Insurance was transferred as of january 1 from a managed Medicaid to traditional Medicaid. Does the episode from the managed Medicaid need to be discharged and a new soc completed under traditional Medicaid?
Those on NH Medicaid have a SOC based on their monthly income and possibly any exemptions allowed to their income (an exemption could be if they have a still in the community spouse that needs some of their income to live on). It also can be called resident responsibility or private co-pay. The actual SOC amount is reduced by whatever your state has as it's "personal care allowance" - this varies from $ 35 - 90 a month. PCA $ depends on state. My mom is in TX and their allowance is $ 60 a month, so all of mom's monthly income (her SS and retirement) except for $ 60 must be paid to the NH each & every month. Many NH press upon families to have their SS, retirement or other income go to the NH directly so many don't realize what the SOC and PNA actually is - but you don't have to do it this way, you can write a check to the NH from your elder's account and keep the PNA and let it build up as an asset in the bank rather than @ the NH as a resident use fund. Just need to make sure it never gets above the 2K allowed for assets.
what is a "soc"? typically, when you transition from one type of insurance to another (managed care medicaid to traditional medicaid), if there is an ongoing episode of care treatment, then the new insurance transitions it over which may mean everything continues as before but you have until a certain date to switch over to specific providers or it may mean you have to do the switch right away. it's probably best to contact your state's medicaid (dept of health) office.
From Medicaid dot gov States can allow people to voluntarily enroll in a managed care program, but more frequently, states require people to enroll in a managed care program. Managed Care Organizations (MCOs) – like HMOs, these companies agree to provide most Medicaid benefits to people in exchange for a monthly payment from the state. Traditional Medicaid is a program created to provide health care coverage to individuals with low income. Medicaid provides assistance for medical expenses such as doctor visits, prescription drugs, dental and vision care, family planning, mental health care, surgeries, and hospitalizations.
Medicare and Medicaid are two different things. Medicaid is state welfare by what ever name your state calls it. Medicare is the federal health care for those over 65 or qualified due to disability. It sounds like it was changed from a MEDICARE Advantage plan back to a traditional Medicare plan plus you would need the Part C supplement and Part D drug plan to go with it.
Those on NH Medicaid have a SOC based on their monthly income and possibly any exemptions allowed to their income (an exemption could be if they have a still in the community spouse that needs some of their income to live on). It also can be called resident responsibility or private co-pay. The actual SOC amount is reduced by whatever your state has as it's "personal care allowance" - this varies from $ 35 - 90 a month. PCA $ depends on state. My mom is in TX and their allowance is $ 60 a month, so all of mom's monthly income (her SS and retirement) except for $ 60 must be paid to the NH each & every month. Many NH press upon families to have their SS, retirement or other income go to the NH directly so many don't realize what the SOC and PNA actually is - but you don't have to do it this way, you can write a check to the NH from your elder's account and keep the PNA and let it build up as an asset in the bank rather than @ the NH as a resident use fund. Just need to make sure it never gets above the 2K allowed for assets.