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mollymoose Asked February 2021

Medicaid paying nursing home incorrect amount, any tips?

My brother handles this end of things with our Mom's care so I don't have the paperwork in front of me.


He recently got a bill from the nursing home for $3,000 for my Mom, who is a permanent resident there. She has been there two years, was self paying for 11 months till her money ran dry. She did NOT even get to keep her $2,000 that Medicaid allows you to keep. She has been on Medicaid since Jan. 2020. Why on earth have they waited until this point to say something??? The bill is in her name, and when he called they suggested that she only keep $5 of her personal needs allowance and start paying the balance back with the rest.


My brother and I *think* Medicaid is not adjusting correctly for what Mom is paying for her prescription drugs and/or her AARP supplemental insurance THAT THEY TOLD US TO KEEP. We asked more than once about dropping it because it's not benefitting my mom and each time they told us not to. The nursing home filed for Medicaid for us, all we had to do was bring mom's bankstatements, etc to them and sign papers. She was approved right off the bat with no problems.


A telephone hearing is scheduled for later this month with Medicaid. They sent my brother a letter with an access code that does not work, so he could view her information online. It's impossible to get anyone on the phone at that DFACS office and they don't seem to be interested in returning calls. And of course you can't get inside right now.


All we definitely know is that the nursing home is getting every penny that my mom has, except her personal needs allowance. I told my brother not to start turning that over to them until they threaten to kick her out or sue us. We have been mostly pleased with this facility.


Has anyone been through this? Any tips or advice?

newbiewife Feb 2021
Nursing home may have filled out the paperwork for Medicaid application, but mom's POA or approved personal representative would have had to sign off if mom isn't competent, I believe. That person (your brother?) should have received a letter from the state Medicaid office stating that mom is eligible and what her share of cost of care is. There is an annual review and more paperwork needs to be submitted. Any time there is a change in the amount your mom needs to spend, for example, on her AARP health insurance, you should make sure to send a copy of that in writing to the state office handling Medicaid. It sounds as though the nursing home may have messed up in the application and overestimated your mom's share of the care cost so Medicaid has been underpaying. I believe it should still be possible to correct that and have Medicaid pay the additional amount retroactively. Technically, someone in the family should really have checked when the eligibility letter came to make sure that the amount stated for Mom's share of cost would actually work with her income and other fixed expenses. It also sounds as though the NH may be the rep payee for mom's social security if thay are controlling her personal needs allowance. She is allowed I think $40/month from her social security and as others posted, that is hers and should not be used to pay the NH.

KathleenQ Feb 2021
Please discuss this with an elder care lawyer. Does she have a lawyer or a will?
mollymoose Feb 2021
Her elder care attorney, also a county commissioner, after charging thousands of dollars and never completing work (he was going to do the Medicaid forms for us) is actually setting in jail after threatening his wife and shooting at cops.

We could find another one, but my brother and I would have to pay for it, so we are hoping to straighten it out ourselves.

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JoAnn29 Feb 2021
I agree that the problem is between you and Medicaid. Your problem maybe the way the NH filed it. My State you can drop your insurance once on Medicaid. Other states rather you keep it and adjust there contribution accordingly. Do not make arrangements for the money to come out of her PNA account. A mistake has been made. If its the Facilities, then they need to straighten it out. My cousin was told by a Hospital SW not to allow the Nursing home to do the application.

From an article I have

More specifically, the regulations provide a “partial” list of unacceptable uses of the PNA:
1. group activities or entertainment which occurs within the facility;
2. facility-organized parties;
3. medically-necessary drugs, medicines, or medical supplies;
4. funeral expenses, up to $5,400;
5. room and board to the facility;
6. non-customized wheelchair purchase, rental, or repair;
7. physical restraints;
8. transportation to necessary medical treatment;
9. gifts to relatives in excess of $25.00; and
10. medically necessary treatment normally paid for by Medicaid.
mollymoose Feb 2021
I didn't think they could force her to pay with her little allotment.

We actually paid an attorney to do the Medicaid forms for us, but he never did. He had done a great job on some other legal stuff so we thought he was trustworthy. He is in jail now on several felony charges, for threatening his wife and shooting at police. Pretty sad.

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