Aside from my Mom's social security check ($1176). How much does Medicaid pay a month for her care?


Does this have to be paid back? She passed last week at Sunset Lutheran Home in Texas. She had a home that we rented out to pay for the insurance and taxes.....What did Medicade pick up every month to go along with her social security of $1176?

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For TX Medicaid day rate for room & board is right under $ 145.00 a day. As far as determining just what Medicaid has paid for beyond that will depend on what services she got in the NH as payments vary & then some things are being paid by Medicare with Medicaid the secondary insurer. Roughly in TX avg stay for a year paid by Medicaid is about 60K. Which is low.

If you wondering about what happens with the house, TX has contracted out MERP Medicaid Estate Recovery Program to HMS. They are the big player in estate recovery and do this for about 20 states & get a % of the recovery. Once the state has been notified of the death, then TXHHS lets their contractor (HMS) know. In turn, HMS sends a "Notice of Intent to File a Claim" to whomever was the point person for the deceased (like whomever was the one who got the annual renewal letter for them from Medicaid, or got the letter that stated she was approved for continued payment by Medicaid). I'm not sure what the time lag is for HMS's letter. There are folks on this site who have done posts on this and got a letter over a year since death and others within a couple of months of the death. But you want to be on the lookout for it as you are supposed to let MERP know if there are any exemptions, exclusions or hardships that exist and will change the amount of the possible MERP recovery.

All the exemptions, etc are on the state's Medicaid website. Personally I think the website is a bit junky and better explanations of the exemptions, etc are on the TAC site (Texas Administrative Code).

If you think you or other heirs qualify for one of them, you need to let MERP know of them within whatever timeframe MERP requires. They are going to want detailed supporting documents on all this too. Otherwise there will be a claim against the estate for whatever the elder's Medicaid tally was. If it's 150K but the house sells for 100K, then the MERP recovery would be limited to the 100k from the sale of the home. Family is not responsible for the overage.

If you going to do probate or a muniment or small claims, you really need to make sure that you & your attorney are familiar with how MERP runs in TX. TX is a pretty simple probate state, but I think really you need a lawyer to deal with MERP.
Good luck and find out just who in the family is likely to be the one to get the letters from MERP.
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Texas has some pretty liberal estate laws, compared to other places. I would suggest you settle her estate with the help of a lawyer who can minimize your losses and will advise you how to handle the house. There are way too many possibilities to list here. If the Nursing Home was 12,000 per month, then Medicaid paid out over $10K a month for her care.
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