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How it runs in my mom's state is that each NH has a specific state caseworker that get's that NH's applications. You can get their name and then send or fax them a letter asking to be contacted regarding the status of the application. Fax is better than a phone call as a fax establishes a legal papertrail for contact which a phone call doesn't do. My mom's Medicaid application (over 100 pages) was submitted by me to the NH with the documents based on the 1 page list of required items from the NH. In turn the NH submitted my mom's application and her 100+ supporting documents ALONG with their NH invoice to the state for Medicaid reinbursement for her daily R & B costs. This is set by the state and each state has a different rate. For TX it is about $ 145.00 a day the state pays the NH for the elders care - yeah it is low. Some states day rate is much, much higher. You need to know what the rate is BECAUSE if you run into a problem with the application, it will be that rate the NH can bill you if mom was admitted "Medicaid Pending."
Is the facility she is in and was she admitted "MEDICAID PENDING"? If so, then she (& you!!) are OK for her staying there till the Medicaid review is done. If she was not a Medicaid pending admit, you could be on the hook for paying @ private pay rates if there is a Medicaid decline or transfer penalty. Really you should go to the business office and have a detailed sit-down with them. How does it read in the admissions contract as to how they deal with Medicaid acceptance? If you do not have a copy of the admissions contract and her Medicaid application, you need to get a copy which the business office should have.
I'm assuming that mom is fully paying her co-pay to the NH each month less whatever is mom's states "personal needs allowance". You need to know what that is and how it is being handled (you or other family is managing her banking and keeping the PNA, OR is such that the NH getting her checks and they have a PNA trust for her set up). In TX the PNA is $ 60 a month, and I pay my mom's NH from mom's bank account that get's her SS and annuity BUT keep the $ 60 a month in it. Now what is the situation for your mom? and are you or whomever in your family is dealing with mom's stuff paying the NH regularly each month her co-pay less her personal needs allowance? You have to do this to be in complaince for Medicaid admission. I have know of situations where the sibling who is still living at mom's home was keeping the SS check to live on and NOT paying the NH, which is not kosher for how Medicaid works. You want to make sure the NH is being paid their full co-pay each month & check w/business office on this.
The NH does not have to keep them per se, they can have them discharged to another facility. What I've seen happen is that if there are payment issues, the NH will send the resident and whomever signed the contract a "30 Day Notice" - also the state DHHS gets the letter too. In it, it requires that someone has to come to an arrangement with the NH regarding the outstanding bill or mom will be issued a discharge from the NH. No, mom won't be kicked to the curb but it starts the system to have her moved to another facility probably within the next 60 - 90 days.
IF you get this it is a total panic situation and the social worker can help you sort it out. Sometimes it takes this point for the state to move the application review into high gear too.
Now in the admissions contract it will probably state how delinquent accounts are dealt with. If the elder signed it, then there isn't much that can be done to collect on the debt if they have nothing. BUT if family signed their name and did not sign it only in their capacity as DPOA then they can be held responsible for the debt. At my mom's old NH, one lady's son (imho a real a-hole) refused to pay or come to an agreement on his mom's debt @ the NH. There seemed to be issues with a big transfer penalty that kept her from being accepted on Medicaid. Anyway it went on for months and she was made a "temporary ward of the state" and transferred to a NH in another county that had a super low occupancy rate and needed residents. He still had to deal with the debt from the NH too, which I assume got turned over to collections as it was big enough $$$ to be worth doing that as he was yelling about it one day I was there. What a charmer, he was.
So find / get the documents and review them carefully. Contact the caseworker to see what might be missing and if it is something that you needed to submit, then fax it over to them asap. Keep open communication with the business office and the social worker at the NH. Good luck and keep a sense of humor!
Medicaid, a government program, is at the forefront of taking monies for it's recipients, and you need to know the law, in your state, and, as it applies to the beneficiary. Keep in mind that anytime you get free money from the government there are consequences. Keep in mind also, that the government-paid caseworker works for Medicaid, not you. A good elder-care attorney should be on your Rollodex ( old), or your Speed Dial..
They will not make you go without or kick you out of your home. I know this for sure.
But you have to check your state's program to get the details.
I will have to wait till Monday to try and find if this is true. I can't take much more
I am ready to go to sleep and not wake up. I just can't do it anymore.
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