Nursing home changed insurance then charged out of pocket for it.

OP says this person is young, so unless she has a disability she wouldn't be on Medicare, but could be on Medicaid due to being low income. Younger people on Medicaid are generally covered for medical care in the community, and it's quite unusual for a younger person to be in LTC in a nursing home. If a person needs Medicaid for LTC, that would be a different application process and different criteria than for "community" Medicaid coverage. She, or someone on her behalf, would have to apply for LTC Medicaid. Some states I believe have Medicaid managed care systems where services are contracted through 3rd party contractors, and it's possible this young person had been covered in one of those systems before entering the nursing home. This would have been just for community care, not facility care. https://www.medicaid.gov/medicaid/managed-care/index.html

I didn't answer this question before because I really did not understand it because the facility does not determine what type of healthcare coverage you have. I assume that by "She's on Medicaid" you mean Medicaid is paying for her care and as such if she is on Medicare Medicaid is now her suppliment. All the facility needs to worry about is that Medicaid is paying for her care and they are getting her SS and any pension she receives.

Providers are the ones who would be asking what insurance she has. A facility doctor should be able to bill both Medicare and Medicaid. The pharmacy doing business with the facilty should be able to bill Medicare and Medicaid.

I have a gut feeling that this facility no longer takes Medicaid for LTC. And as such, Medicaid no longer pays providers. Medicaid may not have renewed their contract with this facility or visa versa. Residents should have been notified in writing. No private insurance is going to pay for LTC.

Another scenario would be that she started out in Rehab. Medicare only pays for 100days, 20 days 100%, 80days 50%. The balance that Medicare does not pay is the patients responsibility. If she has Medicaid for health insurance that balance should have been paid. Just because you have Medicaid for health does not mean you have it for LTC. After 100 days if she is staying in LTC she now must pay for it. If she can't she applies for Medicaid. The NH can do this for her. She may have been turned down. So now she is responsible for the months never paid by Medicaid.

You really need to sit down with the finance dept and see what she is being billed for and what she signed.

Confused
You are talking a 110,000 bill here!
You say she cannot reach anyone.
You aren't there, and I think your thinking she is capable of handling what is happening here is in error, as she has signed things she admits she doesn't know what she signed.

This is time for a visit if you are at all her POA.
If not, this is the time for HER to visit an ATTORNEY, as they are not communicating with her and this is 110,000 BILL! That is a whole chunk of change.

Just tell her that until she clears this up she pays NOTHING because if she starts paying on this she may be legally "assuming the bill".
Hope you will update us on this mess! Yikes. Scary stuff.

Contact your state's ombudsman. They should be able to offer some assistance.

Perhaps she had Community Medicaid and it was getting changed to Long term Care Medicaid?

I would call the local Area Agency on Aging and local elected representatives; they generally have specialist who work on elder affairs and can help sort this out.

Hi everyone, I’m just on here to clear up a few things, she is sound of mind just not sound of body. The nursing home changed to a different kind of nursing home or something (sorry I am not completely clear on that either) but in doing so they changed insurance. They still take Medicaid, but they were going to come back with the necessary paperwork to change her Medicaid to the right kind. I’ve been trying to reach management with phone calls (I live two states away so I can’t physically check) but they are never there/half the time I get voicemail and my calls are never returned. She has been asking the aides to get management, but they will not come to talk to her. We are probably going to move her to another facility who has better communication, but in the meantime what can be done for the remaining six months bill that was received? Can we be held liable even though they never returned with the paper work? Just very confused as to why we got a bill when they never returned to facilitate the change.

Is this person a senior? Younger than 65?

Maybe the facility stopped offering Medicaid beds. Talk to an ombudsman. Talk to her caseworker.

Your family member may need to assign a PoA to advocate for her if she's that sick/disabled.

They didn't issue a 30 day notice? If she can't pay , that would probably be the next step the facility would do.

I don’t quite understand what took place at this facility as there are too many unanswered questions to piece this together. You stated that a younger family member, who has Medicaid, is recovering from an illness in a facility and “management changed the type of insurance needed to stay at the facility”. Does this mean that this facility is no longer accepting Medicaid insurance? Did the facility just abruptly stop accepting Medicaid? Did something happened at this facility which caused Medicaid to stop doing business with them?

To get an answer as to why this happened, you need to speak to management at this facility. You also need to hire an attorney to see what can be done about the $110,000 charge. Otherwise, if your relative cannot afford to pay an attorney then the other alternative will be to apply for Charity Care to prevent payment of this hefty facility charge.

Sadly, this will be an uphill battle but you just need to persevere and don’t give up with the roadblocks you will face and everything will be fine.

Clearly she was put on an advantage plan. This isn't uncommon. Many advantage plans now work within facilities. In my brother's case he chose to keep his United Health (mistakenly I think) because he wanted choice of any MD anywhere. But most chose the Advantage Plan recommended and with that a Nurse Practioner came one a week and checked on folks, diabetics, those with high blood pressure, those with any wounds or any problem, and etc. I thought it would have been a good choice. Once a year the choice can be changed, and this is apparently when your loved one changed plans.

Now as to whether she was competent to make this choice or had instead a POA who this should have gone through, we cannot be certain. The POA will have to trace down exactly what was changed, exactly what these costs are, and etc. They have nothing to do with supplemental insurance, and if they have to do with long term insurance, then having someone not competent to sign things is fraudulent.

The 80,000 bill for facility of course has NOTHING to do with any health insurance supplements.
You will have to have the POA contact the admins of the facility and discuss what this charge is. We surely, as complete and total strangers could not fathom a guess.

I can but wish you the best of luck tracking down what all is happening her.
I hope this elder has a POA and one who is very COMPETENT in knowing what to do, what attorneys to contact and etc. Good luck. Hope you will update us.