Mom is approved for Medicaid. I just received a bill from the nursing home for self pay rate. Now what? -

Mom is approved for Medicaid. I just received a bill from the nursing home for self pay rate. Now what?


I had Mom approved for Medicaid. June 9th she was admitted to a skilled nursing facility. The told us at the admission meeting that she had been approved under Medicaid. When I called to confirm this, the billing department said that they were waiting for the state to send them what her portion of the bill would be so that I could pay that and then they would bill medicaid. Why would they send the bill for the 6th through the 30th of JUne and prebill for July at the full rate? When they receive the spendown account from medicaid will the adjust the billing? The current statement is for over $9000.00 for the June days and the month of July. Anyone I should call? Would it be better to Department of Health and Human services. FYI we are in Illinois

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thanks, igloo, reason for asking, was waiting on that SS notice of next year monthly income for hub's aunt and uncle to use to file for Veteran's Aid and Attendance, thinking come either in December, maybe officially supposed to but like said tends to wait on that COLA, which don't think had gotten for several years but think did get recently, but that just happened to be the year got the call about my dad 3 days after Christmas and ended up leaving and being gone the whole month of January so when got back of course the paperwork had come in but had forgotten about them paying taxes on their income because of uncle's private pension, which my dad didn't have so he hadn't had to pay taxes, so had given it to their son for those purposes but he doesn't understand the A&A so couldn't get it back so nothing to do but try to get it again or just wait for another year but since in the meantime she had gotten home health, along with home care they also provided even though Medicare doesn't pay for it, she wasn't expecting it to quit and was enough for the time and didn't want to rock the boat by asking for it back and could cause issues to try to get it again so we decided to just try to wait it out, which worked out for half the year till they ended up quitting when they reached another evaluation time that had to be signed off by the doctor and she was out of the country and we couldn't get another - covering - one to sign off on it so they said they'd just have to quit coming, which they did and they way it had been presented it to his doctor, when she got back in she wouldn't re-refer then, but as he's gotten worse, we've gotten the idea she has now referred him to the specialty geriatric clinic we've just now found out they have but then we were told she didn't so not sure what's really going on; if not, may just have to change doctors; however, at the time we were able to continue his personal care but no more help for her with any housework or anything, although at the time we thought it was - we're just now finding out it wasn't supposed to be - which wasn't really too bad at the time but has since gotten steadily worse without any help, as, with her having to do it all, has gotten her in worse health and she forgot again this year as the paperwork came in; I didn't press the issue enough, I suppose; at the time didn't seem as if it would be an issue, but since turned out to be, she told me later I should have pressed more but now they've changed some of their procedures; the way they were making provision before for you to be able to do was never designed for situations like this where it would take this long, so now they have a formal procedure where they will work with you more but being formal does mean yet another form to sign, maybe even fill out, not quite sure
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Deb - if I'm recollecting correctly the sequencing of important stuff for my mom was:
Tax assessor notice of next year appraisal / April (45 days to file appeal by 6/1)
Tax assessor bill for next year / Oct (due Jan)
Civil service / federal retirement notice of next year monthly payment / Nov
SS notice of next year monthly income / Dec (I think this comes later as SS can get a COLA last minute)
Civil service / federal /SS income paid for past year taxes (w-2) / Jan
Dividends, interest for past years / Jan

Annual Medicaid renewal was about 90 days before her initial eligibility month & due back to TxDADS / HHS 14 days from date of letter and every year was either postmarked days after letter date so received past due date or right on due date or a day before. This same thing (consumer loss of days to respond) is also happening with MERP letters.
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those award letters are supposed to come Nov/Dec? not January?
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Could it be that your mom is Medicaid Pending rather than approved for Medicaid?
If she is pending, you need to look at the admissions contract to see just how this facility states they can do the billing at till she is fully eligible and approved.

Do you have your mom's awards letters….by that I mean the letters from SSA and from her retirement or any other monthly income? For SS & civil service/federal, they come in Nov/Dec and state what they will get paid starting Jan of the new year. The awards letters are basically what the state Medicaid program uses to determine mom's co-pay or "SOC" (share of cost) required to be paid to the NH less whatever your state has as the personal needs allowance (this runs from $ 105 - $ 35 a mo). Like for my mom she got $ 900 a mo SS less her Medicare payment (abt $ 104) so roughly $ 800 a mo SS plus a retirement of 1K, her personal allowance was $ 60 (TX), so every mo her SOC was $ 1,740 that had to be paid to the NH. I wrote a check for it from her bank account and let the account build by the $ 60 personal allowance each month.

If you did the paperwork for your mom's Medicaid application, the awards letters were probably a part of the documents required. I'd copy them and do a brief note with a check from mom's bank account for exactly whatever the co-pay/SOC (less the personal needs allowance) is and send all to the NH. If your gut feeling is that the facility biz office is incompetent, send it certified mail with the return registered receipt from USPO - runs about $ 8.00.

Have you done a trust account @ the NH for mom? The trust account is for incidentals like beauty shoppe, the canteen (if the NH does one) or to pay for their phone or cable if the NH has a fee for that. WHat seems to happen is that the NH presses upon family to have all their monthly income go directly to the facility and then the facility places their allowance in the residents trust account. But you do NOT have to do this despite whatever the NH says…….

If you should ever decide to move mom to another NH, having them get her monthly income will be a beast to get changed & deal with.
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I would not call the state. I would start with the business office of the nursing home. They can tell you what your mom's SOC (share of cost) is each month. Are you her representative payee for SS? It is usually the case that her SOC is her full monthly SS benefit, minus a small personal needs allowance. Medicaid does not mean that the entire bill is covered.

If indeed, this is the self pay rate (that would put it at about $5000 per month? My mom, who is private pay, is $15,000/month) it's most likely a billing error and easily rectified. If not, remember, this is your mother's bill, not yours.
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