If a person is on Medicaid in LTC facility that facility has dentists, doctors, eye doctors and podiatrist who come into the facility. These people must except Medicaid.
It eas explained to me, once a person is receiving Medicaid they must use a Medicaid doctor. A doctor who does not except Medicaid should not be taking money from a person on Medicaid. I havevthis delemia right now with mt nephew for glasses and a Neurologist. One retired the other died. Now he needs to find each within 30 miles where he lives.
AlvaDeer, great answer; there is one minor correction needed. Medicaid covers dental expenses, assuming you can find a dentist who accepts Medicaid. In this way, Medicaid differs from Medicare, which doesn't normally cover dental work. Dental expenses are usually so high that it would be very difficult to pay them with only $60/month available (and some of that monthly allotment would be needed for other personal expenses.
Original Igloo here, regarding Medicare, in the past it could be viewed as that but not now.
CMS under PFS 23 & 24 final rules allow under both Medicare Part A & Part B coverage of medically necessary dental services linked to, related to and integral to the clinical success of other covered Medicare medical services in both inpatient and outpatient settings. CMS also now allows for Medicare to pay for ancillary services critical to the success of the dental services, such as X-rays, administration of anesthesia, use of OR.
In the past Medicare dental was geared to Part A stabilization or removal of teeth related to jaw / face trauma or cancer. No more.
Now Medicare can pay for dental services such as work needed prior to cardiac valve replacement, head & neck cancer work, organ transplant. This is an huge number of procedures. And also pay for dental work needed during or after chemo, cell therapies, radiation. Which tend to really affect teeth and gums. For the oral surgeon and endo types, they already have privileges at hospitals, so getting them to include Medicare as insurance in their practice won’t be too much of an issue imho. The freestanding DDS, they will be slower.
But what going to happen according to my Magic 8 ball is some enterprising DDS plus VC $ is going to form businesses to do this dental work and bill to Medicare. It’s just like once ESRD got to be a special category for early Medicare coverage and Voila! DaVita and Fresenius started popping up all over the US to capture that Medicare part b $. And this will be both Part A and Part B $, serious Medicare $ to be made….. maybe even accept Medicaid for a limited %.
Why do u need to pay medical bills? If on Medicaid, bills should be paid by them after Medicare pays their part. If before Medicaid, then u inform them that the person is now on Medicaid and has no money. They will just need to write if off.
PNA is just that, for personal needs which includes clothing and snacks. Hair cuts even cigarettes. The NH should be able to tell u what can be bought.
Yes. So I’m guessing your family member just went into a NH and onto LTC Medicaid and all this is spanking new to you as their POA? My answer is based on that being the case. The $60 is referred to in Medicaid speak as a PNA aka personal needs allowance & technically used for things not covered by the NH &/or not covered by Medicare or Medicaid but needed for their person or personal comfort at the NH. So using it to pay for costs on their old home or paying on life insurance premium is kinda a no-no, just sayin’.
The first biggie to me is how is their monthly income - like Social Security income - being handled?
If you as POA and they as SSA recipient allowed the Nh to become their representative payee for SSA income (& any other income as well) then from here on out the NH gets their income every month and that $60 a month will automatically go into a “trust fund” at the NH that can be used to draw from for incidentals. A better NH will send you as POA a statement every 90 days and there should be interest paid (it will be teeny tiny). You do need to be aware that the $ in the NH trust fund and any other $ they have (like in a preexisting old bank account) is considered an “asset” and for almost all States assets cannot go over 2K to stay eligible for LTC Medicaid.
The NH trust fund account probably will have an acknowledgment that the NH can draw from it as needed as per request of the resident. So if your mom wants to go on a field trip and it’s $32, then that $32 can be withdrawn from the “trust account”. Or it’s used automatically to pay the beauty shoppe at the NH for twice a mo visits. Fwiw for both NHs my mom was in I had to go to the business office during their regular hours and sign a ledger to do a withdrawal or deposit, which may or may not be convenient for you. Also upon my mom’s death the balance by check sent to me as mom did the paperwork to have it “pay on death” to me. You might want to check on this lil detail cause otherwise the NH may make the check for the balance made out to the “Estate Of” which will be way more cumbersome to deal with.
However, if you have decided NOT to have the NH the representative payee for SSA retirement income or any other income as well, so you as POA are instead paying by check from your moms account to the NH for the exact copay amount Medicaid has as the precise copay / share of cost amount due to the NH each month, then the balance of her $ stays in her bank account and builds by that $60. If mom had $ in the account to start with, you need to pay attention that it always ends the month under $2,000. As 2K is the max for assets for most States for LTC Medicaid. You as POA can go an open a “trust account” at the NH billing office to pay for incidentals and you send in a check to tap up the balance as need be. This is what I did as billing office not open on weekends which was usually when I visited.
LTC will have renewals and more than likely it will want 2-3 months of bank statements attached to a renewal. So you just want it where she has any $ to always EOM to always be under 2K. And whatever the amount in the NH trust account (that gets the $60 every month) when ADDED to the bank account combined must not go over 2K.
Pay attention to the $, because you will be quite peeved, if it goes over 2K and you as POA have to deal with spend down/ineligibility rabbit hole that could have been avoided.
Medicaid should pay for the medical bills and dentist bills the patient incurs. As POA, you should use the $60 a month allowance on whatever incidentals your loved one needs like toiletries, clothing and snacks.
60.00 is all they have. They need clothing. Yes. The bills are not yours, they are their bills. And if they come into money for those bills, then they will get paid. You are POA. That means you are designated to act as this person, in your knowledge would act. I assume he or she would wish to be clothed. You are designated to act FOR this person who is no longer able to act for him/herself. He/she can no longer get out for the snacks they love and request. He/she needs basic needs such as dental care and etc. You will use what little they have left the way you deem in their interest, and keep track of the expenditure.
As to the bills? No one can collect Social Security and that is done for with the care. Upon this senior's death the bills will remain. If there is a home then the executor will sell said home and pay back whatever "clawback" the federal government put into Medicaid of whatever, and attempt to settle bills. If there is nothing, then the next of kin, or the executor, will send back bills with the words "Deceased; NO ESTATE". Meaning that person left nothing.
It eas explained to me, once a person is receiving Medicaid they must use a Medicaid doctor. A doctor who does not except Medicaid should not be taking money from a person on Medicaid. I havevthis delemia right now with mt nephew for glasses and a Neurologist. One retired the other died. Now he needs to find each within 30 miles where he lives.
CMS under PFS 23 & 24 final rules allow under both Medicare Part A & Part B coverage of medically necessary dental services linked to, related to and integral to the clinical success of other covered Medicare medical services in both inpatient and outpatient settings. CMS also now allows for Medicare to pay for ancillary services critical to the success of the dental services, such as X-rays, administration of anesthesia, use of OR.
In the past Medicare dental was geared to Part A stabilization or removal of teeth related to jaw / face trauma or cancer. No more.
Now Medicare can pay for dental services such as work needed prior to cardiac valve replacement, head & neck cancer work, organ transplant. This is an huge number of procedures. And also pay for dental work needed during or after chemo, cell therapies, radiation. Which tend to really affect teeth and gums. For the oral surgeon and endo types, they already have privileges at hospitals, so getting them to include Medicare as insurance in their practice won’t be too much of an issue imho. The freestanding DDS, they will be slower.
But what going to happen according to my Magic 8 ball is some enterprising DDS plus VC $ is going to form businesses to do this dental work and bill to Medicare. It’s just like once ESRD got to be a special category for early Medicare coverage and Voila! DaVita and Fresenius started popping up all over the US to capture that Medicare part b $. And this will be both Part A and Part B $, serious Medicare $ to be made….. maybe even accept Medicaid for a limited %.
PNA is just that, for personal needs which includes clothing and snacks. Hair cuts even cigarettes. The NH should be able to tell u what can be bought.
The first biggie to me is how is their monthly income - like Social Security income - being handled?
If you as POA and they as SSA recipient allowed the Nh to become their representative payee for SSA income (& any other income as well) then from here on out the NH gets their income every month and that $60 a month will automatically go into a “trust fund” at the NH that can be used to draw from for incidentals. A better NH will send you as POA a statement every 90 days and there should be interest paid (it will be teeny tiny).
You do need to be aware that the $ in the NH trust fund and any other $ they have (like in a preexisting old bank account) is considered an “asset” and for almost all States assets cannot go over 2K to stay eligible for LTC Medicaid.
The NH trust fund account probably will have an acknowledgment that the NH can draw from it as needed as per request of the resident. So if your mom wants to go on a field trip and it’s $32, then that $32 can be withdrawn from the “trust account”. Or it’s used automatically to pay the beauty shoppe at the NH for twice a mo visits. Fwiw for both NHs my mom was in I had to go to the business office during their regular hours and sign a ledger to do a withdrawal or deposit, which may or may not be convenient for you. Also upon my mom’s death the balance by check sent to me as mom did the paperwork to have it “pay on death” to me. You might want to check on this lil detail cause otherwise the NH may make the check for the balance made out to the “Estate Of” which will be way more cumbersome to deal with.
However, if you have decided NOT to have the NH the representative payee for SSA retirement income or any other income as well, so you as POA are instead paying by check from your moms account to the NH for the exact copay amount Medicaid has as the precise copay / share of cost amount due to the NH each month, then the balance of her $ stays in her bank account and builds by that $60. If mom had $ in the account to start with, you need to pay attention that it always ends the month under $2,000. As 2K is the max for assets for most States for LTC Medicaid. You as POA can go an open a “trust account” at the NH billing office to pay for incidentals and you send in a check to tap up the balance as need be. This is what I did as billing office not open on weekends which was usually when I visited.
LTC will have renewals and more than likely it will want 2-3 months of bank statements attached to a renewal. So you just want it where she has any $ to always EOM to always be under 2K. And whatever the amount in the NH trust account (that gets the $60 every month) when ADDED to the bank account combined must not go over 2K.
Pay attention to the $, because you will be quite peeved, if it goes over 2K and you as POA have to deal with spend down/ineligibility rabbit hole that could have been avoided.
As to the bills? No one can collect Social Security and that is done for with the care.
Upon this senior's death the bills will remain.
If there is a home then the executor will sell said home and pay back whatever "clawback" the federal government put into Medicaid of whatever, and attempt to settle bills. If there is nothing, then the next of kin, or the executor, will send back bills with the words "Deceased; NO ESTATE". Meaning that person left nothing.