Has anyone dealt with Medicaid and the SNF liability balance?

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J

Justrelax77 Asked June 2017

Has anyone dealt with Medicaid and the SNF liability balance?

Hello all! My mom had a stroke on March 3rd and at the end of her hospital stay and 20 days in rehab at SNF she tried living at home for a week but it was a disaster. So she was admitted to another SNF on medicaid pending for long term care. Well, after a lot of paper work she was approved. Hooray! But I'm worried she will still have a huge bill from the nursing home. Here's why; *I understand that she'll have a liability balance to pay the SNF monthly which will be her SSI and pension check minus $56 for living expenses. *However, the first month she was there (May) she still had rent at her apartment and utilities to be paid. I moved her out of her apartment as fast as I could, but the month of May had to be paid. She'll get some money back for her apartment deposit, but that will only cover a few hundred. Also, she was admitted to SNF at the end of April. Leaving three days at $216 each! OUCH! *By my calculations she's looking at a bill of around $1,000 that she will not have cash to cover. So, now what? The SNF wont be able to kick her out, but how upset will they be about the deficit? As long as she's there she will have no way to pay it back. I know I'm not legally required to pay it for her, but after the uptenth piece of mail saying "over due!" I'll probably start to develop an ulcer. (My mother is happy to turn her head to an over due bill, but I'm not!) Has anyone else gone through this? Is there anyway around it?

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score 1 · Answer 1

Glad you worked it out. At least you were not completely sideswiped.

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score 1 · Answer 2

UPDATE #1456 (Oh what a day!) The financial director of the SNF called me before I could call her and she settled my nerves. The difference is b/c my mom had a secondary insurance withdrawn from her social security check. As of July 1st the secondary insurance ends b/c medicaid and medicare will cover everything. Thus her SSI check will be higher. Also the SNF was very nice when I said she still wont be able to cover the full bill. They asked if she could make small payments from her monthly allowance to cover the deficit. That seemed fair to me. She is still very much penniless, but atleast she's safe, in a place that will allow her to recover, and hopefully she's happy.

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score 0 · Answer 3

Well, I called into Medicaid....and things got worse. Her liability for April and May is $1269 per month. AND her regular liability rate is higher than her income at $1395. I'm not understanding this at all. Her income is only $13261. How on earth is it higher??? Has anyone ever fought this system and won???

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score 0 · Answer 4

JR77, ask the Medicaid case worker if there is an exception in this case. They *may* allow payment of the bills if they were for a period that was your mother occupying the apartment as part of her "spend-down" and adjust your mother's share of cost. It really depends on the case worker, and how they apply the regs. I just wanted you to be prepared in case they play hardball. If Medicaid/NH do make your mom liable for the difference, you can ask the NH if they are willing to adjust billing since they will be getting long term care for your mother or a payment plan of say $5-10 per month from the needs allowance as she has no other funds. Worth a try. This is the hardest part of the Medicaid maze - who can pay for what when if people do the home/NH/skilled facility bounce. I am sorry that you are all working thru this.

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score 0 · Answer 5

Guestshopadmin; thanks for giving it to me straight. The only bills that were paid in May were rent, gas and electric. She was obligated to pay those and I moved her out as quickly as possible. But the truth is, that doesn't matter to Medicaid, does it? She lived month to month and had zero savings. So more than likely I'll have to cover the bill. Thanks a lot dear mom.

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score 0 · Answer 6

The days in April and May will be covered but she will be expected to cover her share of cost. That is the SSI plus pension less her personal allowance. You need to sit down with NH personnel and get your ducks in a row to document that all monies not spent paying the nursing home were spent on items directly related to your mom's care. If you had power of attorney, and you helped apply for Medicaid knowing what money was supposed to be paid to the nursing home for May, and you CHOSE to spend it on something other than the share of cost - you can cause yourself problems. Sit down with your mother's Medicaid case worker, explain the situation, and see what paperwork documentation that you need to fill out to support your case. The nursing home will expect to be paid. If they are paid "short" by Medicaid because you were expected to be paying a certain amount of your mother's income to the nursing home, it will cause you and your mother problems. Check your paperwork for your mother's intake and it will have a variety of information as to what the nursing home's rights are if they are NOT paid.

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score 0 · Answer 7

She was approved to pay retroactively all the way back to March. Any chance that means the extra days in April and May's balance would be covered?

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score 0 · Answer 8

Yes. Mom was admitted to NH Medicaid Pending. The Medicaid approval process was supposed to take 3 months. But Moms caseworker went on Maternity leave, it was a mess. The approval process took 5 months.

In my state, at the time Mom was in the approval process, once approved Medicaid would pay retroactively for 3 months. Which they did. But there were 2 months still due. All of Moms funds were spent down but thankfully we had held on to her car. We sold her car. It was just enough to cover the balance due.

Check with your Medicaid office as to the time frame Medicaid will pay retroactively once Mom is approved.

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Has anyone dealt with Medicaid and the SNF liability balance?

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