Mother in Medicaid funded assisted living. I'm not sure how Medicaid reimbursement works?

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Hi! My mom was in a nursing home for a year and a half, then transitioned to an assisted living. She is 70 years old. We applied and she was accepted to Medicaid while in the nursing home. She has 2 pensions in addition to social security totaling approximately $3600, which the assisted living gets I'm assuming in addition to what Medicaid pays. The assisted living states that she owes $15,000, I'm not sure as to why since they always got her checks plus Medicaid, which I admit I'm not sure how Medicaid reimbursement works. The facility seems to think I somehow have these funds, which I do not. Has anyone else had an experience like this? Tia!

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Kelly - my guess is that whatever Medicaid waiver situation mom had in place for the NH did not seamlessly transfer to AL. Like Pam said review the billing.

Now at $ 3,600 monthly income, that is flat too high for Medicaid. Medicaid monthly income limits run around 2k - $ 2,200 a month for an individual. $ 3,600 mo income mom would have had to have gotten a waiver or an exemption that all her excess income got paid to the Nh (or possibly a miller trust that got the income) or some other paperwork to get her a waiver or exemption to be "at need" financially for NH Medicaid. You need to find out just what was done, as it could have been done to apply only for skilled nursing care. So since she has gotten better & moved to AL and so not needing skilled, the waiver or exemption is not being done anymore. So Medicaid isn't paying.

If this is the situation, the AL is owed 15k.

But it could be a paperwork glitch and a different wavier needed to be done for AL to keep the medicaid payment stream flowing. Please keep in mind that for most states their Medicaid program do NOT do waivers for AL at all. Or that AL waivers are limited. So if your state does AL waivers & this AL participates in Medicaid AL waiver consider mom fortunate.

Out of curiosity, at 70 mom is still young. Was she put into NH skilled nursing due to a major trauma, auto accident? So mom back then needed critical care but now oodles better so in AL and may continue to get better & go into IL?

Medicaid as written in law in the 1960's was designed to pay for LTC in a skilled nursing facility aka a NH. As time went on, Medicaid funding started paying for AL, or PACE or other community based programs by specific waivers filed for payment from your states Medicaid program.
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My mom is moving in with us from out of state for better care. Recent new cancer diagnosis and she has been falling 1-2 times a day. She is leaving my dad in their rental home and has a low income which qualifies for Medicaid with no assets whatsoever. How long does it take to qualify, when should we start the process?
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Kelly, you need to find how much is Medicaid paying on their share of the Assisted Living, it could be Medicaid isn't paying the whole remainder of the balance. How many months had Mom been in Assisted Living? And I wouldn't be surprised that your Mom is having a higher level of care which cost extra.
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Too little information to really tell you. Ask for an itemized bill; go see the accounting department.
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