The reason for her ineligibility will matter as to what happens. State should send you a letter with the info. NH will be CC’d the letter.
If it’s a medical “at need” eligibility issue, these the NH kinda have to take the lead to deal with internally in submitting or resubmitting health insurance claims for either extra days for rehabilitation stay OR to submit info to State Medicaid assessment review for “at need medical” for skilled nursing care for custodial resident. - For the rehab, they needed to try to get more weeks of rehab filed for (Medicare and her other health insurance plan) as she was not quite yet a true custodial care resident at the NH. - or to get more details in her chart to show “at need” for skilled nursing care as a custodial resident. There could be a 2 month gap in this. It would be unusual but it does happen. Was your mom admitted to the NH from living in her home or in an IL??? So she did NOT come in via a post hospitalization rehabilitation placement to the NH??? If so (this was my mom’s situation) imo I can see there being a 2 or even 3 mo lag time & a medical appeal filed. We had this for my mom, it took slightly over 2 months for the paperwork to clear and get approved. Approved maybe 6 weeks before the appeal hearing. It throws off their overall LTC Medicaid eligibility. During this period, my mom did the required copay of her SS income and other retirement income as required and paid by the 3rd of the month to the NH. It is mucho importante to do this as not paying the copay - during pending phase - can be used by the NH as a rationale to evict your elder if NH wants to be huffy.
HOWEVER, If this was gifting issue so it was an asset transfer penalty, Medicaid should send out a letter with a specific # of days of ineligibility. It’s a # of days based on what her states Medicaid pays the NH for daily room&board reimbursement.
Let’s say AL Medicaid pays NH $218 a day room&board reimbursement. Mom gifted your brother 40K 3 years ago. That is 183 day transfer penalty period that starts the date mom applied for LTC Medicaid. It can be sticky to deal with as NH can want to bill mom their private pay day rate. Which won’t be Medicaids $218 a day, but maybe $350 a day. Here is where your negotiating skills come in as you want to try to get those 183 days at the lower rate if at all possible and that probably means you have all the $ in your hands to pay in full. You can deducted the copay $ from the bill owed!
Whomever in the family who caused / benefitted from the gifting hopefully will pay the $ back and graciously and in full. If not, this falls to the POA to deal with. Fortunately for you it’s just 2 months, so a smallish amount of $. Find a way to pay it and make nice with the NH.
NH can evict her. Will they do it? Nah! It’s bad optics, bad PR. But what they can do if y’all cannot reach a solution, is find a reason to have mom go off to the ER/ED and then they refuse to have her return to the NH. And then you are faced with having to go through all this process again: find a NH and get her moved again, plus get over to the old NH, hopefully her stuff is actually still there in trash bags and you can collect her things… stuff like this goes adversarial real fast. Plus that old NH bill still exists and will be turned over to collections. Any other NH can see the penalty placement by Medicaid too. So she’s toast on going into another NH. Basically someone has to find a way to come up with the $ or you take mom into your home and wait to refile once she is 5 years and 1 month past the date of the gifting.
if your mom is an easy care resident they may be ok with payments stretched out over a few months with a financial responsibility contract signed off by you. It’s just a few weeks, really try to find a way to make the #’s work and at the lower Medicaid reimbursement rate if you can.
Read & Re-read the letter, then calmly speak with the business office at the NH as to options. Good luck.
Usually when a person enters a NH with no money Medicaid is pending. I am under the impression that Medicaid is applied for so the NH is covered from day one. Was Aunt giving the NH her Social Security those two months? Was there gifting she was penalized for? If so, she may owe that money. But you are not responsible for paying the outstanding amount unless you are the one she gifted it too.
Really, an interesting question and one for Aunts medicaid caseworker. Does Aunt have a house or a car that can be sold to offset the 2 months that aren't being paid?
She can't pay if she is out of money, obviously. It is no one else's responsibility either (unless someone else signed paperwork at the facility stating they would be financially responsible for her debts. Hopefully that isn't the case). Nursing home may try to collect from family, but please understand family is in no way responsible. Why wasn't she approved for the 2 months prior? If it was because of gifting of assets it is possible that the NH may attempt to collect from the giftee.
If it’s a medical “at need” eligibility issue, these the NH kinda have to take the lead to deal with internally in submitting or resubmitting health insurance claims for either extra days for rehabilitation stay OR to submit info to State Medicaid assessment review for “at need medical” for skilled nursing care for custodial resident.
- For the rehab, they needed to try to get more weeks of rehab filed for (Medicare and her other health insurance plan) as she was not quite yet a true custodial care resident at the NH.
- or to get more details in her chart to show “at need” for skilled nursing care as a custodial resident. There could be a 2 month gap in this. It would be unusual but it does happen. Was your mom admitted to the NH from living in her home or in an IL??? So she did NOT come in via a post hospitalization rehabilitation placement to the NH??? If so (this was my mom’s situation) imo I can see there being a 2 or even 3 mo lag time & a medical appeal filed. We had this for my mom, it took slightly over 2 months for the paperwork to clear and get approved. Approved maybe 6 weeks before the appeal hearing. It throws off their overall LTC Medicaid eligibility. During this period, my mom did the required copay of her SS income and other retirement income as required and paid by the 3rd of the month to the NH. It is mucho importante to do this as not paying the copay - during pending phase - can be used by the NH as a rationale to evict your elder if NH wants to be huffy.
HOWEVER, If this was gifting issue so it was an asset transfer penalty, Medicaid should send out a letter with a specific # of days of ineligibility. It’s a # of days based on what her states Medicaid pays the NH for daily room&board reimbursement.
Let’s say AL Medicaid pays NH $218 a day room&board reimbursement. Mom gifted your brother 40K 3 years ago. That is 183 day transfer penalty period that starts the date mom applied for LTC Medicaid. It can be sticky to deal with as NH can want to bill mom their private pay day rate. Which won’t be Medicaids $218 a day, but maybe $350 a day. Here is where your negotiating skills come in as you want to try to get those 183 days at the lower rate if at all possible and that probably means you have all the $ in your hands to pay in full. You can deducted the copay $ from the bill owed!
Whomever in the family who caused / benefitted from the gifting hopefully will pay the $ back and graciously and in full. If not, this falls to the POA to deal with. Fortunately for you it’s just 2 months, so a smallish amount of $. Find a way to pay it and make nice with the NH.
NH can evict her. Will they do it? Nah! It’s bad optics, bad PR. But what they can do if y’all cannot reach a solution, is find a reason to have mom go off to the ER/ED and then they refuse to have her return to the NH. And then you are faced with having to go through all this process again: find a NH and get her moved again, plus get over to the old NH, hopefully her stuff is actually still there in trash bags and you can collect her things… stuff like this goes adversarial real fast. Plus that old NH bill still exists and will be turned over to collections. Any other NH can see the penalty placement by Medicaid too. So she’s toast on going into another NH. Basically someone has to find a way to come up with the $ or you take mom into your home and wait to refile once she is 5 years and 1 month past the date of the gifting.
if your mom is an easy care resident they may be ok with payments stretched out over a few months with a financial responsibility contract signed off by you. It’s just a few weeks, really try to find a way to make the #’s work and at the lower Medicaid reimbursement rate if you can.
Read & Re-read the letter, then calmly speak with the business office at the NH as to options. Good luck.
Really, an interesting question and one for Aunts medicaid caseworker. Does Aunt have a house or a car that can be sold to offset the 2 months that aren't being paid?