Hello! A patient (over the age of 65) was admitted into a psych facility (nervous breakdown, dementia, depression, anxiety) and stayed for approximately two months. He was financially approved for Medicaid long term care while there and then was transferred into a skilled nursing facility for rehab therapy. Since he hasn't been home (he can't live alone anymore), his POA is paying all of his bills through his bank account. Now there's extra money since he hasn't been using any of it for living expenses (food, clothing, gas, entertainment, etc.,). Should the POA make sure that the bank account is down to $2000 before he's admitted for long term stay (by spending money on the patient & keeping receipts) so he can stay Medicaid approved or does it matter since he's already approved financially?
Also, does Medicaid recoup that extra money or is the money available for the patient once he's admitted into the nursing home for long term care? The patient could use hearing aids now that he'll have help to operate them in the nursing home w/ CNA's. I appreciate any advice, thanks!
If so, that imo that opens up a whole other set of issues to deal with.
So is there a home that he owns? or has a Mortgage on?
in my experience Medicaid fully expects once they move into a LTC facility & become a LTC resident & apply for LTC Medicaid is that all monthly income needs to go towards paying for their care. What usually happens is that the NH is to be paid whatever is his monthly income less whatever his state has as It’s personal needs allowance (avg PNA is $50) So say he gets $1200 SS AND $600 pension, the NH must be paid $1750.00. The $1750 is his copay or SOC (share of cost). He gets to only keep the PNA $50 which is considered income for the month paid.
However, and this is important, under LTC Medicaid by & large they are allowed to have a max of 2k in assets. So say month 1 in LTC when he filed for LTC Medicaid, he had $1500 in a savings account that $ then becomes considered an asset by Medicaid. If each month, the $50 PNA is not spent but stays in his bank account it becomes an asset. Then in 7 months he will have $2050 in assets and be ineligible for Medicaid. He / POA has to make sure to spend $ so that he always begins and ends each month under 2k in his bank statements. The $ that’s assets is supposed to only be spent on their care and needs related to being in a LTC facility. Like new eyeglasses, hearing aids, dental care, clothing replacement are ok spends. The vibe I got from my mom’s Medicaid caseworker was that none of her asset or PNA $ was to be used for property costs, or to pay on any old debts like credit cards, or anything other than cate related stuff at the NH. Paying an existing premium on a funeral policy with the PNA seemed to be allowed.
If they insist or want to keep their home, they can by & large under Medicaid rules. But family will have to pay all property costs from day 1 of LTC Medicaid till beyond death and then deal with however Estate Recovery runs in your state. Whether or not it makes sense to do or is feasible depends on your specific situation. So if he has a home, decisions regarding the home need to be decided ASAP.
Also if he was on MediCARE, the hospitalization and the post hospitalization discharge for rehab in the NH rehab sector are both MediCARE benefits. First 20/21 days at 100% Medicare coverage. Rehab past initial goes 80% Medicare and 20% secondary insurance or private pay. The DPOA really needs to find out where he is/was for when rehab stopped. Cause after that is when the required income copay or SOC (share of cost) is to be paid. It should be Prorated to date of the switch over.
I applied for Medicaid in April. I was given to July to cash in all insurance policies and set up prefuneral arrangements. Mom paid privately for May and June which brought her under the 2k allowed. At that time, her SS and pension were handed over to the NH, they became Moms payee. Once this was done, I sent Medicaid all the info they needed and they started paying July 1, 90 days from application. If, I hadn't spent down in 90 days I would have had to reapply.
The 100 day rehab isn’t guaranteed. Rehab totally based on on if he is “progressing”. The PO, OT, ST are doing daily notes. Speak clearly with them as to where he is in rehab. I’ve been on this site over 5 years, maybe just maybe 2 or 3 or 4 posters who ever had their elder get the full 100. The daily or every other day notes into his health chart have specific measuring milestones as to “progressing”. Either it’s there or it’s not for rehab.
Really buy him him extra shoes, easy care clothing, toiletries if need be.
If he reads, get him a subscription to large print magazines. He has got to, GOT TO, begin & end his bank statements showing under 2k and once on Medicaid his monthly income going as the SOC to the facility.
Also there may may be another glitch to deal with as to his secondary insurance. If he can be on Medicaid, a secondary insurer may suspend his coverage as Medicaid can be billed instead. Like if it’s BlueCross, they can & will do a clawback of payments to vendors paid as Medicaid was available to pay as he was eligible for Medicaid. So you or dpoa need to look at whatever statements he gets from his other secondary policies as to this (clawback) happening. If so the vendors - like an independent PT who sees patients in rehab - will have to rebill to medicaid. They may not be happy as Medicaid rates seriously lower than what BCBS pays..... also clawback could be a few weeks or months later.