When a Medicaid patient is transferred mid-month from one nursing home to another, do they have to pay the full month at each facility?

NH is billing you? Or Medicaid?

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.

Check to see what the contract says -
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.

Look for a lawyer who may not charge for his/her services.

Tadpole711: The state of Maryland pays by the care day as it relates to Medicaid. You, personally, should never be billed as it applies to your mother's health.

Mid month, my mother was moved from assisted living to nursing care in the same facility. We were billed for a full month in each room. I talked with the management and, after many negotiations, it was agreed that we pay a daily rate for two weeks in each room. After she passed a year later, we were charged for late fees for not paying the full amount for each room. At that point, I paid the bill just to be done with it. The facility is in the business to make money and usually they win any dispute. As family, you are vulnerable to emotions which influence decisions and the facilities are fully aware so they exploit that. If you are tenacious, you may win. I was not; I was tired.

Tadpole, I moved my mom who was on LTC Medicaid in TX from Nh #1 to Nh #2 right after the beginning of the month. Each NH was paid to the penny exact copay for the # of days for each for the new month. $ amount of the copay was based on application approval letter from State of Tx LTC Medicaid which indicated exact monthly copay $ required based on moms income. Move was specifically timed to be right after 4th of the month as mom got SS income paid on the 3rd and a federal civil service annuity paid the 3rd or 4th. Both were still being deposited into her old checking account. NH #1 was NOT her representative payee for her SS income nor for her annuity. NH#1 only had a small trust account under $200 for moms on site beauty shoppe visits.

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.

If your Mom is on Medicaid, she has no money. You are not responsible for her bills.

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.

It looks like Maryland Medicaid pays by the care day, “not including the day of discharge…” (page 6)

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.