MIL is Medicaid eligible. Should we continue to pay her pharmacy co-pay bill or wait for Medicaid to pay it retroactively? - AgingCare.com

MIL is Medicaid eligible. Should we continue to pay her pharmacy co-pay bill or wait for Medicaid to pay it retroactively?

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My wife's mother is finally Medicaid pending and we met eligibility spend down by Nov 1st. So we're waiting for a Medicaid decision...and waiting...and waiting.

Meanwhile, our attorney advised that we spend her money as if she's on Medicaid now to avoid allegations of mishandling her money by the NH where MIL is now. We're keeping household expenses on the house at or below $150/month for the next six months and won't spend more than $35 of her money on her. The rest is supposed to go toward medical care.

The big question is whether or not Medicaid will reimburse the pharmacy's co-pay bill. The prescription co-pays are what's left from her secondary insurance from FIL's federal retirement. She does not have Medicare Part D. The pharmacy that services the NH is sending her bills monthly.

If Medicaid will pick up the co-pays like the state's website says, then wouldn't that be retroactive to when she became Medicaid eligible which would be the first of this month? She'd be responsible for any costs before that, even under the 90 day "retro" period for the PEME process, so paying those now is the same as paying them later.

We're just trying to keep from running afoul with the NH who could accuse us of not giving them around $190 extra dollars per month.

Any thoughts? We're RunRagged!

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Thanks! We plan to call our attorney on Monday but glad to have a sense of this from the community who's actually doing this month-in and month-out. We've got to call the pharmacy anyway, so good point. Glad to have your experience!
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I would check back with the attorney, but here's my take. The NH is entitled to all of her SS check, pension, etc.,as her share of the cost of care. Medicaid pays the NH for room, board and medical care including medications. Mil gets to keep 35$ per month for clothes, toiletries, haircuts. There should not be any medical expenses or pharmacy copays. I would write to the pharmacy and let them know she is Medicaid Pending. I don't know about the house upkeep being allowed, you should double check with the attorney about that.
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That's why we're asking, Pam! We've heard that. Now our attorney does say that she can keep $35 per month for incidentals and up to $150 per month to keep the house going until we sell it for up to 6 months. But the rest of it needs to go to the NH...maybe the pharmacy?
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Medicaid pending generally means the NH gets her entire check. I don't think you can keep any of it. Better read the papers again.
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