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I've paid $10,000 per month for this 8 month period to asisted living facility. Do I recover from the assisted living facility what I paid for those 8 months? If so approx how long does it take to recover? This is in New Jersey.
I get that the OP paid out of pocket for his Moms care thinking that Medicaid would reimburse him. If it had been Medicaid pending, OP should have not paid anything. Just turned Moms SS and any pension over to the LTC facility. Medicaid would have reimbursed the home for those 8 months.
My Mom had a house, I was told by the Medicaid caseworker, any money I paid out of pocket he could not guarantee I would be reimbursed for when the house sold. Even if I kept good records. I have a feeling the facility helped with the application and there was some miscommunication.
Igloo, NJ allows 90 days from date of application to spend down, get info need to caseworker and find a place. Its my understanding, if these are not done within the 90days, the application has to be reapplied for. I mentioned I applied in 2017, before COVID. Things may have changed in how long it takes to be approved, now. But, even so, 8 months is a long time.
For TX & LA, it was for us not filed until they were actually in the NH and considered a long term care resident for bed status. So, if they went in on rehab, the day after they stopped “progressing” in rehab the next day was the LTC date. Application tended to run 4 months WITH the review for being “at need” medically to be cleared first and that could take a week or maybe 4-8 weeks if an issue, but the financial done in 90 days. This was quite a bit ago and I’m sure by now its all done even faster as based on SSN, address, TALX, IRS matching. It’s just a few keystrokes.
So was this an application for LTC Medicaid for SNF/NH? or was this for a LTC Medicaid waiver as it was for AL or MC? The waiver program can have a period of self pay either by a period of time or till a Medicaid bed is open. If so, that $ is not reimbursed. That is something for you to clearly find out about.
The date of entry into NH & the date of filing of the LTC Medicaid application is not necessarily start date of Medicaid eligibility. Start date of eligibility is what matters. The eligibility Notice NJ Medicaid sent to her or you as POA, I would think should state this and also state to the penny what your moms Share of Cost expected of her to pay the facility each and every month as of that date.
If there was any transfer penalty attached to her eligibility, the # of days of ineligibility would have to be private pay till penalty period over. Could this be what happened? Penalty period $ not reimbursed.
As others have posted, 8 months that a really long time for an applicant to be in a queue. I don’t know what NJ does but most States tend to do 3 months on retro payments of custodial care day rates paid by LTC Medicaid to the facility, unless extenuating circumstances. You can ask the billing office as to the exact date, they started getting their room & board day rate from the State. It should be the same date, your mom became LTC eligible.
During the application being processed period, the resident should be there as “Medicaid Pending” status. Was this done? And while “Pending”, she is required to do a Share of Cost paid to the NH of her monthly income (like SSA $) less a smallish Personal Allowance (maybe $50/$75 a mo). Did she do this? That is all that is expected from her while “Pending. If she wasn’t there under Medicaid Pending status, then she was full tilt private pay and no reimbursement.
There is information that you provided that isn't making sense. The payment to the facility during the Medicaid pending phase from July 2024 to February 2025 should only be your mothers income unless the time period was to reach the two year self pay mark some states require to be eligible for Medicaid assisted living. Or has your mother been approved for Medicaid long term care and she is now going to move from assisted living facility to the long-term care facility. Can you clarify?
No, you don't recover your money. You go into ALF and you pay for that as long as you have funds to pay. When you can no longer pay you apply for governmental help under the Medicaid program, a taxpayer funded program to help those who have run out of money while they still need care.
So basically you paid for your care while you could. Now the Government will help you in paying for your care. If your current ALF accepts Medicaid payment then you will be allowed to stay where you are. If, however, they are a private-pay only place, you may need to move to another facility that does accept Medicaid.
I wish you the very best going forward, and hope you have help in managing your assets and paying you bills, as well as making applications for Medicaid. Good luck!
That is a long time for Medicaid approval. I live in NJ and they only give 90 days to get them all info needed and to spend down. I started my Moms application in April of 2017. She paid May and June privately which spent her down. June I confirmed with her caseworker that she was spent down and all info was in and July her Medicaid was approved. Did you allow the Nursing Home to apply for you? If they held up the application, you may be able to sue.
Not sure if you can get reimbursed. The retro the NH receives is because they cared for the person for free, sort of, until Medicaid kicked in. People on Medicaid pending are asked to hand over their Social Security and any pensions they receive to offset their care. This continues, too, once on Medicaid. Medicaid does not pay that 10k a month. After 3 months on Medicaid before her passing, my Mom owed recovery less than 6k.
You may want to talk to a Elder Lawyer to see if anything can be done but I doubt it. You voluntarily paid for Moms stay. If Mom has a house, you may be able to get reimbursed from the sale of it. But you need an Elder Lawyer to help you get that money back. Medicaid is not too great about reimbursements.
First, 8 months seems like a very long time to wait for approval after the application is in. Did you have to provide extra information during this time so the application was not considered complete until all the required documents were received?
Second, why were you paying at all? Facilities will accept someone in "Medicaid pending" status and get reimbursed once the application is accepted. I'm sure they were more than happy for you to pay at the full private pay daily rate, because the Medicaid allowable rate is lower. When Medicaid reimburses them, it will be at their rate, not what you paid privately, so don't expect to get back $10,000/month. And Medicaid only pays the difference between what your mother is expected to pay and what their allowable rate is. So, for example, if Medicaid's allowable rate is $8,000/month and your mom has $2000 in social security, she would pay $1950/month (if personal needs allowance is $50) as her share of cost and Medicaid would pay the balance, i.e. $6,050. [These are totally hypothetical numbers, just to give you an idea how it's figured.]
Third, during this time did your mother pay nothing? Her monthly income (social security, pension, etc.) should have been being paid to the nursing home. Did you choose to foot the whole bill? If so, what happened to the $$ she received during this time from Social Security, etc.?
Not all facilities automatically reimburse family members for payments made while Medicaid is pending. Some may allow for reimbursement once the Medicaid retroactive payments come through, but this would depend on their specific billing policies. Did you clarify this with the AL place in advance? It's a process between you and them, not between you and N.J. Medicaid.
Third-Party Payments: If you or someone else pays on behalf of your mother while Medicaid is pending, some nursing homes might apply these payments toward your mother's balance once Medicaid starts covering the costs. However, there may be paperwork and procedural steps
Normally Medicaid eligibility and payments are retroactive to the date of application. However, If you had the ability to pay $80,000, you had assets that were above the level allowed for Medicaid eligibility. Those payments would be counted as part of the spend down to get you to the asset level allowed in New Jersey, which is just $2,000. You would not be able to get back the $80,000 paid. Going forward, if your assets stay at or below $2,000 and your income is within the Medicaid-allowable level, Medicaid will pay the AL any amounts that are not covered by your share of cost that you pay to the AL. Your share of cost will be your entire monthly income, less a small "personal needs" allowance that you can keep.
So sorry for misunderstanding. My mother is in assisted living and I, her son, have been paying, not her. She has nothing so only way she was going to get in is if I paid. Still would appreciate your advice.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
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APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
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APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
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If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
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This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
My Mom had a house, I was told by the Medicaid caseworker, any money I paid out of pocket he could not guarantee I would be reimbursed for when the house sold. Even if I kept good records. I have a feeling the facility helped with the application and there was some miscommunication.
Igloo, NJ allows 90 days from date of application to spend down, get info need to caseworker and find a place. Its my understanding, if these are not done within the 90days, the application has to be reapplied for. I mentioned I applied in 2017, before COVID. Things may have changed in how long it takes to be approved, now. But, even so, 8 months is a long time.
The date of entry into NH & the date of filing of the LTC Medicaid application is not necessarily start date of Medicaid eligibility. Start date of eligibility is what matters. The eligibility Notice NJ Medicaid sent to her or you as POA, I would think should state this and also state to the penny what your moms Share of Cost expected of her to pay the facility each and every month as of that date.
If there was any transfer penalty attached to her eligibility, the # of days of ineligibility would have to be private pay till penalty period over. Could this be what happened? Penalty period $ not reimbursed.
As others have posted, 8 months that a really long time for an applicant to be in a queue. I don’t know what NJ does but most States tend to do 3 months on retro payments of custodial care day rates paid by LTC Medicaid to the facility, unless extenuating circumstances. You can ask the billing office as to the exact date, they started getting their room & board day rate from the State. It should be the same date, your mom became LTC eligible.
During the application being processed period, the resident should be there as “Medicaid Pending” status. Was this done? And while “Pending”, she is required to do a Share of Cost paid to the NH of her monthly income (like SSA $) less a smallish Personal Allowance (maybe $50/$75 a mo). Did she do this? That is all that is expected from her while “Pending. If she wasn’t there under Medicaid Pending status, then she was full tilt private pay and no reimbursement.
You go into ALF and you pay for that as long as you have funds to pay.
When you can no longer pay you apply for governmental help under the Medicaid program, a taxpayer funded program to help those who have run out of money while they still need care.
So basically you paid for your care while you could. Now the Government will help you in paying for your care. If your current ALF accepts Medicaid payment then you will be allowed to stay where you are. If, however, they are a private-pay only place, you may need to move to another facility that does accept Medicaid.
I wish you the very best going forward, and hope you have help in managing your assets and paying you bills, as well as making applications for Medicaid. Good luck!
Not sure if you can get reimbursed. The retro the NH receives is because they cared for the person for free, sort of, until Medicaid kicked in. People on Medicaid pending are asked to hand over their Social Security and any pensions they receive to offset their care. This continues, too, once on Medicaid. Medicaid does not pay that 10k a month. After 3 months on Medicaid before her passing, my Mom owed recovery less than 6k.
You may want to talk to a Elder Lawyer to see if anything can be done but I doubt it. You voluntarily paid for Moms stay. If Mom has a house, you may be able to get reimbursed from the sale of it. But you need an Elder Lawyer to help you get that money back. Medicaid is not too great about reimbursements.
Second, why were you paying at all? Facilities will accept someone in "Medicaid pending" status and get reimbursed once the application is accepted. I'm sure they were more than happy for you to pay at the full private pay daily rate, because the Medicaid allowable rate is lower. When Medicaid reimburses them, it will be at their rate, not what you paid privately, so don't expect to get back $10,000/month. And Medicaid only pays the difference between what your mother is expected to pay and what their allowable rate is. So, for example, if Medicaid's allowable rate is $8,000/month and your mom has $2000 in social security, she would pay $1950/month (if personal needs allowance is $50) as her share of cost and Medicaid would pay the balance, i.e. $6,050. [These are totally hypothetical numbers, just to give you an idea how it's figured.]
Third, during this time did your mother pay nothing? Her monthly income (social security, pension, etc.) should have been being paid to the nursing home. Did you choose to foot the whole bill? If so, what happened to the $$ she received during this time from Social Security, etc.?
Not all facilities automatically reimburse family members for payments made while Medicaid is pending. Some may allow for reimbursement once the Medicaid retroactive payments come through, but this would depend on their specific billing policies. Did you clarify this with the AL place in advance? It's a process between you and them, not between you and N.J. Medicaid.
Third-Party Payments: If you or someone else pays on behalf of your mother while Medicaid is pending, some nursing homes might apply these payments toward your mother's balance once Medicaid starts covering the costs. However, there may be paperwork and procedural steps