Mom was in nursing home for one day of the month. Does all of her income go there? - AgingCare.com

Mom was in nursing home for one day of the month. Does all of her income go there?

Follow
Share

My mom was in a nursing home October 1 and discharged to a Medicaid Assisted Living October 2. When the application to transfer her from nursing home to community Medicaid was approved, it says it is effective as of November 1. When I called Medicaid to ask them to change to October 1, they said since she wasn't discharged from the nursing home until the 2nd, they cannot. They also said that the assisted living shouldn't think they are entitled to her income for October (meanwhile, they wouldn't even allow her to move in without me paying first). They said the nursing home is entitled to all of my mom's October income minus the $50 personal needs allowance. This doesn't seem to make sense considering she was only in there one day.


When I had called the nursing home billing department, they said it was easier to just bill her private pay for the day she was there and refund the rest. They sent the check. I told Medicaid this and asked if I could use that to pay her October rent at the ALP. She stated that she couldn't tell me what to do with the money if the nursing home wanted to send it. This also didn't make sense. I just want to do what is right and not have my mom's eligibility ever questioned. If the money needs to go back to the nursing home, fine, but it doesn't make sense that her entire social security check goes there when she was only there one day.

This question has been closed for answers. Ask a New Question.
Find Care & Housing
8

Answers

Show:
Samantha, it is crazy. Just when you get one thing straightened out,another issue pops up. Hard to keep up with. I feel for those with no advocate.
Helpful Answer (0)
Report

Glad you got it situated. It gets pretty deep sometimes doesn't it. Good luck to you.
Helpful Answer (0)
Report

I got it straightened out. After calling Medicaid and speaking to other people, they told me it was between me and the facility. The facility billed her private pay and then refunded the rest of her social security check to her, which went to the ALP and was less than her Medicaid budgeted amount of income she is allowed to keep.

To respond to Samantha, she never stopped being covered by Medicaid. Here in NY there are a few kinds of Medicaid coverage. She was covered under chronic care (or nursing home) Medicaid through October. She was then converted and covered under community Medicaid at an ALP (an certified state Assisted Living Program who are the only ones allowed to take Medicaid for Assisted Living.) She does have a spend down under the ALP, but that didn't start until November and she has a pooled trust set up for her spend down that pays her rent.

The type of facility she was in was a nursing home. No, it wasn't for therapy. It was for nursing home care. The primary payer when she was admitted there was Medicaid. Her social security check went directly to the nursing home, less $50 for personal allowance. The rest was paid by Medicaid.
Helpful Answer (2)
Report

Probably the best bet is to comply with the NH and keep the one-day refund, though I could be wrong. Is she then gong to private pay the AL?
Helpful Answer (0)
Report

I just thought I would add too... if your mom already qualified for medicaid and then got the refund for the month from the nursing home that small refund amount won't necessarily disqualify her from receiving medicaid in the future. If you must just pay her rent at the AL for the month and then reapply for medicaid. Medicaid WANTS to see her $ being spent on her care. Make sure you have receipts for paying that one days worth and rent. If she has too much $ for medicaid they may give her a "spend down" in which you would submit receipts proving your spent that $ on her and she needs the medicaid.

As far as paying rent for a month... what type of facility was it before she transferred to the AL? Was it for therapy? Who was the primary payer when she admitted there? Our admission agreement states a daily rate and that we would refund any amounts owed if patient discharges within 30 days. I suppose each facility's contract is different.
Ugh.. clear as mud?
Helpful Answer (0)
Report

In general you are expected to give 30 days notice when you leave, therefore you owe the entire months rent even though you may not be living there for the entire month. The same thing happens when people die, the facility still expects payment until the end of the month. Is charging for a whole month when you only were there one day fair? Not in my book, especially when they probably filled the room within days, but that's the way it is done and I imagine it says so in the contract.
Helpful Answer (1)
Report

I'm not a billing specialist but I am a social worker. I agree with the 1 day private pay. I'd pay them and be done with them. Then... move on to the AL. I mean, I know it's easier said then done.
Helpful Answer (1)
Report

I'm not sure so I'm bumping this up. Maybe someone has an idea for you. I think I would discount double check with Medicare to see what the new Person answering says.
Helpful Answer (0)
Report

This question has been closed for answers. Ask a New Question.
Related
Questions