My mom has dementia. Went to ER with high BP event. Sister admitted her to NH. After admission, I petitioned for guardianship and it was granted. Mom had Medicare and BC/BS at admission. She still has her BC/BS policy. The 100-day Medicare is ending on Jan. 5. I applied for Michigan Medicaid but have heard nothing so far. If I bring mom home from the NH and cancel the Medicaid app, and at some time she has to go to the ER again and NH is deemed necessary again, will Medicare 100 days begin again? If she came home her SS would cover her expenses and BC/BS, as before. After Jan 5 she will be responsible for the NH bill, unless Medicaid is approved. I am concerned about her NH care after Medicare stops.

(Mom was sent to the NH because my sister and brother decided they could no longer care for her. She is not incontinent, can feed herself, and can ambulate to the bathroom with her walker but she was weak, now weaker than she was before she went to the nursing home because of inactivity and additional medications/medication side effects.)

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I have read your posts and there are some things I just cant figure out.

I understand you feel the nursing home made matters worse but what is your plan? She has alz. and mobility problems, so are you going live with mom and take care of her? Brother and sister already stated no they cannot meet her needs which resulted in placement. You are guardian, according to other posts, have no vehicle, and give the impression will just let her go home because thats what she wants.

A court has appointed you guardian because she cannot make her own decisions or take care of herself. That means you look out for best interests not wants. Using Medicare 100 day policy as plan A is just irresponsible. If you decide to take her home, why would you cancel Medicaid app when she could receive in-home services.
Helpful Answer (3)
Reply to tacy022

I think there must be a certain amount of time between hospital admissions for Medicare to pay before the 100 day clock is reset. I also think the diagnosis must be different to reset the clock as well but am not sure. As someone said, 60 days is the time period for Medicare, I believe. This happened once to us when my mom was having her periods of in and out of the hospital and we were denied coverage for a NH stay due to this situation. This was 7 yrs or so ago though & Medicare guidelines may have changed.
So if your mom is discharged 12/1 and then gets readmitted for the same thing before 60 days are up (2/1) this is considered as part of the 100 days.
I too recommend calling her insurance companies with these questions and when you do keep notes of when & who you spoke with for reference just in case.
As far as Medicaid approval that may take time as well.
Helpful Answer (0)
Reply to Shane1124

Ask the the social worker for assistance for Medicaid. Also tell them that mom cannot return to sister's house and that she has no place to go and stick with it. That should expedite the social worker to assist. (they do it a lot). If mom is in a NH that does not accept Medicaid, she will need to be transferred to one that does. You as her guardian may have to view the possible places but it is a small price to pay for your time.
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Reply to MACinCT

Contact Medicare and BCBS and find out exactly how her policy works. There are so many variations in insurance plans that they are really the only ones that can tell you.
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Reply to Isthisrealyreal

The facility will get dinged by Medicare if she is readmitted in a specific number of days. It really is impossible to play the system. They should be able to admit her to nursing home as Medicaid pending.
Helpful Answer (1)
Reply to gladimhere

It will if she has had no hospital or Skilled nursing admissions within 61 days of discharge. A second Medicare 100 day admission to nursing home or skilled nursing will start. This information is as of 2017. Check with Medicare - their rules change every year.
Helpful Answer (2)
Reply to UsedupDIL

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