Does anyone know of a rule that says you can't move a Medicare/Medicaid patient to another state unless they are in an Alzheimers unit?


I have a friend trying to move her uncle from Massachusetts to Texas and she was told that she couldn't do it because he's not an Altzheimer's patient. He's been in this nursing home for a long time due to severe retardation, and physical issues. When did it become a rule that in order to move a patient in a nursing home to another state that they could only be moved if they were an Altzheimers or Dementia patient? Is this a new law or is one or the other of the nursing homes (the one in Massachusetts or the one in Texas) being somewhat unclear (dishonest) with the relatives?

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No such rule that I can find, but I would not take him out of a familiar setting and attempt to put him on a plane to Texas. I have a retarded sister who is also epileptic. She has been in the same group home for many years, she has bonded to her room mate and her staff and day program friends. A move like that would be devastating for her. Please think it all through.
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Thoulie - whomever told you all that there was a "cannot move rule" was somewhat correct. Here's why:
- Medicare is a federal program, so it runs nationally and the rules are basically uniform. So you can see a hospital in FL under Medicare when you are at DisneyWorld and break you hip on vacation from your home in Louisiana. Medicare is portable.
- Medicaid, well that's going to be the problem. Medicaid is administered or managed by the states with both state & federal funding. So each state runs it's Medicaid program uniquely. What Medicaid for LTC allows for those who are elderly for one state could be different than for another state (like TX pays $ 145.00 a day room & board a day per resident to the NH, most east coast states pay double that low rate). Medicaid programs for those who are disabled also vary by state. Medicaid is not portable.

Each state can determine the criteria for acceptance BUT within compliance with overall federal guidelines. So the states can require that you are a legal resident of the state BEFORE you can be accepted for Medicaid. You may have to show a state ID or drivers license or other documents or things (like banking) that clearly establish that you are in fact a resident of the state. For my mom & MIL applications, they both had to show documents that clearly established residency in the state. Having a Boston ID probably aint gonna work.

Another issue is real property ownership, if they own a home, the home has to be in the state and homesteaded to be an exempt asset. So if they own a home in Boston, that alone will disqualify them for Medicaid for TX as the home is considered an non exempt assets and will have to be sold with all the proceeds used for spend-down,

Monthly income can differ between the states too. TX maximum monthly income is $ 2,163.00 so you need to see if that could be an issue before he gets moved.

I'd be interested in finding out what the "ready to take him" NH was expecting from family. Facility could take him as a full rate private pay resident while his Medicaid situation & residency done. They could take him as "Provisional" with his income as his copay and a private pay agreement done in which in state family has signed a fiduciary agreement to be responsible for payment if Medicaid is decline. Or the facility could take him as "Medicaid Pending" while his Medicaid application is done and without family signing off on a contract to pay. They need to clearly find out what the payment terms will be. NH in TX are about 5K - 7K a month (cheaper than east coast states) but it will add up to over 100K a year with Rx and vendor services added in.

About the POA, the Mass one will have issues being accepted in TX. Banks especially will not accept out of state attorney POA document. The good part about all this is there are notaries everywhere in TX if you can get by having a document done and then just notarized. Lots of UPS stores have notaries in TX. But eventually they will need to find a TX attorney to do whatever the Mass one does.

You can kinda see how Medicaid differs state by state as this is happening in some states right now (tend to be southern Republican states) as some states are refusing to let the Affordable Care Act extension of Medicaid be available to residents of their states who are currently on Medicaid.
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Thanks for the answer. She was all set with the Nursing home in Texas to take him until this came up yesterday. She does not have POA, but the attorney his parents set up for him before they passed away has the POA. My friend is working with that attorney, who agrees that because he has no family in Massachusetts that it would be great to move him down here. He's truly looking out for his client and has been his attorney for many many years and has taken a real interest in ensuring he's well taken care of. I will try the link at the bottom and see what I can find out by contacting them, and I do appreciate the answer.
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I've never heard of this. I went on the Massachusetts Department of Human Services web site. Nursing home regulations. There wasn't anything under "admissions, discharges or transfers." On their site, scroll to the bottom. There is a link that says "contact us." Contact them. She also needs to make sure a nursing home in Texas will take him. Is your friend the power of attorney? If not, this is all moot.
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