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My Mom is in a facility receiving physical therapy. She’s supposed to be there for approximately 4 weeks. The doctor has determined she needs around the clock care and should be admitted as a long term patient. She has Medicare and Medicaid however I have no knowledge how the system works. I’m getting asked for financial information and I don’t know why if she has insurance. She only receives a Social Security check as far as income. My Mom is 90 years old.

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Medicaid is a needs-based program, so that's why you are being asked for her financial information - they want to know what assets she has. Medicare contributes to the rehab stays, but then people have to apply for Medicaid for the nursing home if they can't go home after rehab.
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Ok, right now she is having MediCARE post hospitalization rehab benefit paying for her stay at the facility.

medicare routinely pays the first 20/21 days at 100%.
then if she is still “progressing” in her rehab as notated in her daily input into her medical chart, she can continue as a rehab patient but Medicare pays 80% and her secondary insurance usually pays the 20%.
BUT
if she stops “progressing” both MediCARE and 2ndary insurers stop paying like within 24-48 hrs. At that point, she stops being a rehab patient. If she is “at need” for skilled nursing care at the NH, she faces staying at the NH. She segueways from rehab patient to LTC resident and how it’s paid for depends on her resources.

The choices are private pay, LTC insurance policy or LTC Medicaid. Now if she has resources - like beyond 2k in nonexempt assets - they will need to be spent down first & foremost before she can ever be eligible for LTC Medicaid. Her 2ndary health insurance almost always will not pay a penny for LTC residential stay.
Her current 2ndary is Medicaid BUT is community based Medicaid; community based Medicaid is a different program than LTC residential Medicaid. She will need to apply for LTC Medicaid and the financials for LTC Medicaid is lots more narrow and has tight specific $ amounts for both assets & income than community based Medicaid does. She may have to do a spend down to get to the 2k asset max for LTC Medicaid.

The facility is asking for her financials as they are trying to determine if she is to continue being there & which type of billing her bed goes under & what copay she needs to pay them. Not all places participate in LTC Medicaid, not all do “Medicaid Pending” admissions. There could be 13 beds out of 80 set aside for Medicaid. That admissions or SW is asking you now on all this is good. They are being proactive & you kinda do need to work with them.

Hopefully she has under 2k in assets & no home.
why? well realize that under LTC Medicaid basically all her monthly income now will have to be paid to the NH as the required copay. So that SS less a small personal needs allowance must be paid to the NH. So if she still owns her home, there will be no-nada-zero of her $ to pay property costs as of day 1 on LTC Medicaid. If this is her situation, decisions need to be made as to what to do with the house if it’s that she wants to continue to own it (which by & large LTC Medicaid allows) or if it’s to be sold.
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anonymous999770 Jun 2020
Thank you for your reply. My Mom lived in an apartment and has no assets. All she gets financially is her monthly Social Security check. It has been determined that she does need to be a long term patient even though she’s presently at the facility for rehab. She is bed ridden and the reason for the physical therapy is to at the very least get her to be able to sit up in her bed and into a wheelchair. The social worker assigned to my Mom’s case is asking to sign paperwork to get my Mom into the facility as a long term patient. My concern is why am I getting asked for her financials if I do not have access to these things. I live in another state and if the facility is saying my Mom is of sound mind to make all the decisions why am I being asked to sign any paperwork and provide my Mom’s financials. I appreciate your knowledge of the situation.
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And I'd just like to highlight one thing that igloo mentioned. Rehab stays are very expensive for Medicare and they don't hesitate to terminate that type of stay if the person isn't making progress with therapy. Rehab is supposed to restore skills and maybe get the person back home. If that hasn't happened (doesn't really matter the reason), they end the rehab stay. Abruptly. With very little notice. You can try to appeal for more time in the rehab and you could get a few more days with another abrupt end. And then it's "get out" because no one is paying for the rehab bed anymore and your mom will need somewhere to go. You don't say how long your mom has already been there, but the clock is always ticking on rehab beds. If you were told she will be there 4 weeks, I seriously would not count on actually getting that. If you want her to stay where she is in that facility, she will be moved to a nursing home bed. I am assuming something is available and that's why they are asking for her financial info. Your best bet is to work with them.
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igloo572 Jun 2020
Mystery, I had PT like 3 yrs ago for shoulder stuff and then in Oct for post knee ortho scope (loads of fun, still not wearing heels). Same PT group. Big change in the place, like staff cut in half. What PT told me was that due to electronic records now if it’s a Medicare / 2ndary insurers like United, the PT is now done as a “maximum bundling” for care based on the ICD code. So if it’s 18 visit bundle that’s it within a set period of time or it’s over totally if their not progressing. Measurements are taken and entered into their chart each visit. PT has very little leeway if MediCARE involved even if more rehab needed. And this is out patient care. For for inpatient rehab, it’s seems even stricter, like 48 hr discharge once not “progressing”.

He told me that the Medicare rehab outpatient now going to Pt that’s adjacent to the orthopedic sports med type hospital. They have loads of PT aide / junior staff so can see lots more in the same 45 minute session under the 1 PT oversight. We’re still under United employer insurance so it was fine, but if I was Medicare he probably would not have taken me due to Medicare inflexiblility.
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As PPs have said, Medicare will only pay for limited Rehab days.  Medicaid is income and ASSET tested.   If your mom has assets, she will have to spend those on her care.  If she gave away significant amounts in the last 5 years (varies by state), she will get hit with a penalty and not be eligible for a period. 

I agree with pps, work with facility if you like it
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She has to be approved for LTC Medicaid. That is different from the community Medicaid she is on now. It should be an easy transition, and it is good she is already in social services database. They still need to view however her bank statements to see her assets and she also needs to spend down her assets to the level your state allows to have and be on LTC Medicaid. Her insurance does not cover long term care, only state LTC Medicaid does, so she has to go through the process to be approved for that. It sounds like the facility is doing the state application for her which is good. One word of advice though, don't sign any admission paperwork there yourself stating you will be financially responsible for her. Make sure Mom signs any paperwork. Just in case. Also, if for any reason the facility tries to discharge her, don't in any circumstances agree to take her home with you unless you are fully able to provide care for her 24/7.
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Rosie, do you have POA?

Do not sign anything as "responsible party". Mom needs to sign that.

Can mom access her financial records?
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anonymous999770 Jun 2020
I do not have POA. It was determined by her doctor that my Mom is of sound mind to make decisions so she is the one responsible for any paperwork. The issue I’m having trouble with is I’m getting asked for her financials and I do not have access to that. My Mom has Medicaid and Medicare. Her sole source of income is social security.
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Rosie, they shouldn't be asking you for financials if you do not have POA or share a bank account with Mom. Mom is going to need to contact her bank herself (because you cannot, the bank won't give you any information) and have them send the last 5 years of bank statements to the facility so they can submit them to the state.
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anonymous999770 Jun 2020
Thank you for the advice. The financial institution that contacted me is part of the facility where my Mom is. I explained to the person I spoke to that I do not have POV and that from a medical stand point her doctor declared my Mom capable of making decisions and sign any paperwork necessary. I was asked for my Mom’s Insurance information and if I had access to my Mom’s bank statements. I did not provide any information because I do not have POA.
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So, if you can't provide the info they need.... who is the person with the info? If another family member has access to the financial info, that person needs to step up and get moving on this. If your mom is the only one with access to the needed info, then make sure facility understands this completely so they know you are being cooperative. Then, someone needs to assist your mom with contacting the bank and getting the information. This is a difficult situation, but it can be solved. In addition to bank statements, they will probably also want something from social security to show how much she gets. Facility will make it clear what they need.
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anonymous999770 Jun 2020
Thank you so much for your input and advice. I’m just so overwhelmed because my Mom lives in NJ and I live in Florida. I’m on my Mom’s emergency contact which is why I’m getting all the phone calls and questions. I have no knowledge as to how the system works which makes everything that much more stressful. I personally do not have access to any of my Mom’s information and given my Mom’s condition I’m certain she’s overwhelmed with everything. She went from living relatively independent to needing to be in a full time nursing home.
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Rjosie, be responsive to the SW by telling her that
1. Mom has no POA
2. Mom is competent to do her own paperwork and provide financial information

Make sure they understand that you are NOT stonewalling, just without the information

Make sure you find out if THEY think that mom is competent and if they are thinking that perhaps the facility needs to file for guardianship.
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anonymous999770 Jun 2020
Thank you for your assistance. My Mom is has been declared by her doctor and the facility psychiatrist that she is fully capable of making her own decisions. I believe the financial institution affiliated with the nursing home/rehab facility is reaching out to me being her daughter for insurance information, financials and social security. Unfortunately I don’t have access to this information. The only information I have is a photocopy of my Mom’s Medicare and Medicaid card. I informed the financial institution of this so I’m cooperating to the best of my ability.
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I just wanted to thank everyone who responded. It is because of each and everyone of you that I now understand and am able to proceed with what I need to do. I’m so grateful to everyone for all of your advice and information you provided for me. Thank you from the bottom of my heart!
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