I'm being double billed for my mom's nursing care. She was transferred from one nursing home to another in the middle of the month. Each nursing home is billing me for a full month when she was only in each one for two weeks. Will Medicaid pay this, or will I be responsible for this with my own money? Nobody warned me about this before the transfer. I can't find anything about this in the patient rights handbook I have. Should I contact the state Medicaid agency for advice?
https://health.maryland.gov/mmcp/longtermcare/SiteAssets/SitePages/Nursing%20Facility%20Providers/NF%20Reimbursement%20Manual%20Revised%20FINAL.pdf
You wouldn’t be personally responsible for any bill unless you signed accepting that responsibility instead of signing as POA making your Mom responsible, and you the person who uses her money to pay her bills. If she has no assets, as seems likely as she is on Medicaid, you have nothing to pay with.
If the contract that you signed as POA allows them to charge for full months, I suppose that if she has a Medicaid exempt asset, like a house, they could attempt to pursue a legal claim to be repaid from the sale of that asset, (Edited to add: There may be special rules limiting the ability to collect privately in addition to billing Medicaid, but I am not familiar with them.)
As always, if you want professional advice you can rely on, consult an appropriate professional.
Did you notify Medicaid of the change. I am surprised transfer was allowed in the middle of the month. Talk to the finance office at each place and explain that Medicaid is involved. I also question how Moms SS was split midmonth. You may need to talk to Medicaid too. But again, you are not responsible for the bill.
That moms old bank account existed imho was very important. If your mom allowed for NH#1 to become her SSA rep payee - NHs really in my experience heavily lean on elderly & their families to do this - your mom will have to personally have this all changed back within SSA system to have old NH removed as a rep payee & new NH become it. Will likely not be at all simple. Why? u ask? Because SSA does not recognize POAs, tadpole, so it will probably be quite the challenge to get your mom to do this. If your mom did sign off to let old Nh become rep payee, please post an update as to this.
Another thought….. when you moved your mom was she totally approved for LTC Medicaid?? OR was she “Medicaid Pending”??
If she was “Pending” status, this could, COULD, be why, she / you are getting full tilt billing. By moving her, it could, COULD, have stopped application process as application is often tied into the NH. At least it was in my experience for my mom, my MiL (more than 1 state). NH often take the custodial care resident LTC Medicaid application along with their (the Nh) bill and submit both in tandem to caseworker assigned to that NH or that zip code. So if your mom moves out before completing her application process 100%, NH#1 stops application cold, she’s not approved…… old NH can bill for her stay at whatever rates they choose to… the new NH who ostensibly took her in on Medicaid once they find out that in fact it’s “Pending” status, they cannot easily go forward with application as initial application items are dependent on NH#1 which has zero reason to be at all cooperative. If this is at all your situation, please post an update as to this.
Whatever the situation, do you as POA have copies of admissions paperwork for ea NH? Or someone else in your family? You as POA should have this. Without this, NHs really can say that you are personally responsible for moms debts as you likely signed off somewhere something when mom got admitted to take on responsibilities on her behalf. Can the NH hold you to it? Well….. not easily but they can and will turn it over to collections and unless you know how to quickly get off those within 30 days “show how I owe this” type of letters, the debt will be validated and go into the giant maw that is debt collection system. If either NH is part of a group, they have attorneys & debt collections group on retainers to do this & do it routinely.
What I’d be on the lookout for next is a “30 Day Notice”. It will be a letter to mom & cc’d to POA notifying that mom has 30 days to settle bill, sign a financial responsibility agreement or she will be evicted. Will be cc’d also to APS & probono legal aid services in your region. All important as a CYA for the NH legally.
Have you gotten this? Check moms room to see if it’s there. It’s important so do go thru wherever it may be squirreled away. NH will not just let mom stay….. NH will find a legit way to get her out…. likely will be an ER/ED run via EMS & then NH will refuse to take her back. Fwiw the NH bills still exist & it will be challenging in part to hospital discharge planner to find a NH to take her due to her old bills.
U may want to work something out w/NH #2 & reapply 2 Medicaid if mom & you like this NH.
How mom / you get out of this will be challenging. That 1st NH really has no reason to be at all cooperative with y’all as far as forwarding any documents submitted in the initial process to the State. You need to find out just where the documents are in the application process from the State. The NH #1 can bill mom at whatever rate they want to. & it’s a valid bill. If they are only billing mom at the State LTC Medicaid room & board daily reimbursement rate consider that to be a reasonable price as they kinda could charge mom full tilt private pay day rate which would be 2X - 4X more.
Talk with admissions at NH#2 as to if mom can perhaps file a fresh LTC Medicaid application. So that she can be a fresh “Medicaid Pending” resident.
NH do NOT have to allow Pending status necessarily. They can require for family member to sign off a financial responsibility contract to be in effect just in case mom is determined ineligible. Mom - no matter what - must do a copay of basically almost all her monthly income to the NH. Copay HAS TO BE PAID.
If your mom was on another Medicaid program - health insurance, community based, etc - that does not matter. There may have been confusion on this by mom / you / admissions. LTC Medicaid for custodial care in a facility is its own program and its own system for eligibility and benefits and requirements. The NH do not have to participate in the program or can limit the # of beds available. Again, if you like this NH, I’d try to work out whatever needed so she can stay till she’s LTC Medicaid eligible.
Please please realize facilities do have “dunning” lists so once your mom goes onto one, it will be hard to find her a Medicaid bed in facility that is viewed as a better more sought after one.
I moved my mom at about month 10. So way after her application had processed & eligibility fixed. It was not so much the level of care but more the absolute cluelessness clusterF of administration & billing which was not ever going to work, plus staff & the medical director was leaving. The writing was on the wall….
Mother was in an adf for hospice - she was admitted mid-month and as such, was only charged the 2 weeks. However, on the last day of the month, she ended up back in the hospital - and passed 6 days later. Because she was still a 'resident' of the adf, and was 'expected to return to her room', not only did the adf keep the 6 days she wasn't there, but, they got to keep the entire month! All because of the fine print on page 34 of the contract that I signed as poa. When someone is entering a facility, it seems like the person who is responsible for signing all the paperwork is already stressed and then rushed through the process with a stack of like 84 pages of a contract- I mean, who has the time, on the day of admittance to sit and read every line of the 84 page contract? I know I should have, but all I wanted was to get my mother settled and comfortable. And no, they typically do not provide a copy of the contract for review prior to being admitted.
I would contact Medicaid and let them know about the bill that may come in. I would also watch her summary statements to see how it got billed and paid. It's possible Medicaid only pays a certain amount regardless how a facility bills it because it would create an overlap if either of them try to bill for full month.
When summary comes in, there should be a page in the packet to question the billing and the payment if you still have questions.