Dad passed on 1/3 after being in SNF since last June. He was recently approved for Medicaid and SNF says our amt due is not prorated for Jan
They said Medicaid does not pro-rate which is upsetting since my mother, surviving spouse has small SS income until we can apply for his benefit. Anyone have any experience in state of NJ?
Your question illustrates the value of hiring an Elder Law Attorney to promptly plan and prepare the application for Medicaid Long Term Care.
It's true, as the nursing home told you, that the monthly Patient Paid Amount ("PPA") stays the same no matter how many (or how few) days the resident was in the skilled nursing home facility. But that's only part of the story when it comes to your father's income (which determines his Patient Paid Amount).
Your question indicates that your mother has little income, and that makes her entitled to keep a Minimum Monthly Maintenance Needs Allowance (Minimum MMNA) from your father's income. The monthly minimum, with no questions asked, is $2,113.75 9 (through June 30, 2020, when it gets a COLA raise).
If your mother's housing and heat expenses are higher, there is Maximum Monthly Maintenance Needs Allowance (Maximum MMNA) of $3,160.50 that could allow her to keep even more of your father's income.
A spouse can keep even more than that upper limit if the healthy spouse shows exceptional circumstances at a Fair Hearing proceeding.
Ask the person who prepared the application to explain how these allowances fit into your parents' case, and your father's PPA.
We did have an elder attorney apply for Medicaid for my father - he is unaware of the amount payable for the month of January with my father having only lived there for three days. I am awaiting a response directly from the NJ Division that handled the Medicaid approval. In the meantime my mother only can keep the spousal allowance for January as all other income now ceases since his death. So the amount she has to pay the nursing home for January will be confirmed by Medicaid hopefully next week.
First sorry on the loss of your dad and your having to deal with the minutia of after death stuff. But better you than mom, get a binder going as there will inevitably be other issues.....
on Medicaid, each states administration of it is unique even tho’ it’s a joint federal and state program. So what’s what for TX may not be the same for NJ. That being said for TX Medicaid (my mom) all NH Medicaid costs were prorated. State paid a daily room & board rate to the NH based on if alive at a set time each AM. The required resident copay to the NH of their monthly income (for my mom it was SS and a federal civil service retirement) was the same # of days that state paid the facility.
I’d suggest that you do a prorated payment for Jan. And send it via certified mail along with the green returned registered card to the NH. If his eligibility was all just done, there's likely to be a flurry of statements incorrect and correct for the next couple of months from NH, Medicaid and Medicare. File in that new binder.
Should the NH get all huffy with mom or you, then you or whomever named in dads will to be his executor (even if you all don’t open probate) can do another certified/ RRM duet to NH that this is a debt of his estate and that as such will need to be presented or filed as a debt or claim on his estate as per probate rules for NJ and that probate is anticipated to be filed in the future and that any & all contact or communications must be in writing to the address on this letter. Btw that green RRM card requires a date & signature, so it’s considered “legal”. It gets mailed back to you and yep, it goes into that binder. Duet costs like $8.00 at USPS & well worth doing imho.
The NH is gonna be all proactive right now as they know that unless they scare $ out of you all now, it’s not gonna happen later on. If dad was on Medicaid there was little or no $, even if your mom was the “community spouse”. There’s not gonna be $$$.
Did dad have any funds in the at the NH trust account? Also called the personal needs account? If so, the NH should send that balance to your mom or whomever was on file as the main signature on it. In theory they cannot hold it. Although that often is not the case.
Regarding SSA, they know your dad has died. The switch over from him & his payout AND mom & her payout in my experience is done by SSA pretty well automatically. They are already in the system. Should happen without you all having to do anything within 3-5 weeks.
Now dad as he lived to the 3rd of the month, should be able to keep the full old regular amount he got paid for in the Jan 2020 check. Ditto for mom. (why? Cause they both are actually payment for Dec, 2019). But if come Feb, 2020 and they still both get a check, then those will get a full clawback by SSA. So you kinda need to keep enough $ in bank account to cover a full clawback if both $ comes in Feb. I bet it doesn’t happen as he died early in this month and SSA is pretty fast on doing the surviving spouse switch so mom will likely get a new check based on her being a surviving spouse for Feb 2020.
also SSA pays a 1 time burial cost if there is a surviving spouse. It’s about $250. I’d monitor her bank account that gets her SSA direct deposit to see when it comes in. If she gets it this month, then everything else should flow automatically for her surviving spouse $ come Feb.
Thank you for your condolences and advice. I am aware of SSA being for December benefit and was told by them that we have to apply for my father’s benefit that it is not automatic (first available date is not until March 10). I plan on speaking to our congressman to see if this can be expedited because it will still take possibly another month for her to receive Dads benefit after the application. Regarding the NH they still owe my mother over $5,400 for money we paid out after Medicaid was approved and retroactive back to October. Yes we are still waiting over one month now, but we were told by them it would take 3-4 weeks. The business manager at NH did tell me if we wanted to hold on to the payment until we received the money owed that was fine. So for now that is our plan, but I will be contacting Medicaid in our state to see if they do not prorate the payments. There is no money in my father’s estate as everything was spent on NH and then remainder on spend down before application. Also we did not set it up for NH to hold his personal needs funds so there is nothing owed back on that. So the balance (if indeed the money is prorated) would possibly go back to the state. I’m not sure I understand why NH would say that Medicaid does not prorate as this is our cost share of money due to NH not Medicaid?? Unless this is the NH wanting to collect as much as possible from us even though my father only lived for three days in January. Even if Medicaid does not pay anything for the month of January the amount we would pay as the cost share for the full month is much more than what it would cost privately for three days. In any event I hope that this is resolved without any further issues - I would like to properly grieve my father’s passing after a long year of him being ill.
One thing you may not know any contract with NH is cancelled, closed, etc. I There should be info on how Medicaid is handled. They are probably charging for Jan, since he did not die Dec 31.
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It's true, as the nursing home told you, that the monthly Patient Paid Amount ("PPA") stays the same no matter how many (or how few) days the resident was in the skilled nursing home facility. But that's only part of the story when it comes to your father's income (which determines his Patient Paid Amount).
Your question indicates that your mother has little income, and that makes her entitled to keep a Minimum Monthly Maintenance Needs Allowance (Minimum MMNA) from your father's income. The monthly minimum, with no questions asked, is $2,113.75 9 (through June 30, 2020, when it gets a COLA raise).
https://www.medicaid.gov/sites/default/files/2020-01/ssi-and-spousal-impoverishment-standards_0.pdf
If your mother's housing and heat expenses are higher, there is Maximum Monthly Maintenance Needs Allowance (Maximum MMNA) of $3,160.50 that could allow her to keep even more of your father's income.
A spouse can keep even more than that upper limit if the healthy spouse shows exceptional circumstances at a Fair Hearing proceeding.
Ask the person who prepared the application to explain how these allowances fit into your parents' case, and your father's PPA.
on Medicaid, each states administration of it is unique even tho’ it’s a joint federal and state program. So what’s what for TX may not be the same for NJ. That being said for TX Medicaid (my mom) all NH Medicaid costs were prorated. State paid a daily room & board rate to the NH based on if alive at a set time each AM. The required resident copay to the NH of their monthly income (for my mom it was SS and a federal civil service retirement) was the same # of days that state paid the facility.
I’d suggest that you do a prorated payment for Jan. And send it via certified mail along with the green returned registered card to the NH. If his eligibility was all just done, there's likely to be a flurry of statements incorrect and correct for the next couple of months from NH, Medicaid and Medicare. File in that new binder.
Should the NH get all huffy with mom or you, then you or whomever named in dads will to be his executor (even if you all don’t open probate) can do another certified/ RRM duet to NH that this is a debt of his estate and that as such will need to be presented or filed as a debt or claim on his estate as per probate rules for NJ and that probate is anticipated to be filed in the future and that any & all contact or communications must be in writing to the address on this letter. Btw that green RRM card requires a date & signature, so it’s considered “legal”. It gets mailed back to you and yep, it goes into that binder. Duet costs like $8.00 at USPS & well worth doing imho.
The NH is gonna be all proactive right now as they know that unless they scare $ out of you all now, it’s not gonna happen later on. If dad was on Medicaid there was little or no $, even if your mom was the “community spouse”. There’s not gonna be $$$.
Did dad have any funds in the at the NH trust account? Also called the personal needs account? If so, the NH should send that balance to your mom or whomever was on file as the main signature on it. In theory they cannot hold it. Although that often is not the case.
Regarding SSA, they know your dad has died. The switch over from him & his payout AND mom & her payout in my experience is done by SSA pretty well automatically. They are already in the system. Should happen without you all having to do anything within 3-5 weeks.
Now dad as he lived to the 3rd of the month, should be able to keep the full old regular amount he got paid for in the Jan 2020 check. Ditto for mom. (why? Cause they both are actually payment for Dec, 2019).
But if come Feb, 2020 and they still both get a check, then those will get a full clawback by SSA. So you kinda need to keep enough $ in bank account to cover a full clawback if both $ comes in Feb. I bet it doesn’t happen as he died early in this month and SSA is pretty fast on doing the surviving spouse switch so mom will likely get a new check based on her being a surviving spouse for Feb 2020.
also SSA pays a 1 time burial cost if there is a surviving spouse. It’s about $250. I’d monitor her bank account that gets her SSA direct deposit to see when it comes in. If she gets it this month, then everything else should flow automatically for her surviving spouse $ come Feb.
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Im sorry about your dad.
May God grant you grieving mercies and strength during this difficult time.
Listen to Igloo, she knows what she is talking about.