My mother has spent down all her money and has been put on Medicaid at the nursing home. Yet I still get bills for x-rays or doctor's visits and most recently from the nursing home. I called and talked to the Financial Mgr of nursing home and she said I should call Medicaid. Said that Medicaid is billing them more for mom's care. I told her that nothing has changed. Her social security and pension have stayed the same. I would think that once she is approved for Medicaid all bills would be covered without me having to call Medicare or her Supplemental insurance company to handle bills.
- review your moms reward letters. Those are the letters received in nov or dec from SS and any retirements that state to the penny what she will receive for the incoming year as income monthly. Her Medicare copay shoud be taken out of her SS monthly - its abt $ 105.00 for most. If she is keeping her secondary insurer, that either is paid by her directly or too is probably being deducted from either SS or retirement.
- now all states allow for a small amount to be held as their personal needs allowance. PNA varies by state from $ 35 - $ 105. For my mom in TX was $ 60.
- So with the insurance deductions & PNA, what $ left, that is her base line SOC (share of cost) or copay needed & required to be paid to the NH under Medicaid rules. Has your mom being paying her SOC each month she has been in the NH either as "Medicaid pending" or Medicaid approved?? Please pls review to make sure mom is totally good on her copay & from day 1 of her NH Medicaid application date. If not, mom needs to be caught up to be 100% on SOC either from that 2k in assets allowed or family makes up the difference.
- If mom admitted to NH from post- hospitalization rehab to NH, there often is a week where it was anticipated Medicare would pay (as its "rehab" a Medicare benefit) but that final weeks progress report doesn't show progress so it gets declined by Medicare but Medicaid wasn't billed. If so, it needs to be rebilled to Medicaid. Medicaid eligibility date may need to have a written request done to be moved back. In theory the NH should do this.... Think if this could be an issue.
- your moms secondary insurer could be part of the problem. Once mom is on Medicaid, she becomes a "dual eligible" as she is on Medicare & Medicaid. Some secondary insurers will not pay if M&M dual eligibility is there. So those payments for secondary insurance coverage should be returned or held if coverage is suspended. Often secondary insurance coverage $ deduction snafu is the source of why there is a balance due. If its looking like this, I'd suggest you as DPOA send a certified letter to the secondary insurance co asking clearly if coverage exists & if not the status of overpayments. If $ coming back, set it aside as $ may be needed to pay vendors who billed the secondary insurance (& won't get paid or get clawed back for payments made) but will not bill Medicare or Medicaid. more on this below.
- if mom entered the NH right at end of month & applied to medicaid then but saw her docs or was in hospital earlier in the month, Medicaid eligibility for some states usually is done for the whole month (& not date of NH entry). So the old secondary insurer will deny all claims for the whole month as shes technically on Medicaid the whole month. & they will clawback payments to vendors. So mom gets billed. Review moms statements from CMS and from her secondary to see if claw backs & declines are happening.
All above are solvable billing /insurance snafus. PIA but do-able.
BUT Then there's NH that flat are just incompetent. Even when the letters from the state show the right SOC which is being paid. My moms first NH was, took 5 1/2 mos to be Medicaid eligible and another 4 months to get billing and payments credited correctly; every month some sort of outside drug or ambulance billing snafu too. I moved her to another Medicaid bed at another NH at month 10. She was pretty happily at NH #2 for another 3 years with final 18 mos on hospice. Moving them once approved for & on Medicaid is pretty straightforward simple with some advance planning. If this place seems like its going to be a chronic clusterF, moving her is an option for you to mull over.
Also where is her PNA $ going? If the NH is keeping it, have they sent you (as DPOA) a statement on it (her personal needs trust account) every 90 days? Is it put into an interest bearing account? Is the PNA trusts status reviewed or included as a routine part of her every 90 days "care plan meeting" required by Medicare? Are they mailing you the letter to schedule a care plan weeks in advance? If not.... well I'd guess this NH is the type that plays loose with rules and not to your elders or your favor. Be wary!
CSRA MMNA varies by state. Some have it pretty high. TX has it about $ 2,800; so in theory if mom made 3k a mo & dad got max MMNA, all the NH would get as moms SOC would be $ 200.
Financials for CS / NH Medicaid couples is somewhat complex. If dad waded through the application on his own while caregiving fir mom, well things to his benefit could have been overlooked as he was & is overwhelmed. If this could be the situation, I'd suggest you find an elder law atty to meet with you & dad to see what can be done to reset her soc before moms annual Medicaid renewal.
Now if dads own personal income is very high, he could not qualify for CSRA.
Nursing homes are notorious thieves and will do anything---including lie---to the family to get more money. Medicaid is not "billing more" for her care. The only entity that is billing for her care is the LTC facility. How it works is whatever the cost of the LTC place is reduced by the amount of social security they get. Then, if your mother gets a pension, that is considered the "patient pay" portion of her care. So, for example, if the monthly cost is $7000 and your mother gets $500 in social security, that brings the cost down to $6500. If your mother gets $2,000 in pension, then she must pay $2000 toward the remaining cost of the LTC facility. Then Medicaid is billed the remainder of the costs. Medicaid doesn't "increase the billing"---whoever told you this outright lied to you. If the LTC facility knows that your mother transferred assets to her children prior to the 5 year look-back period, and they know that the children got her house, stocks, money, and other assets, they may be trying to shake you down for money. Don't let them do this. You don't have to call Medicaid---what you need to do is find out from the LTC facility's financial department how much the total cost is per month to stay there, how much Social Security she is getting & how much pension she is getting, and then find out how much they are billing Medicaid for the remainder of the costs. The only increase in cost would be from the LTC facility.
Furthermore, don't believe what is being told to you verbally. Tell the financial manager that you want to see all of the documents pertaining to your mother's income, the LTC costs & how much they are billing Medicaid. Then read the contract between the LTC facility & your mother, the LTC facility & Medicaid. As I said, they will outright lie to you to get you to pay more money----if they are not pushed into a corner and forced to produce the documents to prove their claim, they won't. Don't let them pull the wool over your eyes.
NH really really don't want to have to deal with incessant debt collectors. It could morph into a reason to issue mom a "30 day notice".
But what could happen that would morph into a much stickier problem, is that the debt that mom walked on, well the provider can take it as a loss but they can issue mom a 1099-C Cancellation of Debt for the amount plus interest and fees. Any creditor can issue a 1099-C for debts written off over $ 600.00. Many companies do 1099-C routinely for any debt written off. It is reportable taxable income as the 1099-C is provided to the IRS as well. IRS fully expects taxes to be paid on this income. It is not income subject to dispute. IRS as a "super creditor" can attach mom's SS and retirement income to do so. Problem is mom is required to be paying that income to the NH as her required Medicaid SOC (share of cost) or co-pay. So someone in the family (the DPOA as they are responsible) will have to pay whatever $ to make the SOC paid in full each month otherwise mom will become ineligible for Medicaid. SSA will be sent a letter from IRS as to the seizure. Stuff like this can snowball into issues with your suitability as DPOA and mom could become ward of the state.
Really please try to work something out with providers if they do not want to or cannot bill Medicaid.