My mom is on Medicaid and gets a small check from SS every month. This is just as of June. Well she was accepted into a nursing home the first week of November. Do they have rights to her back pay SS checks or just those from November on?
Also if Medicaid started for her in Sept, if she was living with you or in her home, her SS is all hers for Sept & Oct. BUT there could be payment issues if she saw doctors or had lab work done or had hospitalizations in Sept & Oct. What happens is once Medicaid becomes an insurer for her, it becomes her secondary insurance to Medicare which is her primary insurance. If your mom had another secondary policy for Sept & Oct, they will likely not honor payments made to vendor and will clawback those payments several months down the line. The vendors (doctors, therapists, etc.) will need to rebill to Medicaid. If some do not participate in Medicaid they can bill your mom at private pay rates and bill like months & months later when they finally finally realize the clawback. You might want to not spend the $ just in case there’s bills she gets from this.
I understand that a medical provider can only private bill the same amount that Medicare approves for a service. You must bring this up with the accounts payable department when you receive the bill.
It also doesn't hurt to ask for more of a discount after they acknowledge that they can only charge Medicare approved rates.
This is something everyone should know and ask about discounts if private pay or deductibles.
Your having your mom continue to have her SS direct deposit into her old checking account & your as dpoa paying the NH, right? that’s what I did for my mom. Here’s how it worked for her, she entered a NH on the 23rd of the month. That was day of admission & date to which she filed application to be LTC NH Medicaid Pending. She was not on any Medicaid program prior; she was private pay in IL with original Medicare & BcBS federal as her gap / supplemental insurer. Her SS paid her on 3rd of the month.
she had to do a prorated copay to the NH from day 23 - to end of the month based on her actual SS received. Not the total paid as that’s before MediCARE takes its monthly out for the MediCARE insurance premium.
that’s what I suggest you pay the NH starting for this month as that when she entered the NH. So say mom gets $1123.45 a mo after Medicare gets taken out. In a 30 day month, that’s $ 37.45 per day. If she entered today 11/13 that’s 18 days to EOM @ $37.44 per day = $674.10.
The rest is her $ and considered an “asset” once after the month it is paid to her. If mom has gotten past due months paid, those are assets as well. For most states an individual maximum asset limit is $2,000. She cannot have herself ever end a month going over 2k in assets.
Mom somewhere has a letter from SSA from this time last year that is her “awards letter”. It reads exactly what SSA will be paying her every month in total & then after Medicare monthly premium is taken out for 2019. I’d suggest you copy the 2019 awards letter and attach the copy along with a check for the exact # of days due for Nov based on her day 1 at the NH.
Did anyone explain the PNA - personal needs allowance? Each state has a set amount that they get to keep as PNA and it’s deducted from the amount due as her copay each month. Most states have this as $50 or $60. Medicaid has this info & should send both you as dpoa & mom a letter as to her required copay to be ok for LTC Medicaid. Often the NH resident opens a personal needs trust account at the NH using all or some of the PNA to support it. Like to pay for onsite hairdresser or for snacks or local school bake sale at the NH. So she doesn’t need to have cash & you don’t need to pay the beauty shoppe. The $ in the PNA gets included in her overall asset kitty. Remember keep it all under 2k.
Personally I wouldn’t quibble about the PNA for this month. Not going to be enough to her to make a fuss over imo. If this is a well run NH, they will figure out what the PNA $ owed to mom is and put it into her PNA at the NH. If mom is doing the twice a mo hairdresser I’d suggest you put 2 months of those costs and maybe $50 extra. You should be a signatory on the PNA account & you as dpoa can add others names as well. I had a local cousin & one of moms old neighbors as I lived out of state. When mom died, the NH sent me a check for the balance about 6 weeks after she died.
She should have just received her awards letter for 2020 this month or maybe end of Oct. This will let you know what she’s going to need to NH starting in January, 2020 minus the PNA. I think there’s a slight increase from 2019!
Let me say that it is okay that she is going to be cared for by professional caregivers in a facility. I think that you did the best you could and now her needs are beyond your ability. Kudos to you for seeing the situation and doing something about it. So many people want to keep their loved ones home beyond the reality of what is happening. No offense or judgment against anyone and their choices.
Is the NH asking for her June and July checks or are they the representative payee and the checks were paid to them?
Since she was admitted in November then she will have to pay her October check to cover the share of costs for November.
The nursing home doesn't charge the same way SSA pays. So her November check will pay her SOC for December, because it is one month in the rears from SS.
As CM said, if the money has accumulated beyond what she is allowed to have to be eligible for Medicaid, then yes, her money will go to the NH.
As if all this is not confusing enough.
Was she in the SNF part of the NH before November? I am confused with her SS check being dunned because she was hospitalized, something is missing. Can you give more information about the sequence of events and where she was before going into LTC?
She was with me June and July but after that was in the hospital. Her ss was approved in the end of September. But because she was in theh hospital and Medicaid was paying for the majority of that then ss onlypays $30 for those months. The back pay check was for when she lived with me and I was caring for her. It doesn't take her over the mark, like I says it's not much. I just can't give her the care she needs so she is now in the nursing home. :,(
If your mother's June-October SS payments haven't taken her cash balance over the threshold - so there isn't a surplus to draw on - then I can't see how the nursing home could claim fees retrospectively. Your mother's SS payments are her contribution towards the fees that the NH charges to Medicaid (which will be much more in total), and those begin when she is admitted, surely?
But I don't know and others will - sit tight and there will soon be expert answers! :)
Thank you, for replying. She doesn't get much from them and she was in the hospital for a while so a few of her checks are only $30 for the months she was hospitalized.
BUT
there could be payment issues if she saw doctors or had lab work done or had hospitalizations in Sept & Oct. What happens is once Medicaid becomes an insurer for her, it becomes her secondary insurance to Medicare which is her primary insurance. If your mom had another secondary policy for Sept & Oct, they will likely not honor payments made to vendor and will clawback those payments several months down the line. The vendors (doctors, therapists, etc.) will need to rebill to Medicaid. If some do not participate in Medicaid they can bill your mom at private pay rates and bill like months & months later when they finally finally realize the clawback. You might want to not spend the $ just in case there’s bills she gets from this.
It also doesn't hurt to ask for more of a discount after they acknowledge that they can only charge Medicare approved rates.
This is something everyone should know and ask about discounts if private pay or deductibles.
that’s what I did for my mom. Here’s how it worked for her, she entered a NH on the 23rd of the month. That was day of admission & date to which she filed application to be LTC NH Medicaid Pending. She was not on any Medicaid program prior; she was private pay in IL with original Medicare & BcBS federal as her gap / supplemental insurer. Her SS paid her on 3rd of the month.
she had to do a prorated copay to the NH from day 23 - to end of the month based on her actual SS received. Not the total paid as that’s before MediCARE takes its monthly out for the MediCARE insurance premium.
that’s what I suggest you pay the NH starting for this month as that when she entered the NH. So say mom gets $1123.45 a mo after Medicare gets taken out. In a 30 day month, that’s $ 37.45 per day. If she entered today 11/13 that’s 18 days to EOM @ $37.44 per day = $674.10.
The rest is her $ and considered an “asset” once after the month it is paid to her. If mom has gotten past due months paid, those are assets as well. For most states an individual maximum asset limit is $2,000. She cannot have herself ever end a month going over 2k in assets.
Mom somewhere has a letter from SSA from this time last year that is her “awards letter”. It reads exactly what SSA will be paying her every month in total & then after Medicare monthly premium is taken out for 2019. I’d suggest you copy the 2019 awards letter and attach the copy along with a check for the exact # of days due for Nov based on her day 1 at the NH.
Did anyone explain the PNA - personal needs allowance? Each state has a set amount that they get to keep as PNA and it’s deducted from the amount due as her copay each month. Most states have this as $50 or $60. Medicaid has this info & should send both you as dpoa & mom a letter as to her required copay to be ok for LTC Medicaid. Often the NH resident opens a personal needs trust account at the NH using all or some of the PNA to support it. Like to pay for onsite hairdresser or for snacks or local school bake sale at the NH. So she doesn’t need to have cash & you don’t need to pay the beauty shoppe. The $ in the PNA gets included in her overall asset kitty. Remember keep it all under 2k.
Personally I wouldn’t quibble about the PNA for this month. Not going to be enough to her to make a fuss over imo. If this is a well run NH, they will figure out what the PNA $ owed to mom is and put it into her PNA at the NH. If mom is doing the twice a mo hairdresser I’d suggest you put 2 months of those costs and maybe $50 extra. You should be a signatory on the PNA account & you as dpoa can add others names as well. I had a local cousin & one of moms old neighbors as I lived out of state. When mom died, the NH sent me a check for the balance about 6 weeks after she died.
She should have just received her awards letter for 2020 this month or maybe end of Oct. This will let you know what she’s going to need to NH starting in January, 2020 minus the PNA. I think there’s a slight increase from 2019!
Is the NH asking for her June and July checks or are they the representative payee and the checks were paid to them?
I still don't get them taking her SS. There is something missing, SS doesn't get taken or modified because of being hospitalized.
Do you maybe mean SS disability?
The nursing home doesn't charge the same way SSA pays. So her November check will pay her SOC for December, because it is one month in the rears from SS.
As CM said, if the money has accumulated beyond what she is allowed to have to be eligible for Medicaid, then yes, her money will go to the NH.
As if all this is not confusing enough.
Was she in the SNF part of the NH before November? I am confused with her SS check being dunned because she was hospitalized, something is missing. Can you give more information about the sequence of events and where she was before going into LTC?
But I don't know and others will - sit tight and there will soon be expert answers! :)