Can the NH make family pay? My MIL has Medicaid, which was approved beginning July, however, we did not get the approval letter. Advice?
We didn't get the approval letter until September. We spent all her funds on pre pay Funeral, etc so we do not have the money to pay July and August. The NH keeps sending us bills -past due for July and August.
Often Medicaid can do a retroactive payment (up to 90 days) for bills incurred before Medicaid begins if the client through application can show eligibility. Copies of the bills need to be submitted so that they know about it. Coordination between the LTC business office and Medicaid is what is needed.
This could be clerical error, such as applying the payment to the wrong account.
Make sure that they have not already been paid. You could create a situation that gets her kicked off Medicaid, if the facility has already been paid at some point that will get caught at which point they would credit her account, this would throw her over the asset limit for Medicaid. They will not just send the money back to the person that paid it.
So please don't let him pay until you find out for sure. If he is adamant ask him if he is prepared to continue to pay if she loses Medicaid because of the asset limit.
Bostongranny while it is truly wonderful your nephew is willing and wants to do this (and can) I would urge you to make sure it’s necessary before he does. Who did the Medicaid application? When you say she was approved the beginning of July is that when the application was put in or when you were actually told verbally it had been approved? I ask because while it’s possible it varies in some states (you may need to indicate the need on the application) my understanding has always been that Medicaid is retroactive to the application date once approved. NH often do the paperwork for their residents and have a very good idea if a patient is likely to qualify or not so plan on the retroactive payment. My guess is the retro payment comes separately from the monthly when that starts (Sept in your case it sounds like) so they are probably accounted for in different places. While they knew they would be paid, your MIL’s July and Aug bill wasn’t actually paid so they system generated bills, they have to so it may just be a clerical thing. Even if you did all the application paperwork, check with the NH before paying out of pocket, they will be able to tell you or at least track down what is happening internally and clarify things. Sometimes a place uses an outside billing service for instance but payments and Medicaid paperwork are done directly by NH office staff for instance.
That PA case is irrelevant. However, everyone needs to start now planning for old age care. States and federal government are both running deficits in the Medicaid program. Changes being planned where I live are going to make it more difficult to get Medicaid. The “free” nursing home is going to be harder to come by.
No need to worry about filial law. Your MIL is on Medicaid. And the case linked below is totally irrelevant and and not helpful all. It’s a totally diffident situation involving someone NOT on Medicaid and who left the country.
I cannot agree that it is totally irrelevant because I strongly suspect that the states more and more are going to take this type route if they can to save money.
Don’t let your nephew pay anything. Medicaid paid for all moms previous bills back to before the date we applied. They specifically told me not to pay any bills and submit them to my Medicaid caseworker. Paying them really complicates the account. Call the caseworker.
Did you contact the department of public welfare to determine why the approval is not retroactive to the time she ran out of funds? Did you keep receipts for expenses incurred during the spend down process? Was there any unusual expenditures that are causing a penalty fee? You are not responsible for the nursing home bill. I would also contact the ombudsmen to see if they could be of assistance. If an elder attorney assisted you with the application, I would contact them as well. If an elder attorney was not used, you still may want to consult with one to see 8f they could assist you with a resolution of this matter.
My mother’s was made retroactive. She was approved in July and I didn’t even know it. Well, In November, I received the approval notice stating that she was approved effective July 1st prior and I had stopped paying and Medicaid paid the back pay. You reminded me of this. You are spot on.
I think you should contact the nursing home and find out if they ever billed Medicaid for those 2 months. Medicaid won’t pay if the nursing home doesn’t bill them.
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This could be clerical error, such as applying the payment to the wrong account.
Make sure that they have not already been paid. You could create a situation that gets her kicked off Medicaid, if the facility has already been paid at some point that will get caught at which point they would credit her account, this would throw her over the asset limit for Medicaid. They will not just send the money back to the person that paid it.
So please don't let him pay until you find out for sure. If he is adamant ask him if he is prepared to continue to pay if she loses Medicaid because of the asset limit.
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Call the caseworker.
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