Check account balance barely over $2k, NH refusing to put into Medicaid pending, demanding full payment.
My mother went in for a Rehab stay in May 2024 - during this time she fell and fractured her pelvis. This meant 6 weeks of no weight bearing, etc. She was already going downhill cognitively and the bed rest of 6 weeks put her into a position where she will now have to stay as a full time resident in the long term care facility/nursing home.
Bear with me here.
After her fall - the "Medicare 100 days of short term care/rehab" period that was covered money wise ended. However we were not in a place financially to apply for Medicaid as she had approx $20k in an IRA.
We self paid the nursing home for 2 months of care, which ate the IRA money. At this point, I started the Medicaid application process with the nursing home business office.
Of course they needed all documentation, etc and received it right away. Part of which was 3 months of bank statements (Sept/Oct/Nov) They are now telling me that they will not attempt to put her into "Medicaid Pending" status until December bc the beginning bank balance in November was over $2k (BARELY). So they are saying we must self pay that month - but there's nothing left to pay them with, much less $8k.
My question is this - if you can't apply for Medicaid until you reach a certain threshold ($2k) but you can't self pay in the time in between - what do they expect you to do? In other words not enough money to self pay, but the beginning balance of her checking account in Nov was over $2k. At the end of Nov it was $57. How in the world do they expect this work? Am I missing something? It seems to me that the Medicaid Pending portion would begin in November (as we self paid in Sept and Oct) bc we did not have the money to self pay another month but we did have slightly more than the $2k limit. There's no leeway here? I feel like they are being unreasonable or I am missing something. Sorry for the lengthy post -I was trying to cover as much info as I could. Thank you all.
When my cousin had to place his Mom, he was told by a friend at the Office of Aging not to use the NH to file for Medicaid. Office personal can't know everthing about Medicaid.
Facility wants to be sure that everything is kosher before "Medicaid Pending" They don't want to do anything wrong to get on the wrong side of Medicaid.
Facility is a business, first and foremost, they're going to do all they can(legally) to make sure they're protected.
You have to file for Medicaid before the money runs out, 60 to 90 days before. And yes, even a few dollars over the 2k, will keep Mom from getting Medicaid. You could have bought her something to get her under. As Moms caseworker said, be imaginative. Personally, I would have never used the NH to do the application.
In my State you do not need to be under the 2k to apply. Mom just needed to be spent down within the
90 days allowed. Since Mom has no assets now I may call Medicaid and set up an appt with them. For now, I would not pay anything towards Moms care. They cannot legally discharge her because its an "unsafe" discharge. Make it known, there is no one who can care for her.
So sorry you are going thru this.
The bill will come back to them "No funds".
You cannot get blood out of a turnip.
Meanwhile you do your Medicaid applications while they "send the bills".
This isn't your bill to pay. Your mother doesn't have any funds. If they wish to go to court they can get a lien on any house or car she has; and get that money when she dies, otherwise it goes wherever dead bills go.
Just continue with your applications for Medicaid.
If they say they won't do it Medicaid pending then you reply "Well, I guess you can send bills but you have already seen she has no money, so I am uncertain how you think those bills will be paid".
Welcome to the world of unpaid bills. It is a world most of us don't live in because we have spent many years in dread of unpaid bills, worrying and fretting how to pay bills. But you may come to enjoy that world of returning things first that say "No funds" and second that say "Deceased; no estate".
What a life, huh? I type this stuff up over and over and sit shaking my head in absolute wonderment.
Good luck OP. Truly you have my heart and my sympathy here.
Also, it's not required that the BOM or anyone in the nursing home be intimately involved in the Medicaid application process. It can just be between you and the county assistance office. I personally believe that some nursing homes make you feel that you have to go through them and give them all the financial documents. I believe they do this so that they can be nosey and get to see for themselves the financial situation of the applicant and then use that knowledge to their advantage.
And, if Medicaid requests more info you need to get it back to them asap because they have a deadline for each communcition they expect from you (so if you get any mail from them open it immediately).
Also, in most cases a Medicaid bed will often mean a shared room.
The app is usually processed within 3 months.
After 2 months of self payment for long term nursing home care - the business manager started our Medicaid paperwork. She received every single item she requested plus some.
She is telling me that because, after reviewing bank statements - the BEGINNING BALANCE of her November checking account was slightly over $2,000 - we must self pay for November, and won't go into "Medicaid pending" until December. (the balance at the end of November was $59 side note)
I guess where i am confused is . . . if you don't have enough money in checking to self pay $7,500 - but you have slightly over $2,000 on that FIRST day of the statement period - then my hands are totally tied. I don't have the money to pay them or I wouldn't have asked them to move forward with the Medicaid stuff. I couldn't submit paperwork and start the process of Medicaid prior to November bc we had to spend down some of her money. I didn't realize that on the exact day of XYZ if her balance was showing $2,320 they'd refuse to even submit the paperwork into a pending status for November.
I guess my point is - there CLEARLY wasn't enough money to self pay, yet we had HAD to start the Medicaid process at that point and they are taking the balance on 1 day and refusing to move forward with it, demanding self pay. It makes no sense.
You can't have both the money to self pay and be under the asset limit. What am I missing?
This is how the timing in the basic application is designed to work:
1) Admit LO to SNF as private pay. Pay SNF an upfront sum -- in your case the IRA amount -- for xx number of months of self pay until LO is below the income and asset limit.
2) Immediately file for Medicaid.
3) During the review period (three months in the case of my MIL with two as self pay), spend down any additional assets AND make sure the income is below the income threshold.
4) Notify SNF Medicaid is in progress.
5) Once Medicaid is approved, Medicaid either starts paying the same SNF or LO may need moved to a Medicaid bed elsewhere.
Medicaid will usually back pay the SNF for three months. Medicaid is month-to-month. A SNF isn't required to accept Medicaid on the months the client doesn't qualify. That means self-pay during those months.
springmcm, if you haven't already applied for Medicaid (hopefully you are not leaving it to the SNF to do this), do so immediately. Give Medicaid any required documentation -- being sure to remain under the asset and income limits. Request that Medicaid back pay the SNF for up to three months. Ask the SNF if they will accept the Medicaid payment as payment in full for November and December. If not, see if you can pay just the difference between Medicaid and self-pay pricing for those two months.
Or, start looking for a cheaper bed that accepts Medicaid and move mom there.
Sorry to have to say, self-pay facilities are under no obligation to accept Medicaid or Medicaid pending clients. Nor are they required to accept a lower monthly invoice because of asset/income limits applied by Medicaid.
Thank you both for your answers.
So perhaps I wasn't clear in my original question (most likely) . . . She is currently at the nursing home now, as a resident. She started as a rehab patient.
After 2 months of self payment - the business manager started our Medicaid paperwork. She received every single item she requested plus some.
She is telling me that because, after reviewing bank statements - the BEGINNING BALANCE of her November checking account was slightly over $2,000 - we must self pay for November, and won't go into "Medicaid pending" until December. (the balance at the end of November was $59 side note)
I guess where i am confused is . . . if you don't have enough money in checking to self pay $7,500 - but you have slightly over $2,000 on that FIRST day of the statement period - then my hands are totally tied. I don't have the money to pay them or I wouldn't have asked them to move forward with the Medicaid stuff. I couldn't submit paperwork and start the process of Medicaid prior to November bc we had to spend down some of her money. I didn't realize that on the exact day of XYZ if her balance was showing $2,320 they'd refuse to even submit the paperwork into a pending status for November.
I guess my point is - there CLEARLY wasn't enough money to self pay, yet we had HAD to start the Medicaid process at that point and they are taking the balance on 1 day and refusing to move forward with it, demanding self pay. It makes no sense.
You can't have both the money to self pay and be under the asset limit. What am I missing?