I thought Medicaid was all they get. She is in a Medicaid bed. This company does accept Medicaid as payment.

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I'm no expert, but in NC, I was told by Social Services, several Assisted Living Facilities and two attorneys, that if the facility accepts Medicaid, then they have to accept what Medicaid pays them on behalf of the resident. The resident's monthly income goes towards the payment, except for $66.00 per month that the resident keeps for personal expenses. The rest of the the resident's income goes to the facility, but the facility must accept that as full payment and can't demand more.

I would check with the Medicaid assigned case worker.
Helpful Answer (1)

Medicaid requires the resident to do a co-pay or their SOC (share of cost) of their monthly income to the facility less whatever small amount your state has as their personal needs allowance.

Medicaid should have sent whomever is on file as the contact person for the NH resident a letter of eligibility that states what the copay is. You kinda need to make sure this is accurate. For my mom, it was SS $ 800 and retirement 1K and personal needs allowance of $ 60. So every month, I paid from mom's bank account $ 1,740 to the NH as her Medicaid required SOC.

So is the facility getting the co-pay & have they gotten it for every month she has been in the facility? if not, it needs to be paid. If those funds were spent on other things by family, then family needs to make up the difference.

If you are good on the SOC, then it's a billing mistake….I'd send a note with the Medicaid eligibility letter to them and that should take care of it.
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Do you mean they sent you a bill? As in you personally? Or was it sent to your mom? Or did someone ask you to sign something saying that you'd be responsible?

A couple of years ago, I came up with a policy that has kept me sane. Whenever a medical bill comes, if it's for more than my co-pay, I assume it's a mistake. Coming at these situations from that point of view makes for calmer conversations.

So, start out by clarifying in your mind who the bill is addressed to. Was your mother approved for Medicaid? Was she admitted as Medicaid pending? If so, I believe that the payment from Medicaid will be retroactive to her admission date.
Talk to the business office and please let us know how you make out.
Helpful Answer (4)

I thought the same as you. Have you discussed this with the billing office, or is there an ombudsman or similar agent that you could discuss this with? This does not seem right to me, unless there are other facts you haven't mentioned.
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