Is there a way to negotiate a bill with AL/NH facility who charges you a private stay since long term care Medicaid was denied? - AgingCare.com

Is there a way to negotiate a bill with AL/NH facility who charges you a private stay since long term care Medicaid was denied?

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Medicaid was denied due to giving money. What are the consequences for not paying their bill simply because you have no money, is there a way to reduce the balance? My dad was there after stroke, now he is home but has very little income and can't afford to pay their bill (private stay). What are his options?

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The $167.50 - the daily MediCARE copay, really imo needs to be paid. You want dad to be totally with no issues for Medicare as he will be using Medicare to see his docs, for a future hospitalization. Pay that as a Priority imo. Please carefully look to see if he has a secondary health insurance (like Blue Cross or United) that will pay the co-pay. 

The “Medicaid Pending” part... ok that means that once he was out of being in rehab / post-hospitalization which is MediCARE a covered benefit for both his medical costs AND his room&board, then he went onto being “medicaid Pending”. So he applied for Medicaid but application is still in review BUT the facility allows him to be a resident under “Pending” status. When you are “Pending”, Medicaid requires if they are a widow or widower to pay almost all their monthly income to the facility as the required copay or SOC (share of cost) or patient liability. If they are married, the community spouse could be allowed a waiver (CSRA or MMNA) to get some of his monincome diverted to her to be a CS. CSRA doesn’t seem to automatically done by the states but more that the CS has to demonstrate need to get the CSRA waiver within his Medicaid application. Otherwise under Medicaid rules ALMOST ALL his SS, retirement, pension monthly income must be paid to the NH. He gets to keep just a small PNA (personal needs allowance), which for more fun varies by state. So did your dad get a CSRA waiver? Did he pay to the NH any of his SOC? He needed to in order to be compliant for his Medicaid application. I’ve been on this site for quite a while and I will say the whole copay required tends to totally be glossed over by admissions at the NH &/or family is interdependent on their parents income as everyone is living in the same household so they need the elders monthly income to keep afloat so don’t pay it OR the community spouse existence gets overlooked. 

 The Medicaid copay requirement comes often as a total surprise.  For my mom in TX at her 2 NH it was referred to as SOC, her PNA was $60 a mo. That was it for her $, just $60 to cover any incidentals like beauty shoppe, toiletries, clothing replacement. She got both SS and a federal annuity widow benefit. About $1800 a mo, and we kept her income deposited into her checking account (as opposed to sighing over to NH to be rep payee). So every mo before the 7th on the mo., I wrote a check to the penny for her SOC to the NH. Under Medicaid rules your dad needed to pay his SOC for the days while Medicaid reviewed his application. SOC started the date he went from Medicare to Medicaid. 

I’m confused.... so is his Medicaid application still in review OR declined? 
When he applied, was the fact that he was married clearly defined in his application? 
To me, This is mucho importante as the rules for assets when it’s a couple are way way different than those for an individual. You know couples Medicaid application when only 1 in a facility needs to be done with an elder law atty as it’s super complicated on asset and their exemptions and getting the CSRA. Community spouse resource allowance/ monthly maintenance needs assessment (allowance), think of it as kinda like alimony for the nonNH spouse. There have been folks on this site whose NH parent ended up with a copay under $100 as their CS needed & got all the rest of the monthly income due to CSRA.
It sounds like realistically he doesn’t have the $ to pay either, is that it? 
Does your dad or his wife have income other than SS? 
They have a mortgage (horrors!), hows the mortgage looking.... like is it underwater or does the mortgage still has eons to run till paid or is mortgage about to be paid off in the near future (like maybe within next 2 -4 years)? 
And the house, does it work for them, like would they realistically live in it for another decade? 
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Reply to igloo572
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If Dad was in rehab Medicare paid 100% for the first 21days, 50% for the 21st to 100 days. If he had a supplimental that may pick up some of the cost.
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Reply to JoAnn29
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Becky Exactly They would be able to file a claim against the Estate for payment.
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Reply to shad250
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They also may want to get a judgement against them so that when they die they might get some money from the house.
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Reply to Becky04473
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Try to research your state's law regarding NH costs. Some if you don't pay will get an attorney and sue in civil court to get a judgement against you.  Regarding negotiating good luck. Many have no interest and want to be paid what is owed.
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Reply to shad250
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igloo572,
thank you so much for giving such detailed insights. Definitely have to research more to figure it all out.
We are in NJ.
I think he spent 40 days under medicaid room & board. Before that - was doing intensive therapy and that considered rehab under medicare.
No, he didn't pay any copay. But now received "this is not a bill but medicaid pending statement" why ???? they say he is not qualified for medicaid, so what kind of games they play...Anyway - asking coinsurance of $167.50 per day for those first 19 days when he was still covered by medicare because of all treatments & therapies

In 2017 there were 2-3 draws from account totaling like 13-14K, all gone and spent.
So trying to follow: if reimbursement rate is $70 , 14K:70= 200 days he is ineligible for medicaid starting date of that draw in 2017, right? Therefore they charge private pay

His income is SS+pension= under 800 total, no assets, 401 K, etc.....just the house they leave in..still w.mortgage. Their monthly bills = or even more that their income

Just too confusing and too stressful...
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Reply to Sabrina2017
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Sabrina - yes there is room to negotiate but whether or not the NH is at all interested in doing so is another issue imo.
So your dad gifted some of his $ to you & your hubs to buy a house within the last 5 years AND then he had a stroke, went into a NH for a few months under Medicaid Pending and then left NH to move back home cause he was better, that’s it right? To me how much negotiation possible depends on the answers to the questions below....

-? Of the total # of days in the NH, how many were rehab and therefore paid by Medicare AND how many were Medicaid room & board paid days?
-? When he was out of Medicare rehab and so then on Medicaid Pending, did he do the required copay to the NH of his monthly income (like his SS)? And pay this for every day he was Medicaid Pending?
- What is his mo income?
- What is your states daily Medicaid room & board reimbursement rate? 
- what is the NH private pay daily rate? 
- Is this NH full, like is there a waiting list or if you called manana would they have an open Medicaid bed?
- does your state allow for unsecured creditor to place a lien on a persons homestead? 
If not, then a lien cannot be placed on his home for his debts easily. You’d have to be a secured creditor to do so, like a mortgage company. 
- is dads only source of income his SS or other federal or state retirement? Just so you know SS is protected income. It can only be garnished by like the IRS or state taxing authorities. 
- Other than his home does dad have any assets? 
- did you, hubs or other family sign off to be financially responsible for him?
Post the answers as folks will have suggestions.

The penalty is basically a division problem, the amount of $ gifted divided by your states Medicaid reimbursement rate for room & board is the # of days ineligible for Medicaid. Like TX is abt $172 a day R&B, so 50k gift is 294 days of penalty in which you are ineligible for Medicaid so you have to private pay. But if dads in a state that Medicaid pays the NH $325 a day, it’s 153 days penalty. States all vary the amount. So what’s dads # of days penalty? 

The penalty starts the date of application submitted for any penalty found within 5 years. So when was that $ gifted to you? Dec. 2017 or Jan. 2013?
What is his health like now? Is he likely to need to go back into a NH before there’s a 5 year distance from the gifting?
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Reply to igloo572
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Sabrina
I’m assuming someone signed a contract with the NH saying that if Medicaid didn’t pay then that person would? The NH is a business after all.
So since Medicaid is not going to pay, the collection agency of the NH will be given the debt to collect would be what I would expect.
Could the person the money was gifted to help?
Who is caring for dad now? How long will he have to be cared for at home before the penalty time has passed?
Any business can negotiate. I think I would contact them before it went into collections with your offer. I’m assuming you would have to be the one paying since dad gave his money away. I hope your dad is getting better. He’s not the first one this has happened to so the NH may have a procedure. You might ask them that question. After all after his Medicaid penalties have passed he may need to go back to the NH for care. Good luck and let us know how it turns out.
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Reply to 97yroldmom
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