Does a resident family member (with POA) have to pay nursing home, when resident can't?

Families are often overwhelmed by numerous nursing home admissions documents. Rest assured that family members cannot be required to sign as a “Responsible Party” for payment, 42 USC §1396r(c)(5)(A)(ii), although some facilities have asked family members to “volunteer” to act as a responsible party. The federal law says: “a nursing facility must (ii) not require a third party guarantee of payment to the facility as a condition of admission (or expedited admission) to, or continued stay in, the facility.”

Why do you think that: “Resident can't apply for Medicaid, until house is sold (it has a mortgage) and money is spent down.”? Who provided you with this misinformation?

Medicaid regulations allow eligibility if the applicant is taking steps toward selling the real estate. When the property is sold, the proceeds can be immediately deposited into a pooled trust account that will benefit the nursing home resident, or into a trust that benefits another disabled person. You may miss out on many options if you decide to try to go it alone through this difficult time of transition. An elder law attorney in your state can give you good advice and services that protect you and the nursing home resident.

To read the nursing home law:

https://www.law.cornell.edu/uscode/text/42/1396r

Scroll down to §1396r(c)(5)(A)(ii)

A nursing facility must have identical policies and practices for transfer, discharge, and services, regardless of source of payment. 42 U.S.C. §1396(c)(4). In my state (Massachusetts) state law prohibits nursing homes from discriminating based on a person’s source of anticipated payment. 940 CMR 4.03(1).

Medicaid reimbursements to the nursing home will probably be lower than if you privately pay, but the nursing home cannot require a resident to waive their right to Medicaid benefits.

A nursing home may be motivated to give preference to people who can pay privately, but they are not permitted to require a resident to give up the right to Medicaid benefits by requiring private payment for a time before the resident applies for Medicaid.

http://www.mass.gov/ago/docs/regulations/940-cmr-4-00.pdf

Nursing homes expect and need to get paid, and demand assurances that that will happen.

You can own a home and still apply for Medicaid. Who told you that you have to wait until it is sold?

What other assets need to be spent down? Is there enough to private-pay while waiting for Medicaid?

Unless you signed something making you responsible you do not need to pay the nursing home out of your own funds. But they don't have to keep the resident indefinitely without getting paid. How long has the resident been there?

How certain are you that the house will sell reasonably soon? How confident are you about the price? How many months of NH costs can be paid with the equity you expect from the sale?

I wonder if it might be worthwhile to consult an elder law attorney to get you started on the Medicaid application process and advise you on options for dealing with the NH in the meanwhile.

Unless Medicare made a huge change in how long they will pay for rehab/nursing home, my Mom was only allowed 21 days under Medicare at 100% last year. A few years ago my Dad had the same 21 days.

Then after the 21 days it depends if the patient is improving with rehab or not. If the patient isn't improving and needs to stay in the nursing home, then it becomes either self-pay or Medicaid. If the patient is improving, then Medicare will pay a certain percentage of the care, with the secondary insurance kicking in to help for a limited certain amount.... for a certain set number of days.

I agree with consulting an elder law attorney. I've been working with one and they are great as they know all those Medicaid rules .

To Christine73
POA is not responsible for bills incurred by the person. Apply for Medicaid and list the house. Some states only allow you to keep the house for a certain number of months.
You cannot apply for Community Medicaid if you are already in a Nursing Home, it has to be Institutional Medicaid.
Call your local Medicaid office and ask if she can apply while her house is on the market and Medicaid will place a lien on the property. They will take back the money that they have paid out before the resident gets any money. The remaining funds will have to be spent on her Nursing Home Bills until she gets below $2000. Then she will be eligible for Medicaid again.
Medicare is not an option Christine73 unless she is coming directly from an INpatient Hospital stay of 3 or more days.
Please don't give inaccurate advice about public programs, it just confuses people.
If a person comes to a nursing home after inpatient hospital stay of 3 or more days MEDCARE ONLY PAYS 100 DAYS. not 200 or 365.

I am seeing some rather incorrect statements here. I think its important for people to avoid writing things that they don't know for sure to be true. Good sources consistently are pamstegma and freqflyer for the record. The poster suggests there is private money which has to be spent down in this case (in addition to the home) before Mom gets down to the Medicaid qualifying amount...so yes POA is supposed to be paying the nursing home for those bills from the patient's money...although not from her own assets. Make sense?

Yup, Elder attorney is the way to go, no doubt. You can't blame the NH for wanting to be paid. If not Medicare, then it has to come from somewhere. They are not a charity, and have bills to meet just as we do. They are not obligated to keep your mom without pay. But, along the same lines, as Jeannie says, if you did not sign anything, then they can't hold you responsible for the bills. If you did sign something when you put your mom into the NH, perhaps as a backup if you're mom can't pay, then you could be held responsible for the bills. So best to talk to an Elder Care attorney on behalf of your mom as her POA. The fee might be able to, ultimately, come from the proceeds of the sale of the house, since attaining the services of an attorney for your mom can be counted as being used for her benefit.

Yes. You are not responsible as POA for mom unless you personally assured payment Being a POA means you "stand in the shoes" of your mom to deal with the business-side of her life. Always be sure to sign anything, For example, "Mary Smith, POA for Amanda Jones." That makes it clear you are signing on mom's behalf.

I agree with the others here, 1) you shouldn't have to sell her house to apply for Medicaid and 2) the nursing home is a business and has a reasonable expectation to get paid. However, before paying for an attorney, you coud start with your local area agency on aging / county senior services for information. They can direct you to free advuce regarding Medicaid etc. Hope this helps.

lamama, If you refuse to apply for Medicaid, they (NH) want private pay. So apply for Medicaid. If you previously applied and were assessed a penalty, selling the house will not remove the penalty.
As POA, if you moved money or assets out of her name, you could be liable for nursing home costs, as in HCR v. Pittas in Pennsylvania.
Work with a benefits counselor. Most NH facilities can refer you to one at no cost.

There are so many conflicting comments on this thread it is a bit confusing. When someone goes from hospital to skilled nursing facility medicare will pay if they have stayed inpatient in hospital for 3 midnights or days. The amount of days they cover is as follows day 1-20 covered 100% day 21-100 covered with copay of 161.00 per day. Day 100 and over not covered. A person must be in need of skilled nursing care or rehab and must be showing progress for coverage to apply. If a person has medicare supplement policy they may cover the 161.00 per day copay as my mothers ins did. Now that being said of a person goes to a nursing home without a qualifying hospital stay medicare pay nothing. It is either private pay or medicaid in that case. We just went through this twice last year with mom so I know the journey all to well.