I was trying to sign my Mom up for Medicaid, and found out the the Nursing home did already almost 2 years ago. OIG is wanting to do a 5 year look back because I called. She never qualified before now. What do I do? Apparently Medicaid has been paying her bill in full under fraudulent terms and an illegal application since I am her POA and Guardian. Do I reapply, or do the 5 year look back. Do I let the Fraudulent one lapse, or give OIG bank statements that will just show that she didn't financially qualify? I am at such a loss. Also, can the Nursing home kick her out if she has attorney bills to pay from a divorce? She was married to a man that had a lot of money. They knew this, but signed her up anyways because he was refusing to pay them. I just don't know what to do and I can't seem to find anyone to help answer my questions.
Thanks for updating us below. So few return to do that, and it is so appreciated. Know that what you learn on your long and difficult journey can greatly benefit others who come here for help, and we would more than welcome you to stay on Forum when you have any extra time.
Good luck.
Seems to me from your responses, this NH treated Mom like she had no family. They should have realized that someone would find out. I feel for the employee because they probably just did what theyvwere told to do. I hope that Medicaid fines them big time and can get your money back for you. I hope they are not excepting any Medicaid applications coming from the NH directly.
So wish you good luck.
Would love for you to update us on how this works out, we learn from others.
Medicaid is helping, but pressing charges has proven to be very time consuming and financially horrible.
Thanks for everyone's support!
I assume she has $ still and I would use it to start self pay elsewhere. There is no sense in trying to qualify for medicaid when you know she won't at this time.
Good luck!
Let them know what proof you have.
From conversations we have had on this forum, I don't understand how the NH was able to accomplish what they did. There is a lot of info needed by Medicaid before the application can be finalized. 5 year look back is one. How were they able to get this info. Proof she has no money. Her monthly income can't be higher than the cap. Husband would need to sign that he is not financially responsible for her care.
Really sorry, but there is too much going on here for us to help. Each State Medicaid is different. Each persons finances are different.
When my mother was placed at a nursing home, I was very pregnant and traumatized. I never had a money conversation except that I was told the Nursing Home was taking care of everything. I am eternally grateful that they lifted the burden off me. Eternally grateful.
Have you checked with the Surrogate's Court to see if your guardianship is in effect? Or has the Nursing Home been granted guardianship?
The Ombudsman is new to her position, so she can only answer so many questions.
Irregular admission paperwork, so maybe no copy of POA on file, and a spouse that won’t pay the bill.
But wouldn’t the new guardian have gathered control of the income and assets that the (old?) POA has been using to pay legal bills?
Or a better idea is to have an attorney communicate with them about it.
Good luck with resolving this matter.
It took more 4 months, $10,000.00 in attorney fees, and the Illinois State Ombusdmen to even get her medical records, because they found out their computer program had a safety net, and all of their records that they thought they had deleted were still able to be retrieved.
Now as her Healthcare POA they won't even communicate with me, and I can't get another facility to take her because I'm literally in limbo with her Medicaid. I'm sorry for the long rant. I really just don't know what to do.
You need to consult with a Medicaid expert in your state. Explain why you believe she wouldn’t qualify then but should now, what you thought was happening with the billing for the two years, and give them a copy of the nursing home contract and their Medicaid application if possible. You signed the contract as POA, so you should have a copy, right?
You should also gather records for the last five years, maybe seven if salvaging the old application might be a good idea.
The nursing home won’t want to keep her if the bill isn’t being paid. If they can’t kick her out, they’ll look for a reason to send her to the ER and refuse to take her back.
Once she is on Medicaid, almost all of her income will go to pay for her care, except for a small personal needs amount for discretionary spending. Nothing will be available for house bills if she is in facility care.
I'm not sure why I need to do the 5 year look back when I can give them all of this information showing that they illegally signed her up. The insurance Medicaid care plan coordinator even filed fraud charges against them. I just don't understand or know what to do.
You might want to pass this whole thing past an elder law attorney first to see what he or she advises. This could be a mess, however it happened.
I wish you luck. I hope you will return and update us about exactly what happened and exactly what Medicaid will now want you to do to rectify the situation.
It's been an absolute nightmare. I have all the proof, but why do the 5 year look back? I know that she isn't going to qualify because of her husband's income. But she put on the application the My Mom was Never married, never owned a home, hadn't filed taxes in 5 years, and didn't own a vehicle. All of which was completely untrue, and have email back and forth about Mom's Long Term Care insurance and no payments from her husband. I even asked them once about Medicaid qualifications once they got divorced and they said that we could discuss how to get her signed up them. SHE ALREADY WAS. Now I can't move her and OIG is wanting a 5 year look back. She isn't going to qualify, and I never signed a single document, and neither did my Mom.
Do I just tell OIG there's no reason for the financial look back and apply from the date her divorce was finalized, or what? It's such a mess.