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She receives $1830 a mth in SSI. Her monthly Medicaid cost for the Dementia unit is $1616.60 per month. Because of the hospital bills, I am able to pay the first month cost but I am concerned that Medicaid would see this as a gift and affect her eligibility!

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So is it the situation that mom paid bills and this has left her $700 short to pay in full her required by Medicaid monthly copay to the nH?

If this is the situation, here's my suggestion: get moms last 3 mos bank statements & a slip from the bank mañana that shows her balance. Go to the admissions office with these and pay all you can on moms required co pay ( like all but leaving enough for service charge). Then @ NH get a separate agreement done for the $700 balance due to come out of her trust acct (TX personal needs $60 a mo) so maybe agreement for $ 50 a mo which you sign off on as DPOA. Hopefully the NH will do this. Otherwise you kinda have to just personally pay the $700 direct to the NH. If you personally pay to NH, then not an asset or income of moms.

You know Medicaid could have approved mom to the month before her entry to the NH. If so, Medicaid could be billed for any services from the date of eligibility till now. So if the provider accepts Medicare & Medicaid, there should be no copay. As DPOA you can send certified letters requesting rebilling to medicaid and return of copay$ to mom. If a provider accepts the M & M's, then they kinda have to do this. It is a lot of paperwork though, so think if worthwhile for you to do. If you have continuing relationships with the providers, well personally I wouldn't do it.

As an aside, are you having it such that moms SSI is deposited to her bank account and you write a ck to the facility for her copay? Or has the facility asked for deposits to go to them? facilities will press on family to do this but legally they cannot force a resident to give them their SS, retirement or whatever eise they get for income. Most often family is in panic mode when placing their elder in a facility so take whatever the facility says as gospel but often it's not in your best interest.
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I agree that the facility will try anything to get more money out of your mom (you). I know that my niece paid the bill for medications at the NH each month. But, she never was asked for a check for his care at the NH. Medicaid paid this direct. Her father was allowed a very small amount every month for personal items....shaver, clothing etc. That money was in an account at the office of the NH. The Resident could ask for it. So I assume if your relative is incapable of asking for it, you could. I wonder how many actually ask for an audit on this little savings acct at the office? The nursing home has their own Pharmacy. So, you can bet the NH is making some profit on this also. I have to assume that the SS check went direct to the NH and Medicaid paid the difference. Even with that, the costs per patient is way lower than a private pay would pay. That is why they try to limit the number of Medicaid residents. (and the fact that the State probably requires so many rooms be made available for the State patients. The NH is all about profit..... PERIOD.... Somehow, my girlfriend who just recently died in a NH, was given such sub-standard care, that I was thrilled when Hospice stepped up to the plate. The manager who ran this NH was just what the owners of the home wanted. She was a tough, straight faced hard women. When I tried to talk to her, it was like she was saying (with her face), go ahead try to get me to change something because it "ain't going to happen" But when she walked through the facility, she smiled like she was the sweetest person there.
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Oregon - just how the Personal Needs Trust Account is handled depends on your state Medicaid program and the individual facilities admissions contract. Family or DPOA do NOT have to have the residents income (ss, retirement, etc) be sent to or direct deposited to the facility. So you can open the trust account with whatever amount you'd like (and you pay the NH the required co-pay). For my mom, she was in 2 different NH, for NH #1 I placed maybe $ 150 to start & got 1 PNTA statement about mo 4 of her stay there & that was it as their admissions contract stated that if it went below $ 100 no statements. Now for NH #2, they sent out every 90 days a statement with detailed accounting for all withdrawals and paid a tiny interest on the amount. When mom died, the balance from it was mailed with a check paid " to the estate of" about mo 4 post death.

It's kinda important that family keep track of and spend the trust account because if it builds up over time and exceed 2K, it will make them ineligible for Medicaid.
Some NH provide a statement or tell family the balance at the every 3 month care plan meeting. If the facility charges for phone & cable, then there essentially is no PNTA funds. If the resident is put on a hair salon schedule, then too there is essentially no funds as well.

What is amazing is that often family sign over the SS check to direct deposit and do not even realize that funds are going into a trust account with sums being withdrawn from it to pay for phone, cable. etc and don't ask the NH for an accounting.
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Yes, I remember when our Brother in law was in a NH and we got a bill for cable. We had never ordered cable as he was in Memory Care. We took care of that little charge quickly. We also bought his shaver (which was lost usually within a couple of weeks). I found out they were using it on other patients. That is SO unhealthy. Then They WASHED his leather jacket. It was one thing after another. I could not believe that the laundry help did not know that leather should not be washed. He had the jacket since his time in the service and it was a collectors item. They lost his clothes repeatedly. We brought a barber in to cut his hair so he was not to be charged for that either. You really have to watch these places. You were on top of it. You have to be...No doubt about it.
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I hope it does not happen that my partner has to go to a nursing home. I am not ready for all this high finance stuff. But, I will stay on top of it.
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No, Medicaid WILL cover bills (in some cases) up to six months before approval. Please ask hospital and providers to bill Medicaid for everything. Only time it is not covered is when provider is not certified biller, however, most hospitals and nursing homes are. If you receive a bill in the mail, you can directly request Medicaid to pay it. If you pay it, you probably can't get it back.
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