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I’m in NY. My aunt is an SNF and was approved for chronic care Medicaid. Her admission was quite chaotic during COVID last fall and communication with family has been poor. The nursing home’s head office in NJ contacted us directly and as she owes NAMI (about 350 a month) we arranged to have it paid via debit out of her bank account. This is happening, no issues with that part.



I am confused though why her social security monthly payments are still showing up in her bank account every month (she has direct deposit). I thought she loses her social security because she is on Medicaid? (With a tiny $50 per month stipend or something.) No one is touching this money because we assume it is not supposed to be there. What gives?


Will the nursing home ask for this money with a big invoice at some point?



My problem is this: we would like to move her into a home based PACE Medicaid funded program, which will require a separate certification process. I guess she has to apply all over again? My worry is that this SS money piling up in her bank account will make her ineligible for Medicaid if we try to get her out of the nursing home into PACE.



Who should I be speaking to? Her Medicaid caseworker seemed confused by my question and said “we don’t take her social security” whereas I assumed it would be automatically garnished or something.



Confused, should I call the nursing home head office?

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Well actually if she is still getting her SS $ direct deposit - even though she is currently a NH resident on LTC Medicaid- this could be a blessing in disguise. As it sounds like this NH is beyond a clusterF as to its management, I cannot image the billing hell she / you’d be wading through if you / her need for them to release a SSA representative payee status as she’s moving out of this NH and going back home / into her community. Just make sure she sets aside what $ amount her required income copay is as eventually it should need to be paid. It may surface if her state does an annual renewal with documentation review for LTC Medicaid as all that $ will red flag her eligibility

I have a question…. If she / you are thinking about her going onto PACE, have she/you looked at in detail how PACE is set up for where she is? We have a PACE center by us. I’m very much a fan of PACE but it’s not geared for everyone as how ours are run. One by us is essentially a M-F day center with everyone as a “dual” so on MediCARE & Medicaid for health insurance and also enrolled in community based Medicaid. Between all 3, costs for health care and day program costs are dealt with. Transportation is provided to/from the center as well and for the rare trips to hospital if needed. The # of days you go is dependent on your assessment and most get 3 days a week. The 1 by us is essentially a mini clinic and has seriously equipped vans (from State Dept of Health or from the hospital group this PACE is affiliated with) drop by on a regular basis for when certain screening/ procedures are needed. PACE is the hub. However, participant will need to be able to be on their own or have family there to deal with whatever oversight or care needed for nonPACE time. So if they are on M-W-F Pace then on their own all the other days & nights. On weekends - if deemed necessary- they might have a health provider do a in-home stop. But at no time will PACE ever provide for 24/7 oversight or care. To get 24/7 they need to be in a facility that is staffed for that.

Please, please pls before she moves out of current NH, look in detail as to just what this Pace does and if it’s at all feasible for her. If she needs others to be there to help her make it through her day, if she cannot do her own medication management, and she’s going to be alone she may not be a good fit for PACE.

Also look as to if there is a waiting list and what the list is drawing from. The PACE by us is run by Catholic Charities health facility administration group. Now CC also has a facilities group with market rate senior apts, income dependent apts, communal living places AND 202 housing. And church has senior groups within their parishes. All of these feed the waiting list for enrollment at PACE center, especially the 202 group. It’s hard for a random individual to get into this Pace, bc of this. There is a CC owned senior apt building by us, that on a regular basis has the PACE van picking up several residents regularly to whisk them over to the PACE for the day. If there’s an event, like Covid shut down or hurricane evacuation, the individual is kinda on their own to deal with it as the PACE will shut down. It’s not a NH that technically due to Medicare compliance has a legal requirement to provide for safe transfer to a comparable NH facility. Just in detail look into all this BEFORE she moves out.

Sounds like she’s still competent & cognitive but her aphasia keeps her from being able to communicate so she can seem incompetent, is this kinda happening? Its so hard to have the time or patience to understand one with aphasia (I have a dear with primary prog) as it takes forever to get a sentence out (my friend does excellent mime). You might want to have her look into 202 supportive housing program, that might be good fit. Good luck in your quest!
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AlvaDeer Jun 2022
I wasn't really aware of PACE programs, so thanks so much for this, Igloo.
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Unless the nursing home was made rep payee for your aunt's social security, her monthly check will continue to be deposited into her account as usual. I'm not sure how it works where the person does not have a POA and is herself incapacitated, but usually the NH bill would be paid by POA by writing a check from the account. Possibly some nursing homes arrange to have a direct debit from the account. The NH bill would reflect the person's share of cost, based on their income, with the $$ for the "personal needs allowance" excluded. Where are the nursing home bills going now? Your best bet is to check with them. And you are wise to leave the SS in the account, as the NH may indeed send a bill. once they realize they haven't been paid.

P.S. What is NAMI? (I think of it as the National Alliance on Mental Illness)
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TerraOcculta Jun 2022
NAMI is the amount my aunt has to pay because she was just a little bit over the income limit for Medicaid. That is being direct debited from her bank account by the NH no problem. (My aunt has no POA but she is competent to conduct her own affairs and I explained carefully what the authorization was for. She also sees every bill. While the NH wouldn’t offer a notary to complete the POA (it’s a long story) and corporate office was happy to accept her signature on the debit form for the NAMI even after I explained the situation. Basically my aunt was admitted to the NH with no paperwork, very improperly. I was advised not to sign as responsible party when I got the paperwork 9 days later (the day her Medicare denied further rehab therapy). It was during extreme COVID chaos last fall where nurses were quitting left and right, no staffing, no visitation, I wasn’t even allowed on premises and I arrived at the NH ten minutes after she was sent there from the hospital. Did not get to speak to her on phone for 3 days and didn’t get to lay eyes on her for 3 weeks. By that time they had already labeled her “dementia” because of her aphasia from
the stroke. She never had the same social worker from week to week - they were constantly shuffled or reassigned or they just quit. Staff turnover at this NH is insane. That was why they wouldn’t offer services of a notary. Due to COVID I could neither take her out to see a notary or have a traveling notary come see her. I fought to have her cognition reassessed by a speech therapist who understands aphasia. The therapist ran different tests and she agreed the original assessment was too low. The corporate office just sort of rolled their eyes and said yes we’ll accept her signature, they know this particular NH is poorly run. Upshot is, she is her own responsible party. A lawyer advised me at the time (COVID hell) that guardianship might take months and they might not even rule her incompetent. He advised us to just have her sign her own checks. (And she isn’t, though she has mild cognitive effects from stroke. She asks all the right questions about her bills and even says no sometimes.)

long story short, the NH seems to accept that she is her own responsible party but they talk to me about medical matters and routine paperwork issues.

anyhow, I believe this is a social security matter and tomorrow I will be with her so I will begin making inquiries with SSA. I believe she is being overpaid by mistake because no one properly changed her address or let them know of her nursing home status. (Although I THOUGHT the NH would do that?)

Yep, that monthly SS money she is still getting is not real, so it is not being touched. It probably has to be paid back to the government. The reason why this is an issue (aside from being not legally correct) is that we want to move her into a PACE program funded by Medicaid and I was advised by her Medicaid caseworker that she would have to go through a new approval process. I don’t want her to look like she has more income than she really has. That income she is getting right now is not real, it seems to be an error.
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Thanks. This has been a nightmare because my aunt had a stroke with no POA named and she lost all documents in a flood right before her stroke. No husband no children. As her niece I have been doing the best I can but I fear that her change of status was not reported properly to Social Security. That money is not supposed to be there. I have not even been able to get her an online SSA account or an updated SS card or anything. Her home address and phone disappeared after she was flooded out of her apartment. No address change with SSA was probably made. She has aphasia and cannot speak so she can’t call SSA herself and can’t go physically to an office and no one at the nursing home will supply a notary because they assume she is not competent just because she can’t speak well. What a royal mess. Every time I think I’m closer to unraveling this more complications crop up.
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LongShot56 Jun 2022
We are in NJ and when applying for our mother's Medicaid application have a similar NAMI condition in this state. We were dealing with monthly pension and SS deposits too and had to contact those agencies directly ourselves to redirect those deposits for the NH. We are not allowed to go over $2000 in our mother's remaining personal bank account or that may disqualify her from future Medicaid coverage. In NJ we must provide yearly filing to confirm her financial status has not changed. You are smart to make these inquiries now as to not jeopardize her future Medicaid eligible status. Keep asking until you get the right answers because we were misdirected several times. Don't assume the NH or some agency is automatically taking care of this situation - these workers are overwhelmed and details are missed.
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Speak to the nursing home. You are likely correct that this should not be the case, but our guesses would only be a guess. Speak to administration.
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