Should I still be getting bills after my mother has been approved for Medicaid at the Nursing home?

Igloo572, thanks for the warning, but, I will never pay my mothers debts. POA ends at her death and, I am not responsible for her debts prior to her Medicaid eligibility. I have already spoken to an attorney and Medicaid Long Term Care recipients are considered indigent once they qualify and pay the Medicaid dictated portion, except for the personal care allowance of $40 for our state. My mother had no assets, except her SS and Pension, all of which is being paid to LTC facility. Medicaid became her payor of last resort when she qualified. What can the IRS take from someone who has nothing and whose money is locked in an agreement with the state Medicaid program? I have never been a responsible party on her bills. In fact, Medicaid recovery for LTC will not even go after someone with assets less than $10,000, period, if which my mother does not have. If anyone on this topic has experience of something different in a parent's financial liability going to them, please give details.

MyLife - Please be careful!!!…. although your mom can walk on her debts, there does run the possibility that the providers cannot bill Medicaid as they do not participate or do not want to take the Medicaid reimbursement rate and in either case will continue to bill your mom and will turn it over to collections. They will send letters and do phone calls to mom at the NH and to you as well if your name is listed as DPOA or as financially responsible.

NH really really don't want to have to deal with incessant debt collectors. It could morph into a reason to issue mom a "30 day notice".

But what could happen that would morph into a much stickier problem, is that the debt that mom walked on, well the provider can take it as a loss but they can issue mom a 1099-C Cancellation of Debt for the amount plus interest and fees. Any creditor can issue a 1099-C for debts written off over $ 600.00. Many companies do 1099-C routinely for any debt written off. It is reportable taxable income as the 1099-C is provided to the IRS as well. IRS fully expects taxes to be paid on this income. It is not income subject to dispute. IRS as a "super creditor" can attach mom's SS and retirement income to do so. Problem is mom is required to be paying that income to the NH as her required Medicaid SOC (share of cost) or co-pay. So someone in the family (the DPOA as they are responsible) will have to pay whatever $ to make the SOC paid in full each month otherwise mom will become ineligible for Medicaid. SSA will be sent a letter from IRS as to the seizure. Stuff like this can snowball into issues with your suitability as DPOA and mom could become ward of the state.

Really please try to work something out with providers if they do not want to or cannot bill Medicaid.

One question I have is why you are getting bills for your mother instead of the nursing home getting them? You are not responsible for paying your mother's bills, especially if the nursing home is taking her social security & any other income she may be receiving. There may be co-pays for the X-rays & doctor visits. Since she is not allowed to have more than $2,000 in assets to qualify for Medicaid, the money has to come from someplace. But that doesn't mean that you are responsible to pay for it.

Nursing homes are notorious thieves and will do anything---including lie---to the family to get more money. Medicaid is not "billing more" for her care. The only entity that is billing for her care is the LTC facility. How it works is whatever the cost of the LTC place is reduced by the amount of social security they get. Then, if your mother gets a pension, that is considered the "patient pay" portion of her care. So, for example, if the monthly cost is $7000 and your mother gets $500 in social security, that brings the cost down to $6500. If your mother gets $2,000 in pension, then she must pay $2000 toward the remaining cost of the LTC facility. Then Medicaid is billed the remainder of the costs. Medicaid doesn't "increase the billing"---whoever told you this outright lied to you. If the LTC facility knows that your mother transferred assets to her children prior to the 5 year look-back period, and they know that the children got her house, stocks, money, and other assets, they may be trying to shake you down for money. Don't let them do this. You don't have to call Medicaid---what you need to do is find out from the LTC facility's financial department how much the total cost is per month to stay there, how much Social Security she is getting & how much pension she is getting, and then find out how much they are billing Medicaid for the remainder of the costs. The only increase in cost would be from the LTC facility.

Furthermore, don't believe what is being told to you verbally. Tell the financial manager that you want to see all of the documents pertaining to your mother's income, the LTC costs & how much they are billing Medicaid. Then read the contract between the LTC facility & your mother, the LTC facility & Medicaid. As I said, they will outright lie to you to get you to pay more money----if they are not pushed into a corner and forced to produce the documents to prove their claim, they won't. Don't let them pull the wool over your eyes.

Once you get the eligibility date for Medicaid, call all providers and give them the Medicaid ID #, anything prior to the LongTerm Care eligibility effective date, tell them to forget it. Charity care, whatever. My mom has Medicare Part A and Blue Cross Federal on all Part B charges and these doctors and everyone else got a great reimbursement and her $20 coPay was all they didn't get for the last 2 months before she qualified for Medicaid and I called them all and told them to be happy about what they got from Blue Cross and Medicare and gave them her Medicaid ID for all future bills.

3boys - about the $ 820 copay or SOC. Did you dad file for CSRA or MMNA? It sounds like he is still living at home while mom is in a NH. If so he should apply to get CSRA or MMNA. Community spouse source allowance / monthly maintenance needs allowance or assesment. Think of it as alimony for the NH set. If Dad needs some of moms income to support his lifestyle in the community, then instead of all her monthly income (like her SS & retirement) going to the NH as her SOC, it can go instead to dad.
CSRA MMNA varies by state. Some have it pretty high. TX has it about $ 2,800; so in theory if mom made 3k a mo & dad got max MMNA, all the NH would get as moms SOC would be $ 200.
Financials for CS / NH Medicaid couples is somewhat complex. If dad waded through the application on his own while caregiving fir mom, well things to his benefit could have been overlooked as he was & is overwhelmed. If this could be the situation, I'd suggest you find an elder law atty to meet with you & dad to see what can be done to reset her soc before moms annual Medicaid renewal.

Now if dads own personal income is very high, he could not qualify for CSRA.

Between my mom and MIL, we dealt with abt a dz facilities and hospice providers being paid by Medicaid or Medicare. Billing issues with 1/4 of those and with a couple of places total incompetence within their business office; and with overcharging errors or private pharmacy orders totally to benefit the facility. Here's my suggestions.....
- review your moms reward letters. Those are the letters received in nov or dec from SS and any retirements that state to the penny what she will receive for the incoming year as income monthly. Her Medicare copay shoud be taken out of her SS monthly - its abt $ 105.00 for most. If she is keeping her secondary insurer, that either is paid by her directly or too is probably being deducted from either SS or retirement.
- now all states allow for a small amount to be held as their personal needs allowance. PNA varies by state from $ 35 - $ 105. For my mom in TX was $ 60.
- So with the insurance deductions & PNA, what $ left, that is her base line SOC (share of cost) or copay needed & required to be paid to the NH under Medicaid rules. Has your mom being paying her SOC each month she has been in the NH either as "Medicaid pending" or Medicaid approved?? Please pls review to make sure mom is totally good on her copay & from day 1 of her NH Medicaid application date. If not, mom needs to be caught up to be 100% on SOC either from that 2k in assets allowed or family makes up the difference.
- If mom admitted to NH from post- hospitalization rehab to NH, there often is a week where it was anticipated Medicare would pay (as its "rehab" a Medicare benefit) but that final weeks progress report doesn't show progress so it gets declined by Medicare but Medicaid wasn't billed. If so, it needs to be rebilled to Medicaid. Medicaid eligibility date may need to have a written request done to be moved back. In theory the NH should do this.... Think if this could be an issue.

- your moms secondary insurer could be part of the problem. Once mom is on Medicaid, she becomes a "dual eligible" as she is on Medicare & Medicaid. Some secondary insurers will not pay if M&M dual eligibility is there. So those payments for secondary insurance coverage should be returned or held if coverage is suspended. Often secondary insurance coverage $ deduction snafu is the source of why there is a balance due. If its looking like this, I'd suggest you as DPOA send a certified letter to the secondary insurance co asking clearly if coverage exists & if not the status of overpayments. If $ coming back, set it aside as $ may be needed to pay vendors who billed the secondary insurance (& won't get paid or get clawed back for payments made) but will not bill Medicare or Medicaid. more on this below.
- if mom entered the NH right at end of month & applied to medicaid then but saw her docs or was in hospital earlier in the month, Medicaid eligibility for some states usually is done for the whole month (& not date of NH entry). So the old secondary insurer will deny all claims for the whole month as shes technically on Medicaid the whole month. & they will clawback payments to vendors. So mom gets billed. Review moms statements from CMS and from her secondary to see if claw backs & declines are happening.
All above are solvable billing /insurance snafus. PIA but do-able.

BUT Then there's NH that flat are just incompetent. Even when the letters from the state show the right SOC which is being paid. My moms first NH was, took 5 1/2 mos to be Medicaid eligible and another 4 months to get billing and payments credited correctly; every month some sort of outside drug or ambulance billing snafu too. I moved her to another Medicaid bed at another NH at month 10. She was pretty happily at NH #2 for another 3 years with final 18 mos on hospice. Moving them once approved for & on Medicaid is pretty straightforward simple with some advance planning. If this place seems like its going to be a chronic clusterF, moving her is an option for you to mull over.

Also where is her PNA $ going? If the NH is keeping it, have they sent you (as DPOA) a statement on it (her personal needs trust account) every 90 days? Is it put into an interest bearing account? Is the PNA trusts status reviewed or included as a routine part of her every 90 days "care plan meeting" required by Medicare? Are they mailing you the letter to schedule a care plan weeks in advance? If not.... well I'd guess this NH is the type that plays loose with rules and not to your elders or your favor. Be wary!

It may also depend on the state you live in. In Florida a patient on MediCAID can still have a "patient responsibility" for nursing home care. My mom is in a FL nursing home. The nursing home is about $7,000 a month. Medicaid pays everything but $820 of that, saying that the $820 is her "patient responsibility." It stinks because she has no income other than social security and my dad (her husband) is still alive and relies on her social security check for his own care, but welcome to Florida. To make another point, yes, I would call the Medicaid office and talk to someone. It may be a soul-killing process trying to get through and talk to an actual living breathing person but it will help clear things up for you.

You have to give the Medicaid billing information to the MD, but only for services that were given after the effective date. As for the supplemental insurance, that is usually for mediCARE. Look at the bills carefully, were they for services dated before medicAID kicked in?

What does the agreement say? Also, what is the breakdown of the bills? One thing you may not know,,if your mom needs medication Medicaid may not cover all of them.