We ended last time in the middle of the “What do we do now?” question for a family whose loved one is in need of long-term care (LTC). I’d like to continue that discussion below with some more information we typically provide to our clients, but first, I want to reiterate one thing as just yesterday I ran into the same issue with a client in a nursing facility: The Long-Term Care/Skilled Nursing facility is not going to push your loved one out the door. In fact, the nursing facilities are often happy to hear that a family is working with an elder law attorney and trying to get Medicaid coverage going. If your family is in this situation, (a) don’t panic, (b) read below:
• Always keep in mind that nursing facilities are businesses, too. This is certainly not to say that skilled nursing homes do not have your loved one’s best interest at heart. The vast majority of them do. However, they also have to keep the lights on. And, in our experience, families are often met by a confusing and stressful billing process from the LTC facility when the insurance coverage is coming to an end. The facility informs the family that the loved one’s rehab is ending on a certain date or that they are being “discharged” then follow that up with an invoice for the first month’s rent/living expenses and ask, or demand, that it be paid upfront, in full, otherwise risk the loved one having to leave the facility. This is often the point when a family will reach out to an elder law attorney. Please keep in mind, the facility is not and cannot push your loved one out the door the day after rehab ends. They also cannot predicate care on someone’s financial circumstances. What you need to do is inform the facility that you are consulting with an attorney regarding LTC Medicaid and if the facility has any questions or concerns, direct them to the attorney’s office.
• Note- the sooner you reach out to an attorney in a situation like this the better. The ideal scenario is that the attorney is contacted when the loved one is still in the hospital or at least still under insurance coverage at the facility. This allows us more time to get the LTC Medicaid plan rolling.
• Once the facility is aware that the loved one is pursuing LTC Medicaid, some other determinations will be made. First (or what should come first), the facility will inform the family as to whether or not they have any long-term care beds available. If the answer is no and they tell you there is a waiting list then keep looking for facilities with LTC bed availability. And in the meantime, if it’s a place you like, call them every two days and see if a bed has opened up. Be persistent, it helps. The facility, typically the social worker, also should be helping you find other skilled nursing facilities that have availability; however, just because the LTC facility recommends another facility to you that does NOT mean you have to accept that recommendation. Do your own recon and find the places you are most comfortable with…who also accept LTC Medicaid. (Reminder- only LTC skilled nursing facilities, aka nursing homes, can accept LTC Medicaid).??
• If the facility tells you yes, they do have LTC bed availability for your loved one and it’s a place you are comfortable with, then that’s great. Our next step will be to discuss how to get the loved one Medicaid eligible as quickly as possible. This varies based on every person’s financial situation and marital status.
• Always keep in mind, nursing homes are businesses. It’s so important I am mentioning it again. The facility is concerned that someone is going to remain at their facility without a pay source and then, upon leaving, never pay their bill. This is why the facility is very comfortable with your loved one being there during the Medicare/insurance coverage and then not so comfortable when the insurance stops. They want to know how you plan to pay for the care. What a lot of LTC facilities don’t understand though is that in order for a patient to qualify for LTC Medicaid they CANNOT pay the nursing home for the upcoming month. This payment counts as “cash on hand” for the Medicaid applicant and will actually disqualify them for Medicaid for that month. If you find yourself in this situation, please feel free to cite the following from the State of Michigan Bridges Eligibility Manual, which governs the Medicaid application and approval process:
BEM 405, page 13 of 23 (as of 7-1-2019)
Note: An individual is not eligible for MA in a month they have prepaid for LTC. Because federal law directs a resident in a nursing facility must have access to all monies held by the facility for the resident, count the money held by a nursing facility as cash.
As you can imagine, there is still more to cover when it comes to LTC Medicaid, even after two somewhat lengthy (you be the judge?) blog posts. Perhaps we will cover some of the other intricacies of the LTC Medicaid process in the near future, but if you’re reading this (thanks mom!) and would like to continue the discussion, please respond to this post. As I’ve mentioned previously, your questions often overlap with someone else’s and the more interaction we have the more useful the information is that we are providing. Of course, if you’d rather discuss things privately, please feel free to contact our office as well.??
Until next time, we wish you and yours a very Merry Christmas and Happy New Year,
Ryan
