So my friend's mother is in the nursing home going on 6 months. The nursing home applied for her late husband's death benefits that she has received since his death every month. Her brother has her debit card and has been saving all of her money until it gets rerouted to the nursing home so that he can start a savings to help with her funeral costs. Today however, they called to inform him that they applied three months ago to start getting her checks sent to them, because her "medicare ran out". They informed him that they need the last 2 months of money that was deposited into her checking account or they would have to evict her. Does this sound right? Is what they are asking legal? Any time now they will start receiving her benefits, most likely the next check she is due at the first of the month. Until they do start receiving her benefits, can they legally kick her out or demand her last two months of benefit deposits to be withdrawn and taken to them? My friend and his uncle are trying to hang on to the money to help bury her because she has no life insurance policy, so this will be a good start to building that up seeing that she may not be around too much longer. Her checks were being used the first four months to pay her bills etc. but now that she needs long term care she no longer has bills outside of the NH. When she was first admitted to the NH they were advised that if she resides there more than five consecutive months they would garnish her benefits. So they took the steps to become her legal payee, but given it has not happened fast enough, they are asking the family to bring in what she had left in her banking account until they start getting it. Can they do this? Can they threaten to evict her if the family refuses?
Now she is private pay with maybe Medicaid pending. Now her Social Security and any pension she has goes to the NH to pay for her care. Once Medicaid is approved, they will back pay their share. The mothers SS and any pension will always be used to offset her care.
A prepaid funeral is allowed when doing a spend down. For me, it was cashing in a life insurance policy that Medicaid required. I was allowed to take that money and do a Funeral trust thru the Funeral home. If Mom has no money, you cannot hold back her SS or pension payment to save for a funeral. It could take a while for the NH to become payee for Mom. In that time a check for Moms SS/pension needs to be sent by the person who is overseeing her finances.
Evict, I doubt it because it would be an unsafe discharge. But your friend needs to realize the NH needs to get paid.
A NH can ask a resident to let them become the representative payee for a residents SSA income. Resident signs a document which NH submits to SSA. Routinely done. It looks like this NH did this so NH now gets her SSA $ ea month. But the first 2? or 3? months of income that went into her old bank account ARE OWED to the NH.
Please please realize if she had preexisting bills, or has a mortgage, or had rent, or has other debts, LTC Medicaid does not give a rats butt.
LTC Medicaid is all about her income and assets.
What her debts are and whether or not they get paid is absolutely no concern to Medicaid (except for unusual circumstances).
Right now she is out of compliance for LTC Medicaid. NH can evict her.
Will NH do that? Probably not but if need be they will find a way to get her out of the NH. Most likely by having her obstensibly have something that requires a trip to the ER & then NH refuse to take her back. If this happens, the NH bill does not vanish. NH will turn it over to collections to go after the lady, her assets (via a judgement if she has a home) or whomever in her family they can hound to pay.
If NH kinda likes her…. Like she is easier care type of resident, they may want to have her stay. I’m guessing as NH has already done SSA representative payee change to them, they want to keep her. What a NH can then do is involved APS (Adult Protective Services). And this could go very very bad for your friends….. APS can open an investigation to find whomever has taken advantage of her or her assets. NH already has the communication timeline to your friends on their attempts to get the required copay which NH gives to APS. If your friends have taken any of her money or are keeping her from accessing it, they can be charged with “taking advantage of a vulnerable adult”; if they are her POA, they can be charged with “dereliction of fiduciary duty” as well. APS will forward charges to law enforcement. Usually sheriffs department does arrests on behalf of the State. Will be State charges. Stuff like this snowballs serious fast.
if your friends do anything that requires any background check - teachers, handle $, have a sticky divorce w kids situation - being arrested causes big problems. If they or their family is military, even bigger problems.
LSS imo your friends need to pay the NH whatever amount of the lady’s monthly income copay that should have gotten paid & ASAP.
That they paid her bills rather than using her money for her required by Medicaid copay, does NOT matter. Again Medicaid does NOT care about her bills (except for unusual circumstances). If the lady has bills, then either her family pays them on her behalf out of their own wallet or she default on her bills.
Medicaid does allow for her to buy a preneed funeral / burial policy. But has to be Medicaid compliant & within Medicaid limits and actually done & paid to a FH. They can’t be holding onto $ and letting it build in her bank account to use it in the future. Letting $ build up in her bank statements beyond $ 2K takes her over maximum in nonexempt assets for LTC individual Medicaid. She will be made ineligible. NH is well aware of this and a reason why they need for the $ to be used to pay her deficient required copay. Comprende?
If she filed for LTC Medicaid, she owes the copay. Your friend will be best off to write a check from her account with the future funeral $ and pay whatever $ to get her caught up with her delinquent copay. Please try to have them do this way before this EOM. So she starts her month 6 totally ok for her NH bill and in compliance for LTC Medicaid.
The family does have the right to do pre-paid funeral arrangements for her. That is allowed.
If no one has POA and the nursing home has already petitioned to become her payee which would be POA or conservatorship they will get it. You or your family member can beat them to it by petitioning the probate court in her state yourselves to get a POA or conservatorship for her.
Transfer whatever money she has into another bank account while it's still possible. Do not give the banking info to the NH until a pre-paid funeral arrangement has been made for her.
Here’s what I think has happened….. hang with me on this as it’s not straightforward…. I imagine she entered a NH after being hospitalized so was discharged from hospital to a skilled nursing care facility for rehab. MediCARE would have paid for both hospitalization & rehab & info on MediCARE would have been in her hospital discharge records that went to the NH.
BUT
at some point her MediCARE paid NH rehab ended.
AND
for her to continue to stay at the NH, she would need to private pay or file for LTC Medicaid. If she was on Medicaid, as she’s lower income, that info would be in her chart as info on Medicaid as her secondary health insurance to her MediCARE.
HOWEVER
and to me this is super important if you are not familiar with how Medicaid works, she would need to apply for LTC Medicaid. Her old Medicaid as health insurance or Medicaid paying for a community based Medicaid program is NOT the same as LTC Medicaid. It’s only Medicaids Long Term Care program that will pay for her room&board and custodial costs for her to stay in a NH. It’s a separate application. If she was on another type Medicaid, her basic details as to income, residency, etc are known by the State. So if this NH helps residents apply for LTC Medicaid then they can get with the State Medicaid caseworker for this NH and between the resident, the hospital/rehab chart info and her old low income Medicaid details then use all this info to do a LTC Medicaid application for her. NH doesn’t necessarily have to go through the POA or family for the lady; the NH admissions or social worker can ask the lady if she wants to apply to have the State pay and if she says “yes” then they will get that LTC Medicaid application done and submitted on her behalf. She would be a “Medicaid Pending” resident.
ONCE
she applies for LTC Medicaid, then strict rules for LTC Medicaid income, assets & required copays come into force. This is very important for your friends to understand as it looks like the NH is trying to do enforcement of these regulations as to what is happening…..
Under LTC Medicaid - for most states - an individual applicant who is a widow or widower with no dependents can have a maximum of $2,000.00 in non-exempt and a maximum mo income of abt $2,200. Their income will be their monthly Social Security income and any other type of retirements or annuity. Older folks tend to have a SS payment of $1200 a mo so totally under the maximum. The lady will be required to do a copay of basically almost all of her mo income as a copay to the NH each & every month starting the month that LTC Medicaid application was filed.
for example, say she gets $1,190 a mo SSA $ and she lives in Texas which has a $60 a mo personal needs allowance (PNA) for LTC Medicaid residents. She would be REQUIRED to pay the NH $1,130 each mo and the $60 she can keep & usually goes into a personal trust account at the NH. (PNA kinda gets used each month as it pays for their beauty shoppe and phone / cable charges).
She is legally required to do the copay and if someone is keeping her from access to her money, her income/ assets, the NH is required to do whatever they can to get the $ owned to them. Again the NH as they participate in your States LTC Medicaid program has to do whatever they can to get a resident to be compliant on the financial requirements.
Im going to do another post on what might can happen if your friends do not cooperate with the NH….. it will not be pretty.
So, the lady would either have to stay there or do a direct transfer to another nursing home. No matter what, any facility needs to know how they will be paid. In our case, the lady had to go "Medicaid Pending" and she was able to stay in the same place where she was doing her rehab - she just had to move to a different room. While she was Medicaid Pending, we prepaid her funeral - which we were allowed to do. We did have to spend down her assets and squirreling away money while on Medicaid for a funeral or any other purpose is not allowed.
Her only income is SS. She does not get to keep her SS each month. It still gets directly deposited into the same checking account she always used and I then write a check to the nursing home for the total amount minus the $50 she's allowed to spend on incidentals. Nursing home is allowed to demand this. I have not tested the theory of what happens if I don't give them the money each month.
Medicare does not pay for nursing home care. Medicaid does. Medicaid needs full disclosure of all income and assets. I disclosed everything and there were STILL moments when I felt I was not being believed. Medicaid is for those who cannot afford the care they require. Medicaid is government funded and one must qualify to be on Medicaid. It's much different from Medicare. I wish the names were not so similar.
I am far from an expert, but this is how it all happened in my case. Others here on the forum will know a lot more.
When my father passed his NH resident account had almost $500.000 in it. That's for things like shaves, haircuts, etc... I got that money refunded. I had to work for it and go through a lot of red tape and nonsense with the NH, but they had to refund it.
Also, I always held back the $60 a month (in my state) that he was allowed to keep. That was his money, not theirs. I never gave them any access to his banking information either. Every month I insisted on a written bill. I made sure they were paid, but only what they were actually owed. There were several times when he was hospitalized more than three days and Medicare with secondary insurance would kick back in because he had days left and he'd need skilled nursing for a couple weeks. I wasn't cash-paying for those weeks because they weren't owed.
People often make the mistake of thinking that Medicaid and 'the nursing home' are one in the same. They're not.
People have to give full financial disclosure to Medicaid. Not the nursing home. They are not owed any explanation on a person's finances. Their part is to send a bill every month. Medicaid is far more reasonable to deal with than any NH.