My Mom is in a facility receiving physical therapy. She’s supposed to be there for approximately 4 weeks. The doctor has determined she needs around the clock care and should be admitted as a long term patient. She has Medicare and Medicaid however I have no knowledge how the system works. I’m getting asked for financial information and I don’t know why if she has insurance. She only receives a Social Security check as far as income. My Mom is 90 years old.
medicare routinely pays the first 20/21 days at 100%.
then if she is still “progressing” in her rehab as notated in her daily input into her medical chart, she can continue as a rehab patient but Medicare pays 80% and her secondary insurance usually pays the 20%.
BUT
if she stops “progressing” both MediCARE and 2ndary insurers stop paying like within 24-48 hrs. At that point, she stops being a rehab patient. If she is “at need” for skilled nursing care at the NH, she faces staying at the NH. She segueways from rehab patient to LTC resident and how it’s paid for depends on her resources.
The choices are private pay, LTC insurance policy or LTC Medicaid. Now if she has resources - like beyond 2k in nonexempt assets - they will need to be spent down first & foremost before she can ever be eligible for LTC Medicaid. Her 2ndary health insurance almost always will not pay a penny for LTC residential stay.
Her current 2ndary is Medicaid BUT is community based Medicaid; community based Medicaid is a different program than LTC residential Medicaid. She will need to apply for LTC Medicaid and the financials for LTC Medicaid is lots more narrow and has tight specific $ amounts for both assets & income than community based Medicaid does. She may have to do a spend down to get to the 2k asset max for LTC Medicaid.
The facility is asking for her financials as they are trying to determine if she is to continue being there & which type of billing her bed goes under & what copay she needs to pay them. Not all places participate in LTC Medicaid, not all do “Medicaid Pending” admissions. There could be 13 beds out of 80 set aside for Medicaid. That admissions or SW is asking you now on all this is good. They are being proactive & you kinda do need to work with them.
Hopefully she has under 2k in assets & no home.
why? well realize that under LTC Medicaid basically all her monthly income now will have to be paid to the NH as the required copay. So that SS less a small personal needs allowance must be paid to the NH. So if she still owns her home, there will be no-nada-zero of her $ to pay property costs as of day 1 on LTC Medicaid. If this is her situation, decisions need to be made as to what to do with the house if it’s that she wants to continue to own it (which by & large LTC Medicaid allows) or if it’s to be sold.
He told me that the Medicare rehab outpatient now going to Pt that’s adjacent to the orthopedic sports med type hospital. They have loads of PT aide / junior staff so can see lots more in the same 45 minute session under the 1 PT oversight. We’re still under United employer insurance so it was fine, but if I was Medicare he probably would not have taken me due to Medicare inflexiblility.
I agree with pps, work with facility if you like it
Do not sign anything as "responsible party". Mom needs to sign that.
Can mom access her financial records?
1. Mom has no POA
2. Mom is competent to do her own paperwork and provide financial information
Make sure they understand that you are NOT stonewalling, just without the information
Make sure you find out if THEY think that mom is competent and if they are thinking that perhaps the facility needs to file for guardianship.