My mother-in-law was admitted to a nursing home by a family member without consulting the rest of the family. We want to get her out and back home, but don't know if Medicaid is withholding her Railroad Retirement check as payment for the nursing home, and if she would continue to receive her check right away once discharged from nursing home, or would Medicaid continue to withhold her check until any balance, if any, was still due on nursing home.

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Poppy - you might want to take a step back in all this to find out a couple of things first. Do you know for sure that MIL is on Medicaid…that a Medicaid application with supporting documentation has been done and MIL was found eligible? Are you familiar in how RRB (railroad retirement board) is different than SS and how Medicare (Medicare not Medicaid) is somewhat different for those on RRB?

We had RR in our family (with Tier 1 & 2) and it is somewhat different in structure than SS and because of that can be different in what happens with Medicare & Medicaid. RRB pays usually lots more $$$$ than SS ever would, so often the railroad retiree is over what the state sets as the maximum Medicaid income (varies by state & most are at 2K in monthly income) to qualify for NH Medicaid. Most RRB won't qualify as income just too high. Find out what MIL RR check is & what your state has for NH Medicaid income max and if their RR check is more.

If so, 2 things could be happening:
1. your MIL income is over the Medicaid maximum, but MIL has done a Miller Trust or some other agreement with the state to deal with the overage amount and due to this now qualifies. An attorney would have been needed to do a Miller Trust and someone with DPOA for MIL would have had to taken her to get this done, with documentation, etc. Or a state social worker could have helped get her income qualified in another way to get Medicaid & again there would have been documentation done by her or her DPOA. If this was done, it's a pretty tight binding legal document and not easily changed. You need an attorney to work through changing this. BUT……..
2. what is more likely is that if her RRB pays pretty good, is that the NH is OK with the NH getting paid MIL's RRB retirement check as their payment in full for the NH. So MIL would either sign it over to the NH or your MIL requested in writing or on-line for RRRB to direct deposit it to the NH. If MIL's RRB $ is about 5K - 7K a month, the NH probably is fine with accepting it as payment in full.
Whichever the situation, the NH needs for MIL to pay in order for her to stay there. What the terms are (like for moving out and canceling the agreement) depends on the admissions agreement that MIL or her DPOA/MPOA signed her in under. If you do not have a copy of the admissions agreement, get a copy from NH business office asap to see what's what.

Also RRB Medicare has a different Part B coding system than regular Medicare. If this NH does not have a lot of other RR retirees as residents, they and any medical providers billing to CMS Medicare aren't likely to know this. Everything for RRB Medicare has to go Palmetto GBA in Georgia. Bills have to go to Palmetto in order to be processed and paid.
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