My ex-husband has Medicare and Medicaid with zero deductible. He is in a long-term care facility he entered under skilled care. Who pays?

Your ex, are you his DPOA? Or is he still competent & cognitive to deal with Medicaid status changes?

Probably something had to be filed within Medicaid to have him transition from community based Medicaid for when he was living on his own before the hospitalization to LTC in a facility Medicaid. For LTC his assets have to be under 2k, if before he had a bit of savings, he could find he’s over the nonexempt asset limit. So a quick spend down may need to be done. Probably easiest is a 8-10k funeral / burial pre-need. But imo what to do depends on just how much $ he has as an overage. Like 10k easy to spend within a week or so..... 20k+ needs more creative and that could need time.

Just how much of an issue a delay in transitions becomes a problem depends on your state and also the social worker & billing at this facility. Community based & LTC are two different Medicaid programs. Try to ask if it’s been done or if there’s something he / dpoa needs to do.

As others have said, once on LTC Medicaid, basically all his monthly income must be paid to the NH are the required by Medicaid copay or SOC (share of cost).

What I’d see as a glitch would be, say he’s discharge from post hospitalization rehab at this NH Oct 23. So Medicare stops paying 10/23. If he had say $4,567.89 in his back account in Oct, he’s over the 2k in assets for LTC Medicaid, so he’s private pay for 10/24-10/31. If in Nov, he’s still over 2k, he’s still private pay till at 2k. Then either goes onto LTC Medicaid if yourcstare has an easy way to segueway from community to LT; or for more fun... they don’t, so he has to go “Medicaid Pending” while the state approves the application for LTC Medicaid and he submits the financial documentation to show “at need” for LTC Medicaid. Yeah total butt rash, but they are two different programs under the Medicaid umbrella. Comprende?

Either way, the SOC has to get paid from whatever his monthly income is (SS, pension). Speak with billing & social worker to get clear answers as to just what may have to be done.

it may be simplest to have him stay at this NH till he absolutely has been approved for LTC Medicaid then he can move laterally to any facility that takes Medicaid and determines they can meet his care needs. I moved my mom from 1 NH to another much better one at about mo. 8 & couple mo after she cleared billing clusterF from NH#1. It can be done but it’s a bit of a ballet to get done smoothly.

If the place you like will take him unconditionally as Medicaid Pending, you might be able to move him now. Usually they should do an on site visit to do a needs assessment on him at the current NH. A word of caution, for Medicaid Pending, a facility may press upon you to sign a financial responsibility document for you to pay should Medicaid not find him eligible.

Do you mean by skilled he went from a hospital to rehab? If so, Medicare would pay 100% for only 20 days. The 21 to 100 only 50%. So he needed Medicaid at this time? When did he start his rehab? They may be entitled to some but not all.

His SS goes to the nursing home. He may not have a Medicaid deductible but if they are paying for his nursing home care, then all his income goes to the nursing home and Medicaid pays whatever is left. He doesn’t get to keep his SS. He’ll get a personal needs allowance usually $60 a month. But all his income will go to the nursing home and Medicaid pays the remaining balance.