My mother is in a rehab facility and her Medicare is running out. We are waiting on a decision regarding TennCare and Medicaid. What do you do until this is approved?
Ideally mom would be in a rehab facility that also is a NH (so does LTC) and mom would after Medicare rehab benefit runs out would then become "Medicaid Pending" resident of the NH section. She or you as her DPOA does the Medicaid application with the supporting documentation & then the NH submits it along with their bill to the state.
The NH should have a list of the supporting documentation needed to accompany the application. It will be quite a lot…. like her annual awards statement from SS that reads the exact amount she will get paid for 2017; plus any life insurance policies; months or years of bank statements; citizenship info; details on any real property she owns. You just have to go down the list and find the item and then copy a couple of sets and then attached them to the Medicaid application. My mom's was over 100 pages….. but a good third of this was her super old school life insurance policy that was over 30 legal size pages. NH if they take Medicaid will have a list of documents needed as they may look them over in advance to determine IF they will accept her as Medicaid Pending.
Under Medicaid Pending, mom would need to pay all of her monthly income (like her SS or any other monthly #$ like a retirement or annuity) to the facility as the co-pay or SOC (Share of Cost) requirement of Medicaid participation. Now she is allowed a small PNA - personal needs allowance. PNA varies by state from $ 35 - $ 115. so mom gets to keep the PNA. Often the NH will highly suggest that they become the rep payee for her income and all the $ goes to them directly with the PNA going into an on site at the NH personal trust account. BUT mom DOES NOT HAVE TO DO THIS. So if mom has a checking account, you or her can just write a check to the Nh each mon for the copay. I did it this way & mom's first NH was kinda peeved but just too bad; her 2nd NH was totally whatever works for you, we're fine with it.
Now mom would likely transition from 1 room to another, but perhaps just stay in the same room. It kinda depends on how the LTC is set up. My mom's first NH had a wing just for rehab which was much newer and much much "nicer" but my mom's 2nd and eons better NH had all residents in the same type of room.
If this is a rehab only facility, then you have to asap speak with a discharge planner to see where she could move to as Medicaid Pending.
IF there is any way mom can continue to "progress" in rehab so that she can possibly qualify for more days (up to 100 day max), pls, pls, please try to do this. Medicare pays way way more than Medicaid & a facility will want a Medicare paid bed filled. Id clearly speak with her therapists and social worker as to where mom is in her progress.
Remember whatever you do always always sign each & every page or signature clearly as her DPOA and have copies of the DPOA paperwork to attach if needed to any agreement. AND make sure you get a copy of any & all contracts. Do not leave or pay an advance without getting copies of all. At 5K - 15K a mo for NH, if things should go askew, that is a lot of $ to possibly be held responsible for. You have to always do whatever to CYA on these costs imo. Get copies of any paperwork.
The NH should have a list of the supporting documentation needed to accompany the application. It will be quite a lot…. like her annual awards statement from SS that reads the exact amount she will get paid for 2017; plus any life insurance policies; months or years of bank statements; citizenship info; details on any real property she owns. You just have to go down the list and find the item and then copy a couple of sets and then attached them to the Medicaid application. My mom's was over 100 pages….. but a good third of this was her super old school life insurance policy that was over 30 legal size pages. NH if they take Medicaid will have a list of documents needed as they may look them over in advance to determine IF they will accept her as Medicaid Pending.
Under Medicaid Pending, mom would need to pay all of her monthly income (like her SS or any other monthly #$ like a retirement or annuity) to the facility as the co-pay or SOC (Share of Cost) requirement of Medicaid participation. Now she is allowed a small PNA - personal needs allowance. PNA varies by state from $ 35 - $ 115. so mom gets to keep the PNA. Often the NH will highly suggest that they become the rep payee for her income and all the $ goes to them directly with the PNA going into an on site at the NH personal trust account. BUT mom DOES NOT HAVE TO DO THIS. So if mom has a checking account, you or her can just write a check to the Nh each mon for the copay. I did it this way & mom's first NH was kinda peeved but just too bad; her 2nd NH was totally whatever works for you, we're fine with it.
Now mom would likely transition from 1 room to another, but perhaps just stay in the same room. It kinda depends on how the LTC is set up. My mom's first NH had a wing just for rehab which was much newer and much much "nicer" but my mom's 2nd and eons better NH had all residents in the same type of room.
If this is a rehab only facility, then you have to asap speak with a discharge planner to see where she could move to as Medicaid Pending.
IF there is any way mom can continue to "progress" in rehab so that she can possibly qualify for more days (up to 100 day max), pls, pls, please try to do this. Medicare pays way way more than Medicaid & a facility will want a Medicare paid bed filled. Id clearly speak with her therapists and social worker as to where mom is in her progress.
Remember whatever you do always always sign each & every page or signature clearly as her DPOA and have copies of the DPOA paperwork to attach if needed to any agreement. AND make sure you get a copy of any & all contracts. Do not leave or pay an advance without getting copies of all. At 5K - 15K a mo for NH, if things should go askew, that is a lot of $ to possibly be held responsible for. You have to always do whatever to CYA on these costs imo. Get copies of any paperwork.
Good luck and keep your sense of humor going.