Medicaid: transferring to another nursing home. Any advice?

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My mom is on Medicaid in a nh and wants to transfer to another nursing home, one that has a high rating. Admissions people at the nh Mom wnats to go to say this is possible but cannot guarantee when due to a limited number of Medicaid beds. Mom is excited about the idea of moving but I worry that maybe this is not going to happen. Is it common for an upscale nh to accept Medicaid transfers?

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Trevor, just to clarify, Medicaid does not cover the cost between patient income and nursing home cost. Medicaid pays one rate for everyone, and the nursing home has to take it if they take Medicaid patients. It is not negotiable. So for example, nursing homes in NY are $12,000 a month. Medicaid may pay $8000. As a Medicaid recipient in nursing home care, a patient must also surrender their social security check to the nursing home. So the person with a $500 SS check is worth $8,500 to the NH while a person with an $1800 social security check is worth $9,800. When they see those 2 numbers on an application, they are a business that wants to stay in business. They will take $9800 every time. $8,500 will be told there are no open beds. Sad.
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Bob, it really should be a non-issue, but it's not since in addition to the standard rate that Medicaid pays per resident, the nursing home is also entitled to receive that resident's social security check as a "copay" in addition to the Medicaid amount. That adds to their bottom line, and believe me, they're watching. They will use that criteria to decide which Medicaid patient to accept. Sad.
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The county social services is just that: Social services...here I think they are called Division of Social Services, DSS. It would be in a public building, likely along with Probate court offices and others such entities.

Grace + peace,
Bob
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Bob, I get what you are saying but it seems to conflict with what Christine says. I am talking about a transfer from nursing home to nursing home, so the issue of qualifying for Medicaid has been determined. Mom is already on Medicaid. Also if the nursing homes are in different counties, which county social services do you talk to?
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When applicant to Medicaid has an income over a certain annual amount, it is my understanding they do not qualify. When my wife applied several years ago, the nursing home never asked about her income..That was addressed by the County Social Services staff. (agents, so to speak, of Medicaid). The amount of allowable income for "mom" may differ by state..if there is a spouse still at home (community spouse) then the income of said spouse has no bearing on mom's application.. Much more to it...The "difference" in income among various applicants should be a non-issue with the nursing home. Their role is: Medicaid bed available? yes/no. End of conversation. Remember, one does not "apply" for Medicaid through the nursing home. I would deal first with county Social Services.

Grace + Peace,
Bob
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Christine, I guess I did not understand how Medicaid works. I thought that Medicaid paid the difference between what the resident can pay (Social Security, pensions etc) and the nursing home's actual monthly cost up to a certain limit ...for example, resident contributes $1,000. NH costs $8,000. Medicaid pays $7,000. What you said is different. Medicaid pays a set amount (any idea what an average is?) and then resident pays their share as I stated earlier, so the resident with the higher income will be favored. Have I got this right?
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Christine - just reread your post. You mentioned the other family was railroad retirement. I'd bet that was a factor too. RRRB pays really high. Like it isn't unusual for a retiree to get 3k, 4k, 5k a month. Their lifetime benefits especially if they were professional or the widow of one will be quite quite high. Like enough to pay in full or come so close to it that NH will waive the difference. RRRB pays like clockwork. Their Medicare payment system is different too. Palmetto processes RRB Medicare (totally different coding) and they too pay really fast. Most NH now in the US probably don't get RRRB residents as there just aren't as many RR retirees. But for those that know how it's structured, a RRRB is a windfall.
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The NH cannot require the residents monthly income (their SS, retirement check) to be paid to the NH. The DPOA can keep their monthly income as a direct deposit to the elders bank account & the DPOA snds a check for the SOC required to the NH & the bank account buildsceach month by thier personal needs allowance. So the eiders bank account builds each month by their needs allowance (from $ 35 -$ 105 a mo) that enables you to buy things for them that you know they need or would like or let It build to under 2k pay to offset future funeral costs.

The NH wants their income as they get to control the funds AND they also get to build the residents trust account & NH coffers by whatever your state has as its personal needs allowance. One thing that has surprised me in this adventure of elder care is that often family does NOT even know about the personal needs allowance trust fund at the NH. The NH implies that all income has to go to them...it's all so much easier for family to do it this way.....so much less worries for family. Yeah sure & I have some gulf front land on the Louisiana coastline I want to sell to you.

In theory, the NH is supposed to provide a statement on the trust account regularly. My moms first NH didn't; her second NH did every 90 days & with interest. There have been a couple of posters on this site who were unaware of the trust account & how it builds & had their moms NH used it to buy wheelchairs for them from the trust account to get it zero'd out.

Also if they should move to another NH, getting the direct deposit switched will be a cluster to do. Probably a month /6 weeks to accomplish. Getting the $ from old NH may not be simple....
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I'd like to add my thoughts about the SOC & the appearance of facilities preferring those with higher SOC/higher monthly income....In theory there should be no preference for higher monthly income applicants as Medicaid pays the same reinbusement day rate for room & board for all Medicaid residents.

But here's my experience with this "reality" based on my mom @ $ 1,800 in mo income & MIL who had around $ 600 a mo. For both, they were coming from an at home living situation to a NH. Mom was in IL & MIL was in a senior housing apt. So not an admit to rehab at a NH ( so coming in with Medicare paying the rehab benefit). The NH's I toured we're positively giddy to take my mom with her $ 1,800 a mo income. For MIL not so much based on what my BIL /SIL said.

Why?....well Medicaid takes anywhere from a couple of months to almost a year to process an application. My moms took almost 6 mos to get medicaid approval. MIL moved into NH but within 4 mos went into the hospital and then into a freestanding hospice where she died within a couple of weeks. MIL died before her NH medicaid application was approved & it was approved over a year later after her death.

During the application process, the state medicaid pays zero -nothing -nada BUT the resident has to pay their SOC every month while they are " Medicaid pending". So my moms NH got $ 1740 a mo from mom. But for MIL around $ 500. A lot of residents die within the first 6 mos too. So the NH can end up not ever getting paid if Medicaid doesn't get processed & get approved. The elder is dead and really there usually no estate to go after. Most families aren't going to continue to dog the Medicaid application to get it approved (like my BIL/SIL did) once their elder dies. So the NH is flat out of ever getting fully paid.

That's why imho a potential resident with a high SOC makes admissions giddy. & why they will do a not-by-the-rules preference for higher SOC elder.
It's all about the $$$$$$$....always.
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I can answer the medicaid question. When you're on medicaid in long-term care, medicaid pays a set amount to the facility per month. Additionally, the facility gets the resident's social security check, pension, and required distributions from their 401k. They call this the resident's "share of cost" and it is usually sent directly to the nursing home from social security. Everyone's share of cost will be different. It makes a difference because this is extra money the facility is entitled to. So if one person's ss is $1500 and another person's is $500, the facility will want the person who gets 1500, because they'll be getting a "copay" that's $1000 more per month.
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