Does a nursing home have the legal right to demand a resident's financial information that is listed on their Medicaid application? - AgingCare.com

Does a nursing home have the legal right to demand a resident's financial information that is listed on their Medicaid application?

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My grandmother was admitted to a nursing home over a year ago. As of a few months ago, when I took over as her POA, the nursing home had never submitted a Medicaid application from her time of admission, claiming non-compliance from other family members, myself not included. Now the facility states it has rights to access all her financial information documented in her Medicaid application. I explained to the nursing home it does not have any legal rights to the financial information, and at the time of filing, instructed Medicaid not to disclose her financial information to the nursing home. I sent a redacted copy to the nursing home. The nursing home now claims it is owed money from the day of her admission to this day, even though I've stated severally I'm not responsible for the actions of family members before I came into the picture. The question remains as to what legal extent, if any, a nursing home has rights to my grandmother's financial information.

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Hold on.

The nursing home is asking for two different things, then.

1. Payment of accounts due from before you took over as your grandmother's representative. Well, the money is either owed to them or it isn't. And the fact that the liability was incurred before you took on the job is neither here nor there - it is still *now* your responsibility to determine whether or not there is a debt and, if there is, to see that it gets paid. Note that you are not personally liable for this debt whatever happens, but as you've accepted power of attorney for your grandmother it is your responsibility to get the problem resolved.

Then 2. What right does a nursing home have to financial information about its residents... well, they've a right to ask, but they've left it a bit late haven't they? They should have ensured that they had all the information they required before they accepted her admission in the first place, surely?

Can you be a bit more specific about what it is they want to know? What information are they asking for that you're not happy for them to have?

The other thing that strikes me is that you seem to hold the nursing home responsible for failing to submit your grandmother's Medicaid application, at the same time as you seem to be saying they have no right to access her private financial information. How would you expect them to have managed the one without the other?

Assuming you want your grandmother to stay comfortably in this NH, I should start negotiations again bearing in mind that a nursing home that does not operate some kind of credit control won't be in business for long. The aim is to figure out what is owed and how it is to be paid, and don't stand on principle unless it really is important to your grandmother's best interests to do so.
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To me, so much going on..... but short answer is YES as NH must know what her income is via her "awards letters" as copay is determined by them.

There's probably all kinds of issues in gran situation. For a start, You as the new dpoa need to get original admission agreement & all other initial NH paperwork that was done. NH biz office may have this. But if their part of a chain, it would be at corporate HQ. Either way they can charge you a research & copy fee for it. You really must have this to see exactly what's what in this clusterF, and who's liability as per signatures is on the line for payment. You as dpoa can also send a letter to your states LTC Medicaid ombudsman to request a copy of all correspondence regarding grans application.

Now the old DPOA, what's the backstory?
Really why you as dpoa & why now?
You could ask old dpoa for their copy of the admissions paperwork, but I'm guessing they unless old dpoa is dead or themselves now have dementia, they didn't ask for or wait to get a copy..... and there is some sort of transfer of assets within past 5 years that will be a problem & why the non-compliance on turning in documents. 

My experience as I've dealt with Medicaid for my mom & mil in 2 states & 5 NH facilities has been that for all, is the NH handed out a list of items needed & required to accompany the Medicaid application; which in turn was filled out by me Or hubs/bil at NH; and then application sent by NH along with the supporting documentation (my moms was about 130 pages mainly due to vintage life insurance policy) along with the NHs bill to the state caseworker assigned to the NH. 

At each NH, admissions reviewed the documents to determine IF they will accept the elder as a "Medicaid Pending" resident AND/OR to determine the to the penny copay or SOC (share of cost) required each mo to NH. It's my understanding that a facility can take Medicaid but doesn't necessarily have to accept them as a "Pending" if there are documents missing or items that could be a redflag for Medicaid. On the latter, they all seemed to do some sort quick math of income & bank statements to see if poverty made sense; And did X reference via Redfin, MLS, Tax Assessor, on residents name & prior address to see if home sold within past 5 years,,.... if either seemed off, NH could determine if accepting them as "Pending" or it needed to be as private pay under contract signed by financially responsible family member (so no "in my capacity as dpoa" type of signature allowed).

I would suggest that you calmly & clearly ask NH what grannies payment status is (Pending or PP) and what amount is due each month?; ask is she current on her SOC? Is her SS, etc going directly to NH? What's the amount in her NH trust fund? & what does the NH show as grannies current awards letter(s) amount?

Really NH needs to review items to determine if Pending makes sense to be allowed by the NH and what SOC to be paid each month.

Try to stay in check. Don't be hostile. It reads that the NH has cut granny a lot of slack if she's still not on Medicaid and it's been a year. NH probably likes her, she's an easy care resident. You want this to work out imo as she's not going to ever be able to get into another NH easily.

You don't want NH to go for the nuclear option...... which is they contact APS and ask for an emergency ward of the state status placement for grannie. Which a judge will do. Being dpoa requires a fiduciary duty by you on grans behalf from her assets. Your fiduciary duty is for all her debts not just for those placed after you became the new DPOA. If NH has sent bills, 30 day notices, etc and nothing seems to be moving, they will eventually do nuclear. Things like this snowball..... guardian has pretty wide ability... they can request APS investigation of you, your home life, run credit checks, contact your employer. If you or your household has military or need clearance or teach, APS will contact HR for your employer and it will not be pretty. They can determine grans NH.

At my moms first NH, a son sold his moms very very modest home after she entered NH and on Medicaid. He kept house $. It surfaced so Medicaid found out and lady ineligible. She was sweet. Son contacted & ignored all. nH sent 30 day notice. Staff would ask him about payment whenever he visted her. It apparently had gone on for close to a year. He kept ignoring all. One day, huge commotion, cops called, Sonny came to NH but his mom had been moved to another NH by the new guardian as she had been made a ward of the state. I cannot imagine just how awful for the little lady. The SW told me that ApS would likely file charges against Sonny for actions harming a vulnerable adult & NH would turn bill over to collections. 

Pls try to work with the NH to get whatever needed to get her eligible & with retroactive payment by Medicaid. 
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Doling out money to the grandchildren and putting funds into a private trust fund from her SS and Pension Income will not be allowed in conjunction with being on Medicaid. It is sad about what happened to your grandmother's assets, but she cannot expect taxpayers to fund her nursing home expenses while gifting money to the grandchildren.
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She's got money. She is not eligible for Medicaid and never will be if she's got a trust that she is in control of.
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Kell, sounds like grandma does in fact owe the nursing home for care - it is a morally valid debt. And the responsibility for grandma's business affairs does in fact fall on her on her POA's. Basically I don't believe the nursing home is being unreasonable - why not work out a payment plan, get the Medicaid application in and approved? I can understand why they want their money. And I hope you are not disbursing any funds to grandkids, or others. Remember no gifting.
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A question I have about this situation is about sharing financial records with the NH and your grandmom's request not to share them. How can the NH determine what she is to pay if they don't have that information, and what's the big deal about sharing them for that purpose? You say you are filing a complaint about NH not having the right to request a residents financial information. Since when? Your grandma is applying for state/federal aide when she is applying for Medicaid. This this is taxpayer funded, but you don't think she should be presenting a true and accurate account of her finances & won't let them see her bank statement? I don't understand that.

Sounds like there was a little hanky panky going on with her money just about the time GM went into the NH. Perhaps her prior POA was unavailable or reluctant to provide the necessary paperwork for her application back then when he was cleaning out her bank account. It's not the nursing home's fault that her accounts were drained by her prior POA who also sold her house, gave the NH $15k and pocketed the rest. I will bet the NH tried getting records from him but he was busy committing fraud. 
If anything the NH has been quite accommodating with GM. 

And..There was an APS investigation as well during this time. 

You've got a full plate to deal with; maybe as CM stated there is more details you just don't know. 

A suggestion would be to at least set up some sort of payment plan  in good faith while this is being resolved as if the NH chooses to evict her for non payment she won't have anywhere else to go as her house is gone as well as $40k and whatever the house sold for minus $15k.  

Choose your battles carefully. 
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Time for the grandkids and other trust fund beneficiaries to pay for grandmother's nursing home stay. When you ask for public assistance, the public has every right to see financials.
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Again, hold on a minute.

Your grandma. Independent, marvellous little old lady, yes? They love her to pieces. Well isn't that nice.

She owes them money. She does not get to lay down the law about who can do what and who gets what and *at the same time* play the sweet little old lady who's being gouged by Evil Capitalist Profit-Hungry NH.

That APS investigation. How did the previous DPOA account for the money from the house sale? Did his disabilities come into it? If APS didn't address the question, maybe you need to say "APS meet Medicaid, Medicaid meet APS, you two play nice now" and see if you can get them to reconcile their conflicting assessments of their client's financial wellbeing.

But going back to grandma, is she legally competent or not?

If yes, it's up to her to pay her debts and to work out how. Not to conceal assets, not to bestow favours on grandchildren, not to waïve questionable actions of her disabled child and his friend.

If no, your DPOA (although to grant you POA your grandmother would have had to be competent, so unless she's gone downhill since that's the question answered) obliges you to act in her best interests. Which would include settling her debts and complying with regulations.

I get a faint impression that grandma is running rings round you and everyone else. Respect her rights and her autonomy by all means, quite right, but don't let her take the mickey. You have been given a responsibility, your grandmother also has to allow you the authority to carry it out. So, for example, she can require the NH to give you sight of all relevant contract terms and conditions.

And are you sure she's telling *you* everything she should about her finances?
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I live in TX and when we had to put my mom on Medicaid it was up to us to file the financial info to Medicaid and the Nursing Home was responsible for submitting a "medical necessity" form. When we began the process, we used a lawyer, and a date was set that we requested Medicaid to begin paying for her care. Even though the claim did not get approved until three months after the requested date, Medicaid paid retroactively from the original date requested. Up to that date my mother was responsible for the Nursing Home bill. After the agreed on date, if the Nursing Home is a facility that advertises they will accept Medicaid, then they have agreed to accept less than their usual rate. They cannot bill the patient for the remainder. You need to make sure this is not what they are trying to do. As far as the nursing home wanting her financial info, I can't imagine what for and am suspicious of what they want to do with it. Having said that, you need to be attentive and make sure they don't take this out on your loved one because sometimes it happens.
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I don't get it. Granny received care. Granny owes money for her care. Get on with it and stop fighting it. As CountryMouse describes, you can do this the hard way, or you can do this the easy way.
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