Medicaid question regarding the nursing home.


My mom was in a nursing home locally in which she was accepted as Medicaid. She was there about 2 years and during that time there were a few months in which Medicaid did not pay the entire amount for each month, of which they did not address with Medicaid at that time. Now Mom has moved to another state and the local nursing home says that she has a balance of about $1800.00 and they are pursuing it through Medicaid. However, Mom has a patient fund account, at the local nursing home, in the amount of about $800.00 and they are refusing to release that money saying that until Medicaid pays her balance, it is considered a patient bill. Hence, holding onto the money as I know they will probably apply to her balance if Medicaid does not pay. I thought that since they accepted her as Medicaid, they could not keep the patient's patient fund account. I really am wanting to have this patient fund account sent to her new facility, but so far, no progress made in that direction. They absolutely refuse to release her money to her. Any ideas on this are greatly appreciated.

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what about when the person dies
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Thank you so much Igloo572. Fortunately I did not sign even as POA since my mom could sign her own documents and we had an Elder Law attorney handling all the Medicaid stuff (they are no longer on her case since she moved). NH#1 has been good about communicating with me and always return calls. They have submitted bill to Medicaid, again, for repayment, so we will see what happens. NH#2 is great, where she is now a resident, and it is in another state where my sister-in-law is a VP of many nursing homes/communities, so my brother and sister-in-law now keep tabs on everything with her. I kind of figured mom will have to write off that $800.00, which wouldn't surprise me and yes, I do try to keep a good sense of humor about it. Heaven knows I spent many years stressing over my mom in the nursing home (you know, the normal, guilt feelings, what if they don't get their money, will they come after me, etc). As I said, the good thing is that I did not sign any documents; so, if they choose to pursue her for the money, they won't get anything as she does not have anything to her name anymore and is Medicaid in the new state and so the saga continues......
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I think you have reached and impasse and probably should not count on getting the full 800.00 back. The NH point is valid & it sounds like they are being fair.
They could go after you (if you signed the documents) or your mom for the full debt but are not going that route. What does the contract read for the NH #1?

What may have happened is there was a lag between the reporting of increases in SS or retirement and the difference isn't paid by Medicaid and you don't increase your co-pay to the NH. I had a problem with this with NH #1 (terrible business office and 3 - yes 3 - different administrators in the less than a year she was there). NH # 1 took months to update billing & was SOL on getting the difference as it was past their contract requirements and my mom did not maintain a patient fund at the NH they could access. Plus she was already in NH #2 when they finally got their billing act together. If your mom had an change in retirement or cost of living in her SS, this may be why there is a outstanding balance or it could be due to an out of plan service provider - maybe physical therapy? - who the NH uses and Medicaid or Medicare did not pay for the service in full. Or it could be a specialized medication that is not on the Medicaid or Medicare D list that the billing is about. If you want to make life difficult for them, I'd sent them a registered letter with return receipt (the green card at the post office) requesting documentation on all billing and payments by Medicaid & Medicare for the whole period of time mom was there and in it state must be received within 30 days from receipt. IF they don't do it & as per your stated request, then they are SOL in getting paid. Doesn't do anything about the 800.00 they are holding but might make you feel better. Whatever you do everything must be done as "Jane Smith in her capacity as DPOA & MPOA for Ann Jones" & never ever just your name.

What is a learning lesson here is that the "personal needs allowance" or "patient fund" which ranges from $ 35 - 90 a month (depending on your state) NEEDS TO BE SPENT on a regular basis so that it never gets above a couple of hundred $.
That amount - my mom is in TX and it's $ 60.00 a month for her - needs to be spent down on a regular basis for clothing, cosmetics, shoes, beauty salon (get her on a regular schedule & that alone will take care of the fund) so it never builds up. Also IF the patient fund goes over 2K, it could trigger ineligibility of Medicaid as they now have too many assets. You really want to keep the patient fund to a couple of hundred at the most.

The PNA does not have to be placed at the NH either. My mom's SS & retirement annuity gets direct deposited into her bank account, & I write a check to the NH for her monthly co-pay less her $ 60.00. So it builds up her account each month. So when I come in to see her & spend $ 58.75 at Target on stuff for her & $ 100 for those hideous SAS shoes she loves, the money comes out of her account by check to Target & SAS. I control it & it doesn't $it at the NH. She has a NH patient fund of maybe $ 150.00 for beauty shop but not ever more than that.

What I have found is that the NH will press upon you to have the residents SS & other retirement go directly to the NH with the PNA set aside by the NH for them. They may ever say it's their policy but they cannot require you do it this way. You do NOT have to allow this as SS requires self-determination on where the $ goes. Ditto for retirement. Good luck & keep a sense of humor.....
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