How long does it take for Medicaid to begin once my mom is in the facility? This is now 5 weeks.

Contact the billing office and let them know what’s happening and that she is Medicaid approved. If a billing office knows Medicaid is on the way they should work with you. Start a notebook to record the date, the offices you contact, any information you get as well as the name of the person you spoke with. Start being proactive and call with questions. The billing office at the facility my brother is in had a link to Medicaid and knew what was happening. Sometimes the bill goes out while things are in process. I’ve gotten medical bills before the insurance paid. I was told to ignore the bill. Call and ask, ask, ask both Medicaid and the billing office. Hearing from you makes a difference and I’ve always asked them to make note of the conversation which they all do.

It can take a long time for approval. I’m waiting now as well for approval for my husband. My husband was admitted to the facility on December 13 and I still am waiting for approval from Medicaid. I received a bill for $12,000 from the facility and I do not have that kind of money. I called the facilities billing office and they are aware that he has Medicaid pending and told me it’s OK to wait until I know the exact amount that I will be responsible for from his income before I make a Payment. I agree it’s very stressful and also I am very worried about making the payments and worried how I will afford it but the goal is to take care of the patient and not leave the family in poverty so I feel confident with that. Call the facility talk to someone in the billing office and tell them of your concerns. Good luck to you and I hope my good luck is coming as well.

It took 4 months and an elder care attorney to get moms Medicaid to go through. Meanwhile the bill accumulated to 37,000. After paying for the elder care attorney ( one bank repeatedly refused to give us the needed bank statements) she was left with 6,000 in her checking account. Once finally Medicaid was approved her end balance she was responsible for was 7500. No one mentioned to me I should or could have been paying over her SS check every month. Well even so, there would not have been enough money. Once Medicaid finally went through it was retroactive back to the date she was first admitted four months prior. The financial lady asked me how much money mom had in her checking account (6000) to pay her balance she was responsible for. When I told her what moms balance was she said not to clear out moms account. To just pay what I could. I was told originally the family would NEVER be responsible for our mothers debts. ( I think some states laws differ. I read Pa could but rarely never goes after families for nursing home debt) Mom will get a monthly bill it seems, and it appears my mother will always be one social security check behind in what she owes.

oh and a word of advice: I got bills from ambulance, doctors, hospitals, etc., during that 4 months that I paid while mom was in the nursing home ( initially she had collapsed at home with at UTI and has dementia) and I dutifully paid the bills out of moms checking account. Otherwise her being threatened with “collections”. But once Medicaid went through Medicaid would have paid all these things retroactively back to August 30 of last year. So now I have to try to retrieve all these funds back from where I paid them. One is for $1500!! No one told me NOT to pay these bills. Now she sure could use this money back in her account. After paying her latest bill she is responsible to to the home she is left with $500. And I don’t intend to let it get below that in case she needs anything personal like clothing, etc.

Lisa2020: Please get in touch with your mother's Medicaid case worker.

One thing to keep in mind is that Medicaid is administered uniquely by ea State but under an overall oversight by the feds via CMS (centers for Medicare & Medicaid). CMS is the endpoint for both M&Ms. CMS is who send out that forest of paperwork on a regular basis showing what services MediCARE paid for & copay, if any. But Medicaid runs on whatever system it’s State figures is necessary. Medicaids interaction w CMS imo is all about each State getting their $ from feds.

I’ve dealt w LTC Medicaid in some shape or form btw my late mom & MIL in 3 states and other than a mo billing from the NH got no other accounting from Medicaid until the after death supposed tally that MERP / Medicaid estate recovery sends out. I’m kinda surprised that there hasn’t been a class action on this, but then the class would be dead by the time a hearing happened, rotflmao.

But I digress… Your states LTC Medicaid will pay a predetermined rate for daily room & board. Could be as low as $150 & as high as over $300 (Alaska). R&B $ is a fixed amount. NH have to do a “butts in bed” count ea day, much like public schools do to get their per student $ from state education agency. The resident on LTC Medicaid is required to do copay of their income to the facility ea mo based on mo income paid 2 them..
HOWEVER
until LTC applicant actually clears their Medicaid eligibility just what the NH can actually require a resident to do on the copay depends on your states laws. Some states allow NH to require applicant to go ahead & do the copay of almost all their mo income less whatever State has set as it’s PNA / personal needs allowance. Other states laws r so that the applicant cannot be required to have to actually do the copay…. it’s a technicality as you can’t force someone to pay on something that they are not yet enrolled into. So their income from SS & other retirements build up in their checking account till Medicaid clears, and then all that $ less PNA is due in full. This poses risk for a NH as really if family spend the $ it’s going to be difficult & debt collection route to get them to pay. If elder dies, means chasing a claim in probate as well.

To deal this a NH will tout to the elder, POA, family as how much easier / simpler yada yada it is for them to let NH to become the representative payee for their SSA, retirements, etc & NH has paperwork all ready for a quick signature. When I was looking at facilities, more than 1 told me that the representative payee just had to be done… that it was required by Medicaid…., and that friends is pure BS. It may be simpler but it has drawbacks. It is up to POA to determine if it is in fact is the best route. I did not do this for my mom…. every mo on the 3rd a check was mailed or delivered to the NH to the penny as per moms Medicaid eligibility letter. Her $60 PNA built up in her checking account & never ever went over $1600 and separately she had a PNA opened at the NH to pay for beauty shoppe & canteen buys which I keep at 100/250. When within 1st year I was able to move mom to another eons better NH, no issue to pay NH1 their exact $ due for a few days & new NH2 the rest. There was no way that NH1 - beyond inept business office - was ever going to do paperwork & payment needed to recoup any income overpayment or send a ck for PNA balance. So not going rep payee route worked well for our situation.

All paperwork at both were signed by me as DPOA. NH ime really cannot force you to personally sign a financial responsibility contract. But they will heavily imply they can. Now if payments r late or go NSF, NH can ask APS to open a case file on POA. You don’t want to go there…

PNA varies by state from $35 to $120 or whatever Minnesota does (highest PNA). $50 or 60 avg. Please realize that PNA is it for $ once on individual LTC Medicaid. There will be things u just pay out of pocket for your LO.

Scroll down to "Do you have questions" section: https://www.usa.gov/medicaid

I didn't understand that when my husband went into the nursing home that I should have changed the recipient if his social security over to the facility. I kept asking them about a bill but they didn't advise me to do this either and told me not to worry. When I finally got a bill it was for $48000. I freaked. We applied for medical assistance and that brought it down to$16000 and I got no further bills. I had a good job, praise God but it took me 5 years to pay it up, and he'd died in the meantime.

Check the Medicaid approval letter, it should list the retroactive date to her admittance. The facility will file with Medicaid after Medicare allowance is applied. Regardless, you are not liable. Qualifying for Medicaid confirms she has no assets.

My father has been in a NH for a year, and they take nothing out for him it's crazy. I have talked to them plenty of times about this, but no one does anything. I let my dad's money just add up until they come after me some day.

This is great information. My mom was admitted to NH as "Medicaid Pending". Does this mean I should expect to see a bill for services? Should I make the partial payment using her SS funds? (it is in a QIT that I am in charge of making a payment from ).

Thanks for asking the question and all the answers!

My question is when did you place Mom into a Nursing facility? Did you or the NH receive a formal letter saying that Medicaid was approved? If so, the dates that Medicaid starts should be on that letter. It will say "starting from date...". You should be giving the NH Moms SS and any pension she receives to offset the cost of her care for every month she has been there. I allowed the NH to be payee for Moms SS and pension. Medicaid does not get this money, the NH does.

My Mom paid privately for 2 months. I received a letter saying Medicaid would start the 3rd month on the 1st. At that point, I did not worry how the NH got paid. It was between them, Medicaid, SS and the company holding Moms pension. I was out of the picture at that point. So the answer to your question is...Medicaid for Mom starts on the date specified on the letter. For my Mom it was July 1st. When Medicaid pays, is another story. But that has no effect on you. Now they have a letter of approval, Moms account should show the adjustment. All you need to worry about is making sure that SS and any pension gets to them ASAP. Thats moms share of the cost. You are not responsible for Moms care. Never pay anymore than the amount of Moms SS and pension if she receives any. She has no money to pay. If you have a balance from the spend down, that is her money to be used on her not on the cost of care.

Mystery is correct concerning NH pharmacies. They are offsight. Actually pharmacies like we go to. So yes, they are entitled to their money. But, they should have been given the residents insurance info to bill. I think, that any out of pocket you incur for Mom concerning prescriptions , Medicaid allows you to be reimbursed for. But you must send them proof. My nephew was applying for Medicaid for health. Once he received it, I am sure any prescription he purchased 30 days prior to his start date, I was able to get reimbursed. That may have been doctors too.

So, at this point disregard the 15k. Usually billing is computerized. At the end of the month a button is pushed and statements printed. If billing is done offsight, those people have no idea that ur Medicaid pending. So they get mailed out.

Thanks to each of you for answering....I feel at times I'm walking blindly. Grateful for your help.
Lisa in Alabama

This is very intimidating to get a bill that large - I agree. I got them too and paid what was possible from our loved one's funds - not my own funds - until Medicaid was approved. Once it's approved, it's just a matter of renewing it each year. Renewing is child's play compared to the application process. I'll throw this out there too: The room/care bill was plain scary but the most aggressive collection efforts were from the pharmacy. The nursing home has an outside (out of town and out of state) company that provides meds and bills for them. This company did not want to hear Medicaid is pending. Kept billing for thousands of dollars and even went so far as to change the name on the bill to MY name. I have never lived in nor received any kind of care from a nursing home. I am not sure legally HOW this pharmacy could suddenly put my name on this bill. Did they think I'd suddenly panic and pay it off? Probably. I reported it to the business office at the nursing home and was advised by them that they are switching to another pharmacy service due to the unscrupulous practices of the current one. I never heard another word from that pharmacy. Just mentioning this in case this happens to you. As far as I know, pharmacy still doing business (presumably in the same manner). I don't think we can name companies here on the forum - otherwise I would. Thought the nursing home bill would be the only one I'd get and THAT was scary enough as it was. The pharmacy bill (and the aggressive nature of it) about sent me over the edge. Communication is key. Whoever is handling the pending Medicaid application needs to be someone with whom you have a good (if not downright friendly) relationship. Help this person to help you. It will get better.

It is your moms bill, it is not your bill. Say it aloud over & over.

so if mom applied for LTC Medicaid, her application and whatever supporting documentation the state requires (like bank statements, her awards letter from SSA that Indicate to the penny what SS pays her as mo income) is undergoing a review by the Medicaid caseworker. Its processing - in theory - takes 90 days. For my mom it was 5.5 months and the NH did send me a monthly “bill” and a 30 Day Notice at the start of month 5….. it’s just standard practice sent to the POA or closest family member. But again it’s not your bill, it’s your moms.

If your mom went in as Medicaid Pending and she has signed over her SS$ to the NH as moms representative payee it’s just a matter of waiting for the application to be processed. Once processed the NH will be paid retroactively to the date of the application.

Take Barb’s suggestion and contact the caseworker directly. The billing department should have the caseworker contact info. You want to make sure that whatever documents needed Medicaid has. It will work out!

Whatever you do, do not pay any portion of that bill from your own funds!!!

Did you apply for Medicaid for your mom? If you did so, you were probably assigned a caseworker. That's who you call.

Otherwise, call your County social services department to follow up on her application.

Was she admitted to the NH "Medicaid Pending"? Have you spoken to the NH business office about how long it usually takes for Medicaid to kick in?

Medicaid should be approved retroactively. Go to the facilities finance director or accounting manager and ask why the bill was sent. Regardless, you are not responsible, and they can't collect from an estate that has been spent down for Medicaid approval, so I wouldn't worry about it too much.