Hello. I just got a bill for 2 months from mom's nursing home. I have been working with a DSS agent to complete her Medicaid application for several months and have never been billed. I believe I sent DSS the last of the requested financial documents. They have always been slow to respond.
I believe I was told by her NH people that Medicaid would cover any retro costs. I have seen online where people are told to hold off paying any bills until Medicaid is approve.
My question is: Does Medicaid usually cover NH costs while the application is being completed? Should I wait for approval? The bill is for 7K+ for Jan and Feb. (3600/month). PS: the NH is closed for the weekend and usually very slow to respond.Thanks
A ? for you….How has mom’s Share of Cost been handled so far?
If she or you as her POA have not been paying what obstensibly is to be her SOC to the NH for each and every month she has been a custodial care resident, well, that could make the NH super nervous. If her SOC hasn’t been paid, consider doing that. If she has not yet set up an in-the-NH trust account to pay for incidentals (beauty shoppe) do that with the costs of 2 or 3 beauty shoppe visits, do that as well.
Some States have it that the SOC technically does not have to be paid till the application process is completed. But there is nothing stopping her or you as PoA from doing that ahead of time.
But if she has paid her SOC, it could be that this NH routinely does these type of bills at X # of days from the date of application filing.
In theory my understanding is the LTC Medicaid applications are supposed to be done in 90 days. I’m sure for some State’s this is true. But that has never been my experience in dealing with my moms & MILs applications. For us the NHs sent a past due at month 4 and at month 5 sent an 30 Day Notice (eviction) registered letter to the POA on file. Moms was approved @ 5.5 months, got both letters. MIL had LtC Medicaid in 2 States, 1 approved right at the end of mo 3/start of mo 4; then the other State took 4 mo for her 1st time and then she left NH and went onto HCBS housing; then her 2nd LTC application took forever, both letters sent. She actually died b4 the application was completed; took abt a year to finally suss out.
The month 4 Past Due bills seemed to be routine and were straightforward bills at private pay rate less the SOC (not the State negotiated rate). The 5 month EVICTION Notice and past due bill was quite different as it CC’d the letter to APS and a probono legal clinic. What I was told that this enables the NH to request to APS to seek them to get an emergency ward of the State done so an interim guardian placed who can take over decision making and financials of the NH resident. It is happened with a lady x the hall from mom’s room; it was ugly.
If you can’t get connected with answers from Medicaid this Tues or Wed, contact your local State Senator and State Rep for your district. Not so much your Congressional Rep or Senator as that’s more Federal. Medicaid is State run so the members of the State lege may be easier to get to deal with this.
Unfortunately, people procrastinate and wait to apply for Medicaid nursing home coverage, instead of filing an acceptable application as soon as they know the need for nursing home is going to be permanent. They don't understand how to bring their assets into compliance so the application can be allowed.
When filling out the application for Long-Term Care, the Medicaid agency (MassHealth in my state) asks whether you have bills for medical services you got during the three months before you sent in the application. Does this mean that Medicaid will always pay retroactive nursing home bills going back 3 months? Not always.
Let's say that Mrs. Rose is admitted to a nursing home on January First, but she procrastinates, and does not apply for Medicaid until April 1st when she still has $12,000 in her savings account.
If Mrs. Rose uses her savings to buy a $10,000 prepaid funeral contract, that leaves her with only $2,000. She submits a copy of her funeral contract to the Medicaid agency and becomes eligible for Medicaid starting 3 months before her application. Buying the funeral contract doesn’t violate the MassHealth transfer rules.
In my example, Mrs. Rose is fortunate. She gets eligibility “as of the date the applicant reduces his or her excess assets" to the allowable $2,000 asset limit without violating the transfer of resource provisions for nursing-facility residents. Mrs. Rose will only pay the Patient Paid Amount: all of her monthly income except for a small Personal Needs Allowance.
What if Mrs. Rose had assets worth more than her funeral contract, or if she had a Spouse at home who has assets worth more than his Community Spouse Asset Allowance?
If she has unpaid medical bills, those could reduce the value of her excess assets, opening up eligibility during the retro period. But when medical bills are less than the applicant’s excess assets it won't matter because her excess assets are still too high during the retro period.
There are other ways to comply without violating the asset transfer rules. But the nursing home business office won't take time to explain. They need residents to continue paying privately.
In your case, if your mother reduced her life savings below the asset limit (without violating the transfer regulations), she can be asset eligible for her previous 90 days of care. She'll owe only the Patient Paid Amount, based on her monthly income.
Getting professional help to prepare and file the application promptly is worth it. By December 31, 2026, the retroactive eligibility period for Medicaid coverage of nursing home and medical expenses will be shortened to only 60 days!
https://www.ama-assn.org/system/files/changes-to-medicaid-and-chip-enrollment-eligibility-and-cost-sharing-summary.pdf
Our lawyer told us to hold off paying the August bill until we received the award letter which they don't' have yet.
I would suggest waiting because you don't know if Medicaid will be paying and I really doubt you will ever see a refund from the nursing home if Medicaid does cover those months. But when it is all said and done you need to do what you gives you peace of mind.
I would just hold off, if you can, on paying any bills to the NH. The NH has had plenty of patients before who were waiting for Medicaid approval for payment. If it looks likely that the patient will be approved, they know they will get their money, even if it takes a few months.
She has a pending bill that is in limbo trying to get on Medicaid and these guys are ghosting :(
I got a notice that Medicaid was rejected due to not having one insurance document. I have a couple of weeks to fix that. I sent in the requested info and but I can't get ahold of anyone at DSS or her NH to confirm that they received the required docs. No response from email or voicemail and time is ticking. This is nonsense.
Both of these are - in my understanding- considered legal and able to be used as proof if Medicaid gets problematic.mits especially good if you end up dealing with MERP and it’s outside contractors. The cost will be maybe $5 - $10 and well worth it for peace of mind.
Snail mail and email so often goes astray.
The statement that is sent during the pending phase is for the full selfpay rate. Once the application is approved the facility will adjust the invoice to reflect the Medicaid NAMI awarded and and the patient portion responsibility to reflect the fully effective Medicaid long term care approved date. The facility will issue an updated monthly statement. Included is the adjusted monthly Medicaid rate and the credits of the patients payments and the NAMI awarded payment. This will net to zero balance if you have been paying the proper amount.