He has Parkinson's and entered the facility from the hospital with a repaired fractured femur, he was in serious condition. They removed him from skilled care after 5 weeks, they said he hit a plateau, now they're looking to collect his social security from October, November and December. From what I can understand October should be paid for by Medicare 100% for 21 days, the rest his Medicaid should pick up. He has a zero deductible because he has nothing but his Social Security, so my question is under skilled care days 21 on Medicaid would pick up the remainder for October with his zero deductible, the facility is not entitled to his Social Security for October he was on skilled care till November 11th. Is this correct?

I'm hoping to be able to remove him from this facility and get him into a facility where they truly care about him. Instead of helping him to be able to use his walker again he's been bedridden I believe they're just giving up on him.💔

Your ex, are you his DPOA? Or is he still competent & cognitive to deal with Medicaid status changes?

Probably something had to be filed within Medicaid to have him transition from community based Medicaid for when he was living on his own before the hospitalization to LTC in a facility Medicaid. For LTC his assets have to be under 2k, if before he had a bit of savings, he could find he’s over the nonexempt asset limit. So a quick spend down may need to be done. Probably easiest is a 8-10k funeral / burial pre-need. But imo what to do depends on just how much $ he has as an overage. Like 10k easy to spend within a week or so..... 20k+ needs more creative and that could need time.

Just how much of an issue a delay in transitions becomes a problem depends on your state and also the social worker & billing at this facility. Community based & LTC are two different Medicaid programs. Try to ask if it’s been done or if there’s something he / dpoa needs to do.

As others have said, once on LTC Medicaid, basically all his monthly income must be paid to the NH are the required by Medicaid copay or SOC (share of cost).

What I’d see as a glitch would be, say he’s discharge from post hospitalization rehab at this NH Oct 23. So Medicare stops paying 10/23. If he had say $4,567.89 in his back account in Oct, he’s over the 2k in assets for LTC Medicaid, so he’s private pay for 10/24-10/31. If in Nov, he’s still over 2k, he’s still private pay till at 2k. Then either goes onto LTC Medicaid if yourcstare has an easy way to segueway from community to LT; or for more fun... they don’t, so he has to go “Medicaid Pending” while the state approves the application for LTC Medicaid and he submits the financial documentation to show “at need” for LTC Medicaid. Yeah total butt rash, but they are two different programs under the Medicaid umbrella. Comprende?

Either way, the SOC has to get paid from whatever his monthly income is (SS, pension). Speak with billing & social worker to get clear answers as to just what may have to be done.

it may be simplest to have him stay at this NH till he absolutely has been approved for LTC Medicaid then he can move laterally to any facility that takes Medicaid and determines they can meet his care needs. I moved my mom from 1 NH to another much better one at about mo. 8 & couple mo after she cleared billing clusterF from NH#1. It can be done but it’s a bit of a ballet to get done smoothly.

If the place you like will take him unconditionally as Medicaid Pending, you might be able to move him now. Usually they should do an on site visit to do a needs assessment on him at the current NH. A word of caution, for Medicaid Pending, a facility may press upon you to sign a financial responsibility document for you to pay should Medicaid not find him eligible.
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Reply to igloo572
HisExwifecares Dec 4, 2018
Thanks for the info.
He has money, no assets. His Medicaid is a zero deductible because of his poverty level. What I'm not sure of is Oct he was under Skilled care and Medicare pays 100% days 1 to 20 (Oct 5th to Oct 25th)
Who pays what for Oct 26th to 31st.... His Medicaid is a zero deductible.
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Do you mean by skilled he went from a hospital to rehab? If so, Medicare would pay 100% for only 20 days. The 21 to 100 only 50%. So he needed Medicaid at this time? When did he start his rehab? They may be entitled to some but not all.
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Reply to JoAnn29
HisExwifecares Dec 4, 2018
Yes, hospital to rehab in Long term care facility, he will be staying there for good. October is the only month I'm not sure about, because I had to pay his last apartment rent and pay to remove all items from his apartment and pay last electric bill, I used his Oct SS to do that.
His SS goes to the nursing home. He may not have a Medicaid deductible but if they are paying for his nursing home care, then all his income goes to the nursing home and Medicaid pays whatever is left. He doesn’t get to keep his SS. He’ll get a personal needs allowance usually $60 a month. But all his income will go to the nursing home and Medicaid pays the remaining balance.
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Reply to worriedinCali

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