My Mom has had to move into a nursing center. She's applied for Medicaid but unfortunately owes back rent. Advice?

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We have been told by the nursing center that medicaid would pay the past balance there before they would start paying them. of course we are being pressured into signing a promissory note at her past place. she has no money to pay this. we were paying 150.00 more than her rent to get her caught up. who can we turn to get answers w/out paying a huge amount.

Answers 1 to 10 of 13
Py - so is it the situation that mom has applied to a new facility as "Medicaid Pending" AND it is a different facility she owes $ to? that's it, right? if that's the situation, here's my thoughts -

For Medicaid Pending application, if she is approved by the state, they will pay the new facility from day 1 of the application for her room & board and any other charges that Medicaid normally pays. If it takes 5 months on the average for your state's program, then once she is approved, the NH gets the 5 past months and the current month. For my mom, she applied to NH # 1 & moved in a few days into the month so NH was paid starting day 1 she was there for that month (took almost 6 mos) BUT mom was approved for Medicaid from day 1 of the month of approval. Medicaid usually pays the NH as set day rate for "room & board" - like for TX, Medicaid pays a NH about $ 155 a day.

Keep in mind that if they are on Medicaid or "Medicaid Pending", they are required to do a co-pay or their "SOC" (share of cost in Medicaid speak) to the facility of whatever is their monthly income less your states personal needs allowance. So like for my mom in TX, she got $ 1800 a mo income" with a PNA $ 60; so every month she would HAVE TO PAY the facility $ 1,740 as her SOC. The PNA is really not even enough to cover their beauty shoppe appointments, cable, phone, clothing replacement, etc - I mention this because realistically mom will have no - nada - zero $ to pay for anything ever again.

For the back rent, personally I'd base my decision on what the old place could do to me if the past due balance is not paid. If mom 100% signed off on the admissions agreement, then it's her debt and she flat does not have the funds to pay and there is very little the old facility can do. To qualify for Medicaid, they have to be impoverished. Her income will all be going to the new facility and it's protected income if it's SS or most other federal retirements, so it cannot be seized or garnished.

BUT if you signed off on the old admissions agreement or your sibling signed off on the contract, well, that is whole different situation. They can and probably will come after you for the debt; likely to turn it over to collections to. If you now sign off on a promissory note, then you are personally responsible for any costs related to her stay.

I'd be cautious on signing off on a promissory note as she is applying for Medicaid - because what often happens is that IF mom is having some medical costs paid for by Medicare or by her secondary medical insurance and is going through the old facility for billing or for co-ordination of billing, once she is approved for Medicaid, the old insurances may do a clawback on payments they made as mom is now on Medicaid for the period of time and the primary payor. If the promissory mentions something like "any & all costs due the facility or it's assignees", then you are signing off to pay for anything that comes up.

What happened with us, was that my mom had a very good high option federal BCBS - she never had any copay ever. Once she was finally Medicaid approved after almost 6 mo., there were months of items which were billed to Medicare & BCBS. BCBS did a clawback from the vendors starting at about month 9 of admission. Took several months - some over a year - for the vendor to deal with it and the clawback. If the vendor does NOT accept Medicaid, they can bill mom/you for the full private pay costs. One PT took over 2 years; another pharmacy related one over 3 years to rebill. If you signed off on any paperwork during an old office visit or at the pharmacy or the hospital or whatever, they can come after you for repayment. I mention this because if you sign the promissory note, you may find yourself not only responsible for the back rent but also for whatever health care costs may have been paid in the lag time at the old facility.

Not to be all ruthless about this, but you have to take a hard look at just what your exposure is in all this to base your decision on. Mom's impoverished, so nothing a collector can do to her. Good luck.
I concur with igloo572 but would add that in some states, the new facility may be able to pay the debt from the old facility as an " other medical expense", getting you completely off the hook. Ask the business office manager at the new facility if there is an approved mechanism for this situation. Keep in mind that everyone wants what's right and to be as fair as possible. How this works is the new facility can pay the old facility out of your mother's private pay portion, if any. If there is no private income to pay a private portion of her monthly bill, there may not be a way for this idea to work. (my experience is in PA)
Additionally, you should NEVER sign an open ended promissory note. It should be very specific to the amount to be paid and the time period involved. AND do not add anyone (including yourself) to the signatories if there is no previous signed acknowledgement that you or someone else is financially responsible for any unpaid balance. That said, you may feel a moral obligation to pay off what is owed because the care was good and you want to do what is right, but even so, if it would be a financial hardship to you, the facility will get by without your generosity. Most homes include a "bad debt" allowance in their budgets to cover these types of situations.
I'm not sure what you're talking about when you say "rent". Was she in an assisted living place or in a long term care facility before this?

Do not sign any promissory note under any circumstances. It is not your debt & the place cannot do anything to you to collect it. The last thing you want is to be on the hook for any of that debt. Exactly how much is your mother in arrears with the rent? Did she have enough money to pay it when she went in the place? Was there something that changed her income situation?

Since it sounds like your mother is destitute, if the other place sues her & gets a judgment, what does it matter? It's not like it matters if her credit is ruined at this point or anything. Medicaid will pay for the new place & social security is immune to garnishment.

Tell the place that is pressuring you to sign a promissory note to leave you alone. If necessary, write a cease & desist letter & send it certified mail, return receipt. They have no right to pursue payment from you, and if they continue despite your request to stop, you've got a legal claim for harassment.
I agree with above, MIL is on medicaid, no assets. NH gave us a letter stating she was a resident there and didn't know how long she would be there.

I sent that to her creditors and they have to accept that as mom is Judgement proof and will have write the debt off. My lawyer told me that. So don't co-sign or promise to pay for her.

Agree also with cease and desist letter, if they continue to harass you they can be fined.
Do not sign anything saying you will pay this back. Send the cease & desist letter, keep a copy, send it certified return receipt with restricted delivery to the exact person who is asking for payment. You should offer an explanation in the letter that your mom has no funds, so there is no reason to be going after her.
my suggestion.........look up a certified ELDER ATTORNEY and get help. yes it might cost some money but it might save you some money.
If you sign as the person's Power of Attorney with the old nursing home, can they come after the POA for payment?
the only way someone can sign as POA is if they are actually a POA but I don't think you are responsible for your parents bills, unless you are listed on their bills but you should check with Elder Attorney
Don't sign a promissory note!
Talk with legal aid first.
If someone is on Medicaid, that means they are covered by Medicare + Medicaid.
Which means one or both of those WILL cover her expenses--just not the full pricetag regular patients pay out-of-pocket.
The amount Medicare and Medicaid reimburse facilities and providers is a small portion of the full amount they'd like to be paid.
What some places TRY to do, is get a legal document signed, like that promissory note, to force welfare recipients to pay what is NOT covered by Medicare/Medicaid....
I think that's illegal, but none-the-less, some places try to do it.
Also, YOU should NEVER sign a promissory note for anyone's debt but your own--and maybe not then, either!
When your elder dies, some providers, even for welfare recipients, try to harass the family to get paid, some beyond what they were paid by Medicare/Medicaid.
That's illegal, I believe.
NO State wants to impoverish family, in order to better pay for elder's care....because it might end up the State causing family to become yet more welfare recipients--they sure don't want that!

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