Mom in a nursing home with dementia. Nursing home is tacking on extra $1k to mom's balance owing (even though she has a set monthly co-pay rate by Medicaid), based on a four-day hospital admission from the nursing home.

Mom entered nursing home in September 2018. First 100 days paid by Medicare. Applied for Medicaid in November. Medicaid finally approved in March 2019. While waiting for approval I continued to pay mom's BC/BC, along with a few other obligations. This left a $5K back balance to the NH.

After Medicaid approval, I cancelled her BC/BC (a very good policy that she carried for years). I began to pay the current rent immediately, along with a set payment of $40 towards the arrears. Even though the current rent is paid on time, there is a $49 late charge each month on the balance in arrears.

I have lowered the arrears balance to $3K. My sister wants to pay the arrears balance (in exchange for my signing my mom's co-op shares to her. I am my mom's legal guardian).

I called the nursing home business office to confirm the balance owing that my sister will pay. My records show a balance of $3300. Nursing home says $4400. The reason for this is, they state, is because my mom was hospitalized for four days in March. And because it was considered a "re-admit", there is another $1k added to her balance owing.

How can they add another $1K when the monthly rent determined by Medicaid has been established? This sounds like each time my mother goes to the hospital, I will be owing another chunk? And why would this be owed to the nursing home?

I'm not sure I have conveyed this circus dilemma as clearly as it should be, and hoping someone gets it and can ask me the right questions for clarification.

Wow! I’d find an elder care attorney!! They’re robbing you. My mom was in AL. They took all but $40 of her SS & applied for Medicaid for her. She kept getting bills with a balance due each month but we were told to ignore that, they have to send bills out. Once Medicaid went through, no more bills
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Reply to Lostinva
Zelda53 8 hours ago
No money for an eldercare attorney. One thing -- we haven't been robbed until a payment is made. So that's a good thing.

Since Medicaid was approved (mid-March, retro to mid-September 2018 when mom was dumped to NH by my sister after a hospital admission), I have paid the required rent set by Medicaid -- SS/pension, minus $60 my mom gets to keep. So right now I am current except for the amount I didn't pay while Medicaid was pending. So I don't argue the co-pay rent. The late fee for that amount is questionable.

Everything I pay now goes to the back balance, nothing is applied to current monthly rent. I told NH I would pay two separate checks each month -- one for the current month, the other for payment towards the balance accrued during Medicaid pending. That is for my own bookkeeping -- so I can see exactly what is going on, on paper, in front of me on my desk. "We don't do it that way. The whole amount you pay goes to the arrears balance", they said. My reply -- so, in other words, it's like I have a Sears revolving change. Late fee every month and late fee increases the balance every month. There will be a balance owing, forever."

Then of course there is that $1k they want mom to pay. Not touching that. Waiting for Medicaid call me back.

I will continue to write two checks until this is resolved.
I'm a nurse that has worked in NH's and this just doesn't make sense to me.
In my state, when patients were waiting for Medicaid to kick in the NH just billed the state for the back payment. It seems they only care about the money if they charge you a late fee every month.
If it were me I would call the state and have them check out their billing policy.
The NH will have the 800 number to the state agency visible when you enter the billing along with the survey.
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Reply to Jstanford
Lostinva 23 hours ago
You’re right Jstanford, see my post!
Money maker for the NH. They're using hospital admission to justify this charge. Take a look at the contract. It should state out if the resident is charged if he/she is admitted to the hospital. Readmit fee. does not make sense since she has not been discharged from the NH. If that was the case, then you would be able to move her somewhere else and get a final bill from NH
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Reply to shad250

i don’t know if this is the right answer . But even if mom goes into the hospital your still paying rent at the NH for thirty days even if she’s there or not. It all depends on how your agreement was worded that you signed. Some things aren’t covered by Medicaid also. And maybe her other insurance doesn’t pay if she’s not there. I’d ask for an itemized statement of charges and read the lease on the nursing home sometimes there is a one year or two year spend down your paying for before Medicaid kicks in. I was told by Medicaid not to pay for mom’s placement while she was in the hospital. They closed my claim because of this. Now reopening. I don’t understand a lot of this either and image there are a lot of people out there that don’t. Medicaid is such a hush hush thing and they don’t give families much information. People also need to be careful of what they sign before signing these agreements. I had my attorneys look mine over and there were some things I would have been stuck. Paying for if I hadn’t had them look it over . Best to contact someone before signing these NH contracts
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Reply to DeniseMiller

I'm assuming, hoping all of the financial commitments you have made to NH have been made in mom's name, you simply signing as her POA/agent meaning she is the one responsible financially. I thought the usual practice when a NH resident went on Medicaid was that the NH required that patients income to be assigned to them, setting aside the allotted personal account amount for the pt and then they and Medicaid worked out the balance payment, that remove the need for you to do anything with the finances but maybe it varies state to state.

It sounds to me like there has been a miss-communication or something within the business office or perhaps Medicare/Medicaid but that shouldn't be costing your mom. Again some of this may vary a little state to state, Medicaid is run by each state and actual dates may come into play but once Medicaid has kicked in there shouldn't be any back bills left. That's the point they don't kick in until she meets the income and asset requirement, sometimes even back paying a little but she shouldn't have any funds available to pay back rent. Still if I'm understanding this correctly;
Mom entered NH under Medicaid rehab/hospital stay status in Sep. say Sep 1 for these purposes (100 days max) did she enter from a hospital stay that might have started the 100 days prior to entering rehab or another rehab prior to this? Also that 100 days I believe include a lifetime benefit, has mom had any hospital stays in the past that lasted more than 30 days?

She became a long term NH resident at the same facility after being considered a rehab patient when those 100 days ran out around Nov 29. Her BC/BS was paying the co-pay up until this point and may have still kicked in to cover a portion of the cost maybe in conjunction with a different part of Medicare but leaving her with an out of pocket co-pay.

Medicaid approved and kicked in March 1 so she had at least a partial if not full pay for 3 mos. In March she had a trip to and was admitted to another hospital for 4 days or was she a skilled nursing patient there at the same facility? I believe there has to be 30 days of not being a "skilled nursing" or admitted to the hospital patient before a new occurrence starts, otherwise it's considered part of the original admittance but it looks like that should have been met easily. Now it may be that she no longer had the BC/BS policy in effect for that March occurrence so NH is charging for that portion but Medicaid should have then covered it since you didn't drop BC/BS until she was being covered by Medicaid.

I would urge you to talk to a Medicare counselor and a Medicaid counselor before paying another dime out of pocket to the NH, you might even find you need to talk to BC/BS depending on what the other two say and then once armed with info from the payer representatives go back and talk to the NH. You obviously aren't trying to get away with anything or not pay a bill mom is responsible for, no one can accuse you of that and the facility you have chosen made the choice to accept all of these insurances and the rules or parameters that come along with that so you aren't trying to get away with anything by holding them to that.

I don't know anything about the co op shares or how they are considered and passed on but I agree with JoAnn29 you might want to do some investigating about where they fit in when Medicaid was looking at moms financial profile, the last thing you want to do is put your mom and sister in a worse position unintentionally.

Good luck, these insurance, coverage, financial details are rarely simple especially dealing with Medicare and take a lot of time and energy to work out, your mom and your sister are so lucky to have you taking care of these details, watching out for Mom.
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Reply to Lymie61
Zelda53 7 hours ago
Thank you so much for this break down!

I am mom's legal guardian. Period. No POA/DPOA or conservator. Yes, checks are written from her account. I chose not to assign her SS/pension. I thought that was a requirement until I went to SS to do that (after Medicaid approval), who told me -- no, you are not required to do that. You can make the payment directly. And request for assignment has to come from the NH, not you asking for that to happen. Well, thank you SS, and it was a pleasure doing business with you today!

Looking over paperwork, I found "the contract" that was mailed to me months ago. I never returned it signed. I was in the thick of things directly Mom-related at the time, for one thing, and second, I just did not understand the contract. Because I didn't understand it I pushed it aside and stuck with "Mom" as my priority. And booooyy, am I glad I never signed that paper because now I understand it, after the fact.

I'm going to print your response. And thank you again.
I looked up co op shares. So my question is, how did Medicaid look at this? Like a house she is allowed to have? If so, you may not be able to turn over the shares. This is a question for Medicaid.

Another question would be how the NH is billing Mom. Once she is on Medicaid there should be no extra billings. She has no money and you are not responsible for the debt. I would ask her Medicaid caseworker about this. Also, putting late charges on a balance owed.
Helpful Answer (2)
Reply to JoAnn29

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