She's got Medicaid, now what?
So, FINALLY my mother has been approved for Medicaid. (We are in NC, fyi. She is in long term care/nursing home.) I have a slew of questions:
1. Do I call her existing Medicare Advantage plan insurance company and change her policy to a dual one? Or just close it out and change back to straight Medicare? If so, how do I do that.
2. She gets her deceased husband's VA pension. (I thought it was Aid & Attendance, but the letter says Pension.) I know I need to call the VA to tell them she's on Medicaid. Can someone confirm the following: <p data-uw-rm-sr=""> A. once the VA finds out about Medicaid, they will reduce her benefit to $90/month and it will not count towards her "income" when Medicaid adds up everything to determine her patient monthly liability. <p data-uw-rm-sr=""> B. Also, if the VA continues to pay the $90/month, that effectively replaces her $30/month SS allowance, which would then go to the NH?
3. I got a letter from the federal Centers for Medicare & Medicaid Services that says she qualifies for Extra Help for her prescriptions. She is getting bills (sent to me) for her co-pays from the pharmacy the NH uses. I assume I need to give them this information?
4. The Medicaid is retroactive a few months. How do I recoup the money I've already paid for prescription co-pays?
5. Timing of all of the above. Medicaid is retroactive to April 1. There is a promissory note to pay off the NH for the months she wasn't able to pay. Should I continue to move forward with all of the above even though the NH isn't paid off yet?
Whew, thanks!
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I also received a letter that she has been enrolled in NC Medicaid Direct. The letter says it's for Medicaid beneficiaries who are not enrolled in health plans. But she does have a Medicare Advantage plan. I assume this is a separate thing because Medicare and Medicaid are separate things, but this may affect your answers. And just makes me more confused about the whole health insurance thing.
the $90 & the $ 50 for a whopping total of $140 will be moms “spending” money for her to use from here on out. Like for her to pay the beauty shoppe at the Nh. To do clothing and toiletries replacement, pay for cable if the NH does not include this. Fwiw some Southern states have the PNA at $30…. Yes Sister… $30 dollars a month. I just cannot imagine what it’s like for those in a NH who have families who are themselves poor.
on the VA, they could take months to do the full clawback, so the $ has to sit in moms bank account, just awaiting till that happens. It was direct deposited going in… and will be direct clawed back. Could be a few month. Just let the $ sit in the account.
LTc Medicaid should send you as POA an Eligibility Notice that will state to the penny what the State determined as her required SOC / share of cost to the NH. They - the NH - get it cc’d to them as well. That is the exact $ amount they -;the NH - get a check from you written from moms account each month. Mom does NOT have to let the NH become the representative payee for her SS income nor for her VA pension. NH may heavily lean or even imply that this must just must be done but that pure nonsense. You as POA can write them a check from moms checking account that continues to get her incomes direct deposited into them.
on the health insurance issues. Find out - maybe from the DON - director of nursing at the place what insurance system they use. That what mom needs to go on. You’re not going to be shopping around for plans. It’s going to be whatever this Nh uses.
Fwiw the trend for “duals” in facilities, so those on Medicare and Medicaid in a NH and on LTC Medicaid as well; the trend is for them to go onto a MCO. Managed Care Organization. The biggie in MCO for duals in a facility is Molina Healthcare. If y’all’s State is doing this, there isn’t any choice as the MD who is the medical director at the NH is in Molina MCO network and all care & labs etc all go into MCO network system that isn’t actually done by the NH staff. If that’s what this place does, all old insurance stuff stops completely. It’s streamlined for billing.
on her MediCARE Advantage, ADVANTAGE PLANS cannot at all work for those in a facility. Advantage plans require for you to go to see the doctors and clinics and hospital(s) with the Plan. They have to be in-network to be cost effective or it’s out of network and will have significant private pay cost. Which your mom cannot pay as her monthly income is required to be paid to the NH under the terms of her eligibility for LTC Medicaid.
Even if you did take mom to see a doctor and you personally private paid for the visit and her prescriptions, the MD at the NH is in charge of her care. So does not have to coordinate care with a doctor out of network.