Denise! Yeah! It is working out and you just pay NH more $.
fwiw there will be a renewal. Maybe month of initial filing or maybe 2 months ahead. Whatever….. if it’s at all like what I got, will have a questionnaire and resubmission again of some of the initial items and then anything fresh. So you need to keep track of and stay organized with her SSA and any other income she gets and banking statements. Plus if anything filed with her initial application has annual updates. Eg life insurance policy that sends out annual statement.
I had zero idea that renewals happened & had packed all paperwork into bins & put into storage. When I got the renewal, it had like a 14 day turnaround from the date of letter. Which for even more frickin fun had more than a couple of days delay from its postmark & I live in another State. LSS It was a long weekend ending in early Mon AM faxing from Fed Ex office & USPS certified mailings. For yr #2 totally ready.
Denise, yeah it’s a fricking mice maze, not at all straightforward and for even more FUN! each State administers & describes its huge # of Medicaid programs uniquely but under overall federal guidelines. So even more stickiness.
Most States have for LTC Medicaid income to be at impoverishment at $2742 for an individual, $5484 for a couple with both in a facility and a maximum of $2,000 in nonexempt assets (like $ in their old bank account). It’s like all but maybe 5-7 States that do not do this. Fixed and firm. It makes it hard for others to give advice or their experience as they were TX or MS or New Hampshire as they all use the standard formula so useless info for you in Massachusetts. I think it’s for sure CA, IL, MA who have lower income & a couple other States.
& usually if they are “over resourced” (Medicaid speak for too much income & different than a “spend down” which is too much in assets) in whatever State but not enough to ever private pay and meet all other LTC Medicaid criteria, they either do… 1. A Miller Trust for what they have as “ guaranteed income”, like SSA; so Miller becomes the owner of this income source & Voila! They now are poor with just whatever other income they get paid left which takes them below the fixed income max OR 2. have to put their income into a State run pooled income trust. Pooled trusts are not at all in my wheelhouse in understanding.
But it looks like to me, & I could be wrong, that MA for whatever reason doesn’t do this but the extra income over y’all’s low $1,025 mo. income max, goes as a deductible $ amount paid to MassHealth instead. I’m an old health policy planner and I can totally see why a State might want to do this as it gives $ to the States coffers for its costs rather than to owners of NHs.
If I had to guess, at some point in time, the MA State Medicaid program or Mass Health will send mom & hopefully also her POA a Notice / Statement of what’s owed and by when due & in short order. I’d be on the lookout as to if your mom gets any snail mail sent to her at the NH as it can get lost, waylaid….
as a suggestion, if this hasn’t been done already, go an set up a Personal Needs Trust account at the NH with the billing person and at the same time have them go over in detail how MA deals with income. They should know what’s what. I’ve found billing welcomes an opportunity to chat with residents family that they are NOT having to harangue on unpaid balances & past due. ((Billing guy at my moms 2nd & eons better NH gave me a tutorial on issues on LTC insurance policies that I never would have ever know existed)). PNA account gets used to pay for moms on site beauty shoppe, & if the NH has a commissary to buy Candy, magazine, smaller size toiletries. So they don’t need to have any cash. Both can be lil social centers for residents too.
Also as mom is already in & deemed eligible, there is imho no need to find an attorney. It’s just waiting on State bureaucracy to churn along and get things figured out and send of Notices.
if you would, let us know what happens, we do learn from each other!
Denise, Extra $ will be a separate deductible she will pay.
Hang with me on this as it’s not straightforward… It looks like what’s happening is that MA has their income maximum set really low. MA is $1,025 max income allowed for LTC Medicaid. Fwiw avg SSA is like $1200 a mo so $1025 means huge # would be disqualified from the get go & also fwiw almost all the other States set their max income at $2,742 a month. So….What MA and other States that have the super low income do is they allow the excess income to be waived for eligibility BUT the $ becomes a deductible the applicant pays every month for health care.
So Notice from State of MA LTC Medicaid has her copay at $833?? If so the State has her monthly income at $906 for her custodial care income. As the PNA personal needs allowance for MA is $73.00 which she can continue to have go into her bank account OR if she did a sign over of her SSA income to let the Nh become her representative payee then the $73 goes into a PNA account at the NH every month. Whichever it is, you & Sissy have to - HAVE TO - once the deductible $$ issue is cleared up, make sure every month she closes out her $ from her bank account & the NH PNA to be under $2,000 as that’s the exempt asset maximum for MA for an individual on LTC Medicaid which is paying her custodial care costs.
When your mom filed for LTC Medicaid, one of the items required was her “awards letters”. These are the annual mailings sent out by SSA, other retirements and pensions that state to the penny what they will be paying incoming year and what deductions taken as well. Ones from SSA and Federal civil service tend to go out Oct/Nov. Your mom may get another income as well, like an annuity in payout mode. Or perhaps something else. Whatever the case, all her income should have gone as part of her application. & the State via the LTC Medicaid caseworker reviews it to come up with her precise copay or SOC / Share of Cost required to be paid to the NH each month and overage to become the deductible as well. And your mom or whomever is the POA should have gotten the SOC letter and the NH got it as well for what they can expect to be paid for their custodial care of mom. BUT…. Im guessing the extra $1,094 has to be determined as to which health care provider system will be billed for her care and get the deductible. Like if will $ to be sent to MassHealth or if she’s on a specific HMO or MCO* for how this NH runs its medical care billing. Not her custodial care billing but medical care billing. And that Notice is running late because it’s health insurance stuff and they can be glacial in their processing.
* MCO aka Managed Care Organizations are used in some states as to how the in the NH medical / health care costs are done. It’s contracted out and pre-fixe. Molina Healthcare is the big player for this across the US. If it’s Molina, they might take 3 months to process as they are dependent on the State paperwork to them for them to send the deductible billing summary to the individual.
the caseworker may not know which healthcare is the provider. But the NH will know. I’d ask billing at the NH as to just who gets the deductible. If it’s Molina, they know what they are doing, mom will get a statement. If it’s MassHealth, ask the billing guy how organized MassHealth is for timely processing.
Don’t spend the $, mom will get a statement e..v…e..n..t..u..a..l…l.y
Oh, wow. This is so complicated I cannot imagine it. And it isn't even clear to me if there is anything other than a medical POA here. One sis seems to be able to write checks on some account somewhere. Nothing else is mentioned. I hope they have good support. Glad you were around, Igloo. I suspected this had to be an extra monthly charge to her other than SS funds which will automatically go to NH. I hope these two sisters can wade through all this together. I would be running kicking and screaming to an elder law attorney.
Your question is a little confusing to us. Is your mother a resident/or will be a resident of a Medicaid skilled nursing facility (SNF)? If she is then there will not be any money left over as the entire amount, minus a few dollars according to your state, will have to go to Medicaid.
Since Medicaid is funded by taxpayers dollars, they need to recoup the money they paid out in order for the program to continue to operate.
There is no extra money. The facility takes all of her income (except for usually around $60 a month for personal use). Then Medicaid pays the difference. There is no getting around this.
Even if your mother has a Long Term Care insurance policy and that was paying, if it didn't cover the whole expense she would have to pay it out of her income or assets. Medicaid will not pay it and let her retain over a thousand dollars a month out of her income.
How was your sister able to do the forms involving how the nursing home is going to get paid if she is not the POA?
I think you and your sister should talk to an elder law attorney because something sounds very fishy here.
I am confused to. Once OK'd for Medicaid LTC, all their monthly income goes towards their care. Was all her monthly income listed on the application, Social Security, Pension. Who filled out the application. Seems to me something was left out.
Do they mean that her SS goes to the nursing home, and she pays 800 on TOP of that out of her accounts? Because otherwise this isn't making sense to me. There's missing information for certain.
Who IS POA? Because SOMEone got your mom qualified for Medicaid. How, with this much "leftover" I am not clear. So I think what you need here now is a visit to a good elder law attorney with all your information regarding who is POA, how to become a guardian if Mom is incompetent in her own behalf, and etc.
fwiw there will be a renewal. Maybe month of initial filing or maybe 2 months ahead. Whatever….. if it’s at all like what I got, will have a questionnaire and resubmission again of some of the initial items and then anything fresh. So you need to keep track of and stay organized with her SSA and any other income she gets and banking statements. Plus if anything filed with her initial application has annual updates. Eg life insurance policy that sends out annual statement.
I had zero idea that renewals happened & had packed all paperwork into bins & put into storage. When I got the renewal, it had like a 14 day turnaround from the date of letter. Which for even more frickin fun had more than a couple of days delay from its postmark & I live in another State. LSS It was a long weekend ending in early Mon AM faxing from Fed Ex office & USPS certified mailings. For yr #2 totally ready.
Most States have for LTC Medicaid income to be at impoverishment at $2742 for an individual, $5484 for a couple with both in a facility and a maximum of $2,000 in nonexempt assets (like $ in their old bank account). It’s like all but maybe 5-7 States that do not do this. Fixed and firm. It makes it hard for others to give advice or their experience as they were TX or MS or New Hampshire as they all use the standard formula so useless info for you in Massachusetts. I think it’s for sure CA, IL, MA who have lower income & a couple other States.
& usually if they are “over resourced” (Medicaid speak for too much income & different than a “spend down” which is too much in assets) in whatever State but not enough to ever private pay and meet all other LTC Medicaid criteria, they either do…
1. A Miller Trust for what they have as “ guaranteed income”, like SSA; so Miller becomes the owner of this income source & Voila! They now are poor with just whatever other income they get paid left which takes them below the fixed income max
OR
2. have to put their income into a State run pooled income trust. Pooled trusts are not at all in my wheelhouse in understanding.
But it looks like to me, & I could be wrong, that MA for whatever reason doesn’t do this but the extra income over y’all’s low $1,025 mo. income max, goes as a deductible $ amount paid to MassHealth instead. I’m an old health policy planner and I can totally see why a State might want to do this as it gives $ to the States coffers for its costs rather than to owners of NHs.
If I had to guess, at some point in time, the MA State Medicaid program or Mass Health will send mom & hopefully also her POA a Notice / Statement of what’s owed and by when due & in short order. I’d be on the lookout as to if your mom gets any snail mail sent to her at the NH as it can get lost, waylaid….
as a suggestion, if this hasn’t been done already, go an set up a Personal Needs Trust account at the NH with the billing person and at the same time have them go over in detail how MA deals with income. They should know what’s what. I’ve found billing welcomes an opportunity to chat with residents family that they are NOT having to harangue on unpaid balances & past due. ((Billing guy at my moms 2nd & eons better NH gave me a tutorial on issues on LTC insurance policies that I never would have ever know existed)). PNA account gets used to pay for moms on site beauty shoppe, & if the NH has a commissary to buy Candy, magazine, smaller size toiletries. So they don’t need to have any cash. Both can be lil social centers for residents too.
Also as mom is already in & deemed eligible, there is imho no need to find an attorney. It’s just waiting on State bureaucracy to churn along and get things figured out and send of Notices.
if you would, let us know what happens, we do learn from each other!
Hang with me on this as it’s not straightforward… It looks like what’s happening is that MA has their income maximum set really low. MA is $1,025 max income allowed for LTC Medicaid. Fwiw avg SSA is like $1200 a mo so $1025 means huge # would be disqualified from the get go & also fwiw almost all the other States set their max income at $2,742 a month. So….What MA and other States that have the super low income do is they allow the excess income to be waived for eligibility BUT the $ becomes a deductible the applicant pays every month for health care.
So Notice from State of MA LTC Medicaid has her copay at $833?? If so the State has her monthly income at $906 for her custodial care income. As the PNA personal needs allowance for MA is $73.00 which she can continue to have go into her bank account OR if she did a sign over of her SSA income to let the Nh become her representative payee then the $73 goes into a PNA account at the NH every month. Whichever it is, you & Sissy have to - HAVE TO - once the deductible $$ issue is cleared up, make sure every month she closes out her $ from her bank account & the NH PNA to be under $2,000 as that’s the exempt asset maximum for MA for an individual on LTC Medicaid which is paying her custodial care costs.
When your mom filed for LTC Medicaid, one of the items required was her “awards letters”. These are the annual mailings sent out by SSA, other retirements and pensions that state to the penny what they will be paying incoming year and what deductions taken as well. Ones from SSA and Federal civil service tend to go out Oct/Nov. Your mom may get another income as well, like an annuity in payout mode. Or perhaps something else. Whatever the case, all her income should have gone as part of her application. & the State via the LTC Medicaid caseworker reviews it to come up with her precise copay or SOC / Share of Cost required to be paid to the NH each month and overage to become the deductible as well. And your mom or whomever is the POA should have gotten the SOC letter and the NH got it as well for what they can expect to be paid for their custodial care of mom.
BUT….
Im guessing the extra $1,094 has to be determined as to which health care provider system will be billed for her care and get the deductible. Like if will $ to be sent to MassHealth or if she’s on a specific HMO or MCO* for how this NH runs its medical care billing. Not her custodial care billing but medical care billing. And that Notice is running late because it’s health insurance stuff and they can be glacial in their processing.
* MCO aka Managed Care Organizations are used in some states as to how the in the NH medical / health care costs are done. It’s contracted out and pre-fixe. Molina Healthcare is the big player for this across the US. If it’s Molina, they might take 3 months to process as they are dependent on the State paperwork to them for them to send the deductible billing summary to the individual.
the caseworker may not know which healthcare is the provider. But the NH will know. I’d ask billing at the NH as to just who gets the deductible. If it’s Molina, they know what they are doing, mom will get a statement. If it’s MassHealth, ask the billing guy how organized MassHealth is for timely processing.
Don’t spend the $, mom will get a statement e..v…e..n..t..u..a..l…l.y
Since Medicaid is funded by taxpayers dollars, they need to recoup the money they paid out in order for the program to continue to operate.
Even if your mother has a Long Term Care insurance policy and that was paying, if it didn't cover the whole expense she would have to pay it out of her income or assets. Medicaid will not pay it and let her retain over a thousand dollars a month out of her income.
How was your sister able to do the forms involving how the nursing home is going to get paid if she is not the POA?
I think you and your sister should talk to an elder law attorney because something sounds very fishy here.
Who IS POA? Because SOMEone got your mom qualified for Medicaid. How, with this much "leftover" I am not clear. So I think what you need here now is a visit to a good elder law attorney with all your information regarding who is POA, how to become a guardian if Mom is incompetent in her own behalf, and etc.