no nice & easy path once Medicaid has found a resident ineligible after appeals done. NH can take position that the resident or POA themselves misrepresented situation. They did False Representation. If that happens, what a NH can do is to contact APS to intervene & then APS asks the court to have the elder made an emergency ward of the State & a court appointed interim guardian named. That guardian has alot of authority and takes over. Family removed from any decision making. It happens & it’s ugly.

At moms 1st NH, lady x hall on LTC Medicaid continued to keep her modest home. Son sold it & kept the $. The lady was sweet, spry, active & adored her boy. When I’d visit often a huddle in hallway with billing having heated words with Sonny. Property transfer had surfaced in Medicaid renewal review. Medicaid suspended eligibility & clawed back payments. Sonny paid a bit then refused to deal with situation. APS called in, guardian moved mom to another NH. Last time I saw Sonny, he was in a yelling match at NH entrance; police called. I cannot imagine how beyond awful for the lady. & fwiw staff told me the balance due would be turned over to collections in Sonny’s name & APS / guardian might file for endangerment on a vulnerable adult against Sonny. Yeah it’s extreme but at some point, NH has to take definite steps.

MomsOnly, That it’s a specific $ amount is odd. Very odd. A $ 6,801 “deductible”. I think it’s a transfer penalty.

& if a transfer penalty, it’s really hard to refute as reasons for its placement are known & recorded in some way. Medicaid caseworker cannot ignore it. Penalty $ amount placed by Medicaid gets sent to you as POA and via an ineligibility Notice to the NH; and they (NH) find themselves with impoverished & frail resident clearly “at need” both medically and financially for LTC Medicaid BUT ineligible for Medicaid to pay till penalty period (by # of days or by months) has passed. Penalty is $6,801 & mom has that as a balance due to NH.

Hang with me on this as it’s not straightforward…. I went thru your old posts and couple of things stood out:
- mom has / had a condo that is / was in Life Estate. & for more fun in this, she refused to live in it. So lived with you & hubs for 6.5 years.
- did her condo sit vacant? Rented? If so, might be rental details that Medicaid wants an accounting of.
&
- mom did not buy the condo. It was bought by her ex for her, right? Unclear when & if married at the time. Whatever the case…
- their divorce dragged on. Like separated 2016? but not finalized then. Unclear when finalized & IF condo was a divorce settlement or her ex bought it and gifted it afterwards. Might make a difference as could be a taxable event for mom, which Medicaid noticed.
- then mom TRANSFERRED/ GIFTED her condo to you, right?
- Mom no longer owns the condo, right?
- you mentioned trying to get her onto LTC Medicaid Sept 2020 but could not due to a transfer within look back period. She went private pay @ $4500 flat rate w/you paying $1200 difference, right?

What exactly were look back issue(s) in 2020?
I’m guessing it was the gifting of her condo to you in 2020. Correct?
Could condo transfer still be the reason now & for $6,801?
OR
was there another spend Medicaid has an issue with?
Like $ 8,800 funeral she did, was that within NC spend down limits? Any other gifting? Or something that appears to Medicaid to be gifting during those 6.5 years before she moved into AL/MC in 2020 with your now deceased MIL?
Could there be gifting issues in how costs paid on the shared room that your mom & your MIL had at the AL/ MC?

Please realize exact timing on a lookback is super important. 5 years is standard but States can go up to 10 years. Lookback start date is based on initial application filing date, if I’m not mistaken. Look at the dates to see if mom is somehow 2 months inside look back that North Carolina LTC Medicaid can do.

Transfer penalty on real property is hard to get around. Everything is recorded at the courthouse. It’s easy keystrokes for caseworker to find. NH doesn’t have the ability to do this & kinda dependent on the info you provide to them to show mom is “at need”. I don’t think NH was misleading you as to mom being LTC Medicaid eligible day 1 as on the surface mom looked OK for being “at need”. Had NH known about prior asset transfer on the condo, they probably would not have let her enter as Medicaid Pending.

When you take into account the costs of SNF having a balance due of under 7K isn’t bad. You have your own health concerns and cannot realistically be her caregiver again. That she has all her income going to the NH is great as it shows you & mom are aware of Medicaid copay requirements. Try to work something out as low as possible with the NH without you personally being financially responsible even though you are paying it down. Should she pass before it’s paid off, it will become a debt of her Estate. If that condo is absolutely in your name now, she will have no assets to become an Estate so it will be written off. Hopefully it can all work out in a manageable way.

Momsonly, appeal the appeal. It is not uncommon for it to take multiple appeals to get things sorted out. Make them explain what is meant, if you lose, appeal again. Mom doesn't have any money to pay, make that clear.

Good luck!

In NJ Medicaid requires that insurance policies that have cash value be cashed in. I cashed Moms in and used it to prepay her funeral.

Was the insurance policy included in the Medicaid application?

"The denial stated that she didn’t meet the $6801 two month deductible" I have never heard of a deductable. You may want to call the person who sent the denial and ask that they explain this.

If your mother has a life insurance policy upon her becoming deceased, depending on the State she resides in, the facility can exercise the option via Medicare or Medicare can exercise option to place hold on her life insurance payout to you until after they are paid back the money they were not paid. This is the dirty secret of how the govt supports paying out for indigent patients. Govt wants its money back. Govt is needs to make money off assets of its patients when they are deceased to help support its govt program.


US and State govts, including Medicare has option and choice to collect from the assets in the estate including annuities and life insuance to be paid out to beneficiaries upon the passing of the patient they paid out assets on while alive. nothing is free from the US govt. US govt is sneaky. This doesn’t NOt mean they always will do this. Depends on your State laws and the Federal and State govts records of your mother’s assets. So it may not happen.

This is done in some States probate unless the insurance policy is in a trust with you as beneficiary. Trusts protect assets.

Some States have laws on books that it is family’s duty to pay for care of the elderly party. There is a specific legal term for this I don’t recall at moment. The Federal govt doesn’t always confiscate the life insurance to beneficiaries but it has the legal power to do so depending on it there us a law in your State.

Now, if the facility failed to tell you payment would be due, and you relied on thst, it is unlawful FALSE ADVERTISING by the facility. They have a legal duty to tel you exactly the prices of Medicare doesn’t pay, ahead of time.

Check fine print in documents they make family sign. If you relied on their FALSE REPRESENTATIONS they cannt make you or anyone pay. Of course this is for California. I don’t know othet Stste’s laws but I suspect false advertising is illegal in all States.

File complaint for fraud, false advertising/ false representations upon which you relied online with US Federal Trade Commission, your State Health and Human Services, Elder Care Investigaive State Agency for financial elder abuse, and for incompetence to the State medical Licenseing Board.

In CA this would be the Investigations and Enforcement Units of the Health and Human Services, Medical Board, and Civil suit you file against the facility for fraud and false advertising. also you should report this as financial and emotional Elder Abuse to your county elder abuse unit. Also file grievance with Medicare or Medical or whatever free medical is in your State.

Appeal Medicaid's decision.
I don't think they can charge the patient while the appeal is pending.

You should have Medicaid's denial of benefits letter. Ask to see it if the NH has handled this.

This is a NH, a SNF/skilled nursing care facility, right?
So
How did your mom enter the NH? Like was she hospitalized and then entered the NH after leaving the hospital? OR did she move into the NH directly from leaving living in her home (or your home)? OR transferred from some other type of congregate living (MC, AL) to a NH?
and
What was/is her health insurance prior? Like is she is a “dual” so has Medicare and Medicaid as her health insurance OR was/is she on Original Medicare and a 2ndary insurer or on Medicare Advantage?

What type of admissions application & contract did she do at the NH?
and
What was the documentation provided to the facility or the State to accompany the admissions application?
And
who signed the application & contact?
and
Has she provided a copay to the NH of basically almost all of her Social Security income &/or any other regular retirement/ income?

the answers to these are going to solve this problem. So what’s the backstory???

NO, they can't kick her out, or at least they cannot release her to an unsafe environment. Why didn't Medicaid pay for the first 2 months? Did you sign paperwork at the NH stating YOU would be financially responsible? If you did, or if mom was denied for 2 months due to gifting to you, the NH may try to get payment from you. BUT, if you are on disability with no assets, they are going to have a hard time collecting. If you are "judgement proof", I wouldn't worry about it. They can't get blood from a stone so to speak. There is not much you can do, but if you'd like you can contact the ombudsman and the state Medicaid caseworker to find out why they are not covering the first 2 months. They won't kick her out, what NH's sometimes do is send her to the hospital and then refuse to take her back. What happens then is the hospital will find an new NH.

I think there are too many unknowns for us to give an accurate answer, also because Medicaid is state-specific. At the date of the application, if a person qualifies, Medicaid pays for the most recent 3 months worth of medical expenses, in my state (MN).

You can call a social worker and ask for guidance on whom to direct questions about this. Do you know if your Mom actually qualified?

Was your Mom private pay before you applied?

Who applied to Medicaid, you or the NH?

Hmm, do you know on what grounds they did not pay for her first two months? You should not use your money on this, even if you had any. I don't think they will kick her out. Especially since in your other post you are noticing that she is really declining. Does your mom have any money to pay this? Will there be any money when/if she passes that can be used to pay it back?

It's a shame that you have to deal with this financial issue when you're dealing with your mom declining. It's a lot. Take care of yourself.