Will mom be able to keep the same doctors when she is on Medicaid? How are copays covered?

More than likely, yes, she may have to change her providers as many physicians these days do not take Medicaid. Sad but true. Many are also opting out of Medicare as well as reimbursement rates are low and the provider may feel the ppwk involved to file for a menial reimbursement rate is not worth the staff’s time.

If you have time, place a call to her current providers & inquire whether they will accept Medicaid in preparation for when your mother has been approved. This may give you a little insight on the challenges you may face once she is Medicaid.

It is up to the facilities and doctors whether they will accept Medicaid.

Medicaid does not pay for assisted living in my state at all.

Here in California, medi-cal recipients still sometimes have a very small co-pay for some medications ($1-2) that would need to be paid out of their small stipend. There should not be any copays for MD visits, if your doctor accepts both medi-care and medicaid. Some doctors dont want to take the medicaid, and in that case, she would have to pay the 20% co-insurance out of pocket. It's best to find MD who takes both. In my area, you can sign over the medicaid and/or medicare to an HMO. It works out good, because doctors like to contract with them much more than with medicaid and there would be way less copays to have to pay. If you have these plans in your area, I'd call the MD offices to see if they contract with any of them.

Before your mom applies for Medicaid, please get her appointments with all her MDs both to have as much done before she goes onto only being able to use Medicaid participating MD (so have everything as current as possible), and clearly ask each IF they take Medicaid.

I’ve found internal medicine and family medicine doc’s are more likely to take Medicaid. It’s specialist - ophthalmologist or gastroenterologist- who don’t and there will be just a few who do and those usually affiliated with a health science center / teaching hospital system so getting appointments require months ahead for scheduling.

Like see her ophthalmologist and get new Eyeglass prescription. For this one ask if they can write it withOUT a date on the script. Otherwise it expires within a year of its being written. Eyewear is apt at going MIA at facilities. So you kinda want to be able to deal with this ahead of that curve & cliff in the road.

Also speak with the DON (director of nursing) at your mom’s AL. They are going to know who the docs are who other Medicaid/ Medicare residents utilize. There likely will be a existing primary MD for the AL. If they take the M&Ms, it might be worthwhile to go ahead & now move mom over to having them be her primary care provider.

I’ve found physicians totally understand and are equally aghast at dealing with health insurance issues. If you can be organized in your review of mom’s past medical history to tell them what the near future problem or repeat tests/labs will be for your mom, they -ahem - can show need so that testing or lab work is to be done ahead of schedule for her that’s all billed to her current insurances so that she’s updated for care needs. Like she gets colonoscopy done, gets full bloodwork panel done, sees audiologist, etc. All this done like in a 3 -4 mo span before she runs out of $ & applies for Medicaid. Yeah you’ll be busy taking her, but we’ll worth it as she’s be tippy top current.

If she has dental insurance or needs dental done, try to get those done too. Even if her dental is private pay. As sometimes the work that is needed may actually need to be done by an oral surgeon and some are both DDS/DMD and an MD, so can be paid partially by her insurance.

LisaTorres, find out how the nursing home handles this. When my Mom moved to a nursing home, she could only use the "house" doctor who was assigned to that nursing home. My Mom was self-pay, so I assume the same would be for those who need the benefits of Medicaid.

Yes, Mom will have to use Medicaid doctors for her care.

It looks like to me, if Mom is getting a stipend then she will have no money other than the $50 or so they allow her from her SS check. Her SS will go towards her care with Medicaid paying the balance.

Her stipend is not for her to pay copays. Its for her personal needs. Hair done, toiletries, etc. I doubt if she will have any copays or prescription costs. Medicaid will pay everything because...SHE has no money. You are not responsible to pay her medical bills. What Medicare doesn't pick up, Medicaid will. She will get Vision and Dental and scripts. But for Medicaid to pay, she must use their doctors. A doctor not excepting Medicaid cannot bill a Medicaid recipient. I was told this when my Nephew was going to a neurologist. My nephew had gotten Medicaid help. Dr did not except Medicaid. I was going to private pay and was told that was not allow. We had to find another neurologist in Medicaid Network.

The only way u may be able to keep her doctors is if they agree to just except what Medicare pays. I don't think legally they are allowed to bill a medicaid recipient for the balance.