I crushed my ankle on November 4th, 2018. On November 15th I came to SNF Rehab. On January 30th the rehab office person came to me and told me I owe the rehab over $1,600. They said they could take all but $60 of my SSI. If they do I would be homeless. How am I supposed to pay my rent and bills? Doesn't seem fair.
Medicare will pay for the first 20 days of rehab in full. From days 21-100, you owe a copay of about 150$ per day.
Did you sign yourself into rehab? Were the financial terms clear when you entered?
I’m guessing that NH has you tagged as Medicaid Pending resident & for those LTC Medicaid or Medicaid Pending all of your monthly income (like social security $, a pension) must go to the facility as the required Medicaid copay or SOC (share of cost). $1193 - 60 means a copay of $1133 a mo to NH.
But it has to be broken down from Medicare to Medicaid transition date. If in rehab till 12/21 that means from 11/15 till 12/4 it’s MediCARE rehab benefit at 100%. BUT - & this is mucho importante- IF you were still “progressing” in rehab till 12/21, those 16 days its MediCARE rehab paying 80% & you or secondary health insurance pays 20%. Rehab 20% usually fixed rate, for 2018 was $167.50 a day. So 16 days that’s $2,680 needed to pay 20% rehab copay days
This site has a really detailed article called “Does MediCARE cover Stays in Skilled....” by Marlo Sollito, that you should read & re-read.
Yeah its not simple.
Exact dates of discharged from rehab will make a difference as to how bill is broken down. And you or whomever was your dpoa were required to be notified of discharge with orders from rehab portion of facility. Again exact date discharged from “rehab” important to know as that’s the date you switched from MediCARE copay system to Medicaid/ Medicaid Pending copay requirement.
If you stayed past rehab, then you are considered a LTC resident & billed at either private pay rates or at Medicaid rates. But to do it at Medicaid rates, you would have needed to have applied for Medicaid. I wouldn’t be surprised if this place did it for you without truly explaining to you what you were signing. If this place didn’t explain the MediCARE discharge rehab payment terms clearly to you (which it sounds
like), then they likely also skirted by explaining the LTC Medicaid application & payment requirements as well.
If you are not planning on staying in a NH, and you are able to do for yourself via walker or wheelchair and you have a home / apt / family to go back to live with; you -imho- need to get out of this place ASAP. Either you are formally discharged and you take all medications billed to Medicare with you. Or if this place won’t be cooperative, then you kinda have to do it on the downlow, eg you have family or friend to come visit you and take you “out for lunch”. They bring a big purse as you are going to try to put all you can of yours into purse & you layer on as much of your clothing esp a coat as possible without looking too obvious. And you leave to go out for lunch...... you call that afternoon to tell them you are not returning. Note the date and time of the call.
IF you don’t recall applying for Medicaid, you let Medicaid know this by letter once you’ve moved back home & reset your life. If an application was filed, you inform Medicaid it was done by force under duress or drug sedation. Most NH are run by the book but some are totally predatory & place a stack of paperwork for an elder to sign without full knowledge of what rights or terms they are acknowledging. My mom’s 1st NH had vague upon death clauses in admission document that I struck through and nothing they could do about it as Medicaid Pending documentation is what counts for eligibility. I got a copy of all admission related pages too, easily 40+ pages but no copy = no check.
I’m guessing you do not have copy of all documents signed? Once you get back home send a letter requesting these & mailed to you within 30 days and letter is mailed certified mail with return registered card. Duo like $8 at USPO. Try to do this ASAP. Once you get bill from NH, you do a letter requiring itemized billing data from 11/15 to date you left & again response required within 30 days & again mailed certified/ registered mail duo from USPO. No response by 30 days of sign off on registered card, then bill is moot. If all you get is SSI, you’re judgement proof and NH knows it.
Thank you,
Bobbi
If you can, apply for Medicaid and spend down your resources. If you have no resources applying for Medicaid will be easier.
If you have resources they will need to be sold and the money used for your care. You say “they “ say you will never be indigent...why?
I would invest in a secondary insurance policy to supplement Medicare.
Medicare only covers a certain amt of rehab days and you are responsible for their co pays and the 20% Medicare doesn’t cover for many services. Which is why so many seniors get Medicare Advantage or supplementary insurance.
How long do they expect you to be in rehab, and then what’s your goal afterwards? To go home? Do you have resources for CG at your home to assist you?
Sorry to hear about your ankle.
But if you’ve moved to a NH as a permanent resident, that needs Medicaid LTC program to pay for your stay. Medicaid LTC as you now live in the facility pays the room and board. But you have to do a copay of all your monthly income less that $60 allowance. You live in the NH so do not need your income to pay for housing anymore. LTC Medicaid is a seperate program with much stricter requirements like you have to be “at need” financially (impoverished) and medically (need skilled nursing care). I’d be pretty concerned if the NH took it upon themselves to apply for LTC Medicaid for you without getting your signature. And if now their not being clear about just what the $1600 is for without detailed accounting, well something is just not right.
Community based Medicaid is about being lower income to qualify for health care plus other low income programs like SNAP, or extra help to pay for medications or hospitalization sing assistance.
Ltc medicaid is about being “at need” medically and financially for living in a facility and getting skilled nursing care.
To me the decision is..... do you need to remain a resident of the NH as you need skilled nursing care
OR
could you realistically go back home and get the oversight and care you need between what you can do for yourself and what your family can do for you. A broken ankle - that I can relate to as I had that happen a few summers ago - no picnic especially not being able to drive but I was in my 50’s with a hubs and kid in high school who truly could fix meals & do laundry. But crushed ankle that’s lots worse, what I suggest you need to try to do is ask either the charge nurse for your wing of the NH or the DON (the director of nursing and the DON is the center of power in a NH imo) for a care plan meeting to see exactly what your capabilities are for doing your ADLs - activities of daily life - and if its truly realistically ok for you to return home. You need to have your granddaughter or other family at he meeting too.
And if it’s that you could be ok independently in your home, get out of there ASAP. Good luck and be realistic.
Medicaid will not make a "community spouse" indigent, but the patient themselves must be indigent to be eligible for Medicaid coverage.
Do your doctors and therapists think that you will be able to return home to live?