My Mom has a long term care policy that pays $50 per day and I want to know if Medicaid will take this money?

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We will sign her up for Medicaid in a few months and her long term policy will pay out for about 4 years.

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Nasmir, as the wife of a health care provider who helps with the office clerical work, I can tell you that sometimes the paperwork required by an insurance company or out of state Medicaid can be so complicated that it is not worth staff time to try to get reimbursement. We just write off the charges and don't renew our provider contract with that company. I imagine that it is the same with long term care insurance. Also, it is unlikely that a nursing home would want to pay an insurance specialist to navigate the paperwork (probably different for each insurance company) if it is an independent company with limited population turnover. Our insurance person attends seminars every year (multiple times in the last two years because of the roll-out of the ICD 10 codes) just to keep up with the changes. The salary of this person and the cost of the training would need to be passed along to the nursing home residents.
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Health care businesses can determine IF they want to participate in and accept assignments for any insurance. Its pretty straight up like JessieBelle described.

Many providers will not accept duel eligibles (on Medicare & Medicaid). Often a NH will participate in Medicare but not Medicaid. A NH can choose not to accept LTC insurance. My moms NH didn't - to be a resident it was either Medicare, Medicaid or private pay.

About the "submission of a care plan", if they are coming into a NH from a hospitalization, they will have had various ICD -10's in their chart at the hospital. There would be an ICD - 10 probably Z series on rehab in the discharge paperwork in their chart. That's viewed as the care plan & with the codes needed for Medicare. It was there as she admitted to the facility as under Medicare rehab benefit. ICD-10 (which went into effect last year) now provides for easier bridging of codes between doctors & clinics to hospitals / hospitals to NH & vice versa.

The bill for the 20% coinsurance will need to be paid either from the assets of moms estate or by you or whomever signed off on the paperwork to be financially responsible. There could be invoices in the pipeline from OT & PT & the outside pharmacy the rehab/NH uses as well - these seem to take longer billing to be sent. Debts like this gets turned over for collections unless probate is opened.
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Nasmir, each business can decide on their own terms. They can decide whether to take this insurance or that insurance or no insurance at all. As long as they tell you upfront what they will accept, they are not trying to deceive or hide anything.
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Couple of things to find out about BEFORE yiu do the medicaid application:
- will moms $ 50 a day ltc payment be considered "income" by medicaid. Medicaid has a ceiling on monthly income. It varies by state, most are around $2,100 a mo. If moms SS, retirement and LTC (50 x 30 = $ 1500 mo) all count as "income", mom may be over the income ceiling & ineligible for Medicaid. You need to speak with a caseworker clearly on this before you do moms application. There may need some paperwork filed to state it's not reportable "income".
- Will the LTC policy will stop paying once Medicaid eligible? Some LTC are written to be a supplemental payment and since medicaid pays all costs in theory is no supplemental needed once Medicaid pays. This should be a question in writing sent to the LTC for a written response to you/mom.
- will the NH accept the LTC payment? My moms NH would flat NOT take any LTC policies for payment. Why? Well billing told me that each LTC would require some sort of info on staffing ratios, care plan, licensing & CE credits of staff etc in order to pay & each insurer had their own system....there was always paperwork issues and foot dragging by the insurers....that it just wasn't worth the time needed & delays in payment to take LTC.

Do what you can to make sure no nasty surprises later.....
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So in a way - yes. You must apply the daily amount paid by the LTC policyndirectly to NH as that's what it is for.
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They don't take it, but they expect it to keep paying and they only make up the difference.
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