In addition to the Medicaid eligibility requirements, it is not unusual for the procedures of the nursing home to present problems or be a stumbling block to Medicaid eligibility.
For example, the nursing home application should be read carefully by the family members submitting the application. I have seen an application which gave the nursing home the unilateral right to terminate the agreement. Although this is extreme, the signer of the application (it’s not the person going into the nursing home) should sign under a power of attorney with the words “signing in a representative capacity and not individually.” Many nursing homes have a time period for which you must pay privately. As mentioned in prior posts, this is illegal both federally and for the state, but it is a policy which is enforced by the nursing home.
Also, each nursing home has its policy on the amount of deposit requested. The significance of the deposit is that while there is an unused deposit, the applicant cannot receive Medicaid. This point should be kept in mind in the eligibility process.
Nursing home bills should be reviewed monthly. A monthly bill generally invoices for the daily costs in advance of the month and for personal items for the prior month. Therefore, bills should be reviewed carefully in the spenddown process.
As I have discussed, an additional requirement to eligibility other than the financial requirement is an examination by a county nurse which must be undertaken (PAS).
On many occasions, the nursing home will submit the Medicaid application without the assistance of the family or counsel. I have seen situations for which the nursing home has submitted an application without informing the family. The application was cursory and the family was denied timely eligibility.
Finally, it is extremely important to communicate with the financial director of the nursing home so that you are not viewed as adversaries. Having a prior relationship with the nursing home is an asset since it will assist in the admission of a person if the funds available are not substantial.
Disclaimer: This article does not constitute legal advice and each person may have unique facts for which legal consultation may be necessary.
© May 2009, Post 77
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