I think it will be beyond difficult to get this done & not just for the reasons mentioned, but also for why it’s a hurdle for the facility. & that revolves around how Medicaid is funded..... For skilled nursing care aka that done in a NH, $ paid via dedicated funding to LTC SNF NH under current federal regulations. BUT States can decided to have some LTC Medicaid $ instead go to AL, or MC, or PACE type of programs. This done via “waivers” to move dedicated SNF $ to those at lower reimbursement rates. Cause it’s “waivers”, it is not dedicated or guaranteed. Waivers are usually 5-8 yr cycles or if it’s a “demonstration” program 3-5. That waivers are not open ended till forever is why if a facility chooses to participate, it does so at a very low & limited # of beds for waiver residents as there's uncertainty, risk. Facilities do not have to participate in Medicaid waiver programs. If state daily room&board reimbursement rate is at or less than the cost to operate a waiver bed, facility can lower to # of available beds to get to a # that works, or drop out of the waiver program entirely.
What the trend now seems to be is state decides to shift waiver $ from 1-on-1 like AL/MC to something broader like PACE so it’s a wider use of $. PAcE -in theory - is for those who otherwise could be eligible for LTC in a facility but want to remain at home or move from a NH back home & enrolled in PACE for care; so more $ to PACE & less $ to other waivers. So old AL / MC waivers phased out or reduced. Facility that were once Medicaid aren’t anymore as waiver doesn’t cover operating or get it low %, like what JoAnn posted. So there’s realistically not ever a Medicaid bed open. You can’t force them to flip a private pay bed to Medicaid bed. They can unenroll participating in Medicaid & if you were not currently there on Medicaid you don’t have to be notified. It’s on you to pay attention to if any changes. Even if this was in the contract (I doubt facility would paint themselves in a corner like this), there’s some clause on “changes due to unforeseen circumstances” & disputes settled via arbitration.
As it’s not NH, the safeguards that Medicaid requires for skilled nursing care places are NOT in there. Could be a 30 day notice & your on your own to find new place. AL don’t have to ensure safe lateral placement in a new facility like NH must for Medicare & Medicaid. Usually they will do something as it’s lousy public relations & terrible optics.
it sounds like your moms place has Disenrolled completely from Medicaid. If this is it, options are stark.
I’d suggest that you look to having her get a fresh need assessment to see just how close she is to being medically “at need” for a NH. If it’s a matter of having medical records or lab work done & updated to accurately reflect her medical need do that. If it means she sees a new gerontologist and gets labs run every 3-4 weeks for 3 months to fatten up her chart. You get this done. So she moves into a NH & onto LTC SNT MedicAID. I wouldn’t expect her current AL or MC to help in all this, UNLESS they have a sister NH facility with several current unoccupied Medicaid beds. Good luck.
I have spoken with state Medicaid in my area explaining my difficulty finding acceptable Medicaid care, wait list and being bumped out of line due to internal moves, etc. Our Medicaid application was since declined because we were not in Medicaid facility and self pay is almost gone now. Medicaid office explained about a family member did almost the same as you-paying for room under self pay and promise of Medicaid bed when the time comes. Medicaid office said facility is not allowed to deny a room when you need it if you have applied and been accepted to Medicaid. I have also been told read- Medicaid facility has no obligation to fill all beds with Medicaid people. I have been declined a couple places already with no reason given abut why. Another place newly remodeled close to my house-I loved with high ratings- told me weeks later we would not get the room we were showed because we did not have a year of self pay first-they aleady knew this-I put all cards on the table during tour day-I did not want to mislead them or have them say Oh you did not tell us that....Check with your state office of Medicaid or LTC ombudsman, also a lawyer consult to review your case-generally won't take on a case if they won't make any money from taking company/owner/others to court. Check over your contract when you signed up for AL did it mention the need for Medicaid down the road. I was told to make sure the whole agreement covers self pay, amount, time and placement to medicaid bed. I have also been bumped down the list due to Internal moves of current Al residents have first dibs. I agree with other comment they should honor the previous agreement but executive director of facility should have been the one to oversee the contracts and business manager to make sure things are done correctly fairly.
Sorry, there are no guarantees and that is what you should have been told. As u, I thought they said Medicaid would take over after 2 yrs. Once Mom was in the facility, I was told "only if the % they allow is not met". Out of 39 residents only 14% would the facility allow Medicaid.
Then your other problem is change in ownership. You have to be a Medicaid approved AL. The new owners will probably need to apply to Medicaid. An AL near me lost their Medicaid funding because they no longer met the criteria. All those people on Medicaid had to find other places.
There comes a time when those suffering from Dementia don't even know where they are. My Mom ran out of money so I had to place her in LTC. I found she was cleaner in the LTC. She never smelled, she did in the AL. I had to bring it to the aides attention. The AL would not allow her to wear a bib, it was a dignity thing. So, she always had food stains on her tops. The LTC allowed the bibs so she was always clean. I allowed the LTc to do her laundry because the residents always looked clean. They had activities going all afternoon. The aides loved her.
You may want to find a nice LTC now. In NJ u only have 90 days to place the person applying in a LTC, to get all the info needed to be OKd for Medicaid, and spend down. My Mom paid two months up front, May and June. July Medicaid took over. I did the applying and followed up with the caseworker making sure everything was received and we were on the same page. It was me who called and said everything was done he confirmed and then he put in for Medicaid to start July. Exactly 90 days from date of application.
Thanks for response. What do AL and LTC stand for? She has 3 months of self pay funding left. I was going to prepay May in April so I could reach the $2,000 Medicaid threshold by May. I'm calling the county tomorrow to tell them about my situation and start the application process. The memory care facility has not said she's out yet, just that they have to look at their budget. Very different than when I was contemplating putting her in. They said she could stay
after her transition to Medicaid. Really depressing.
No. It was what the executive director told us. She was fired a year later. Now they are saying she made all sorts of promises to people they couldn't keep. They are listed on the state website as a facility that accepts Medicaid. They had no policy at the time on how long the resident needed to live there. They are now in the process of developing a policy. We only selected the facility because they would accept her as a Medicaid recipient when her funding is spent down. She has given them all her money and by May 1 will have been a resident for 2 years and 2 months.
Contact a lawyer. Threaten to sue for breach of contract, or however the lawyer wants to lay it out because they know darn well that a verbal contract was in place between your mother and the old director. They didn't stop taking your mother's money when the director was fired now did they? So in essence, the NEW director was continuing to honor the verbal agreement that was already in place.
Please let us know what a lawyer says. I wish you the best of luck here. How cold that the new director won't work with you and take the medicaid. They should be ashamed.
Is there any paperwork to back up your claim that the AL would take Medicaid when assets are depleted? If not, it may be difficult to enforce. Good luck!
For skilled nursing care aka that done in a NH, $ paid via dedicated funding to LTC SNF NH under current federal regulations.
BUT
States can decided to have some LTC Medicaid $ instead go to AL, or MC, or PACE type of programs. This done via “waivers” to move dedicated SNF $ to those at lower reimbursement rates. Cause it’s “waivers”, it is not dedicated or guaranteed. Waivers are usually 5-8 yr cycles or if it’s a “demonstration” program 3-5. That waivers are not open ended till forever is why if a facility chooses to participate, it does so at a very low & limited # of beds for waiver residents as there's uncertainty, risk. Facilities do not have to participate in Medicaid waiver programs. If state daily room&board reimbursement rate is at or less than the cost to operate a waiver bed, facility can lower to # of available beds to get to a # that works, or drop out of the waiver program entirely.
What the trend now seems to be is state decides to shift waiver $ from 1-on-1 like AL/MC to something broader like PACE so it’s a wider use of $. PAcE -in theory - is for those who otherwise could be eligible for LTC in a facility but want to remain at home or move from a NH back home & enrolled in PACE for care; so more $ to PACE & less $ to other waivers. So old AL / MC waivers phased out or reduced. Facility that were once Medicaid aren’t anymore as waiver doesn’t cover operating or get it low %, like what JoAnn posted. So there’s realistically not ever a Medicaid bed open. You can’t force them to flip a private pay bed to Medicaid bed. They can unenroll participating in Medicaid & if you were not currently there on Medicaid you don’t have to be notified. It’s on you to pay attention to if any changes. Even if this was in the contract (I doubt facility would paint themselves in a corner like this), there’s some clause on “changes due to unforeseen circumstances” & disputes settled via arbitration.
As it’s not NH, the safeguards that Medicaid requires for skilled nursing care places are NOT in there. Could be a 30 day notice & your on your own to find new place. AL don’t have to ensure safe lateral placement in a new facility like NH must for Medicare & Medicaid. Usually they will do something as it’s lousy public relations & terrible optics.
it sounds like your moms place has Disenrolled completely from Medicaid. If this is it, options are stark.
I’d suggest that you look to having her get a fresh need assessment to see just how close she is to being medically “at need” for a NH. If it’s a matter of having medical records or lab work done & updated to accurately reflect her medical need do that. If it means she sees a new gerontologist and gets labs run every 3-4 weeks for 3 months to fatten up her chart. You get this done. So she moves into a NH & onto LTC SNT MedicAID. I wouldn’t expect her current AL or MC to help in all this, UNLESS they have a sister NH facility with several current unoccupied Medicaid beds. Good luck.
Get the application going ASAP and use an elder law attorney to assist.
Then your other problem is change in ownership. You have to be a Medicaid approved AL. The new owners will probably need to apply to Medicaid. An AL near me lost their Medicaid funding because they no longer met the criteria. All those people on Medicaid had to find other places.
There comes a time when those suffering from Dementia don't even know where they are. My Mom ran out of money so I had to place her in LTC. I found she was cleaner in the LTC. She never smelled, she did in the AL. I had to bring it to the aides attention. The AL would not allow her to wear a bib, it was a dignity thing. So, she always had food stains on her tops. The LTC allowed the bibs so she was always clean. I allowed the LTc to do her laundry because the residents always looked clean. They had activities going all afternoon. The aides loved her.
You may want to find a nice LTC now. In NJ u only have 90 days to place the person applying in a LTC, to get all the info needed to be OKd for Medicaid, and spend down. My Mom paid two months up front, May and June. July Medicaid took over. I did the applying and followed up with the caseworker making sure everything was received and we were on the same page. It was me who called and said everything was done he confirmed and then he put in for Medicaid to start July. Exactly 90 days from date of application.
after her transition to Medicaid. Really depressing.
Contact a lawyer. Threaten to sue for breach of contract, or however the lawyer wants to lay it out because they know darn well that a verbal contract was in place between your mother and the old director. They didn't stop taking your mother's money when the director was fired now did they? So in essence, the NEW director was continuing to honor the verbal agreement that was already in place.
Please let us know what a lawyer says. I wish you the best of luck here. How cold that the new director won't work with you and take the medicaid. They should be ashamed.
If not, it may be difficult to enforce.
Good luck!