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Medicaid Pending AL monthly payments

JessC
JessC Member Posts: 6
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edited May 31 in Caring for a Parent

**update: I ended up paying. Director refused to put in writing that they will honor the overpay in credits. Said it would make him look "disingenuous". That he has to honor the credits or it would be Medicaid fraud. It was taking too much of a toll on my mental health to have this battle as my attorney's quit responding to me. Always a learning curve to every situation it seems.

Maybe I just need to air this out, but I am struggling to understand what I should do. I am working with an Elder Law Attorney, just for advice for now, while pending Medicaid approval. It has been over a month since I submitted the application and it has been a couple of weeks since the AL Waiver Assessment. The AL Waiver was approved but we have to wait on the doctor to sign off, then she said that will get the Medicaid process going. (I have only gotten a notice that the application was submitted).

My Attorney said not to pay full amount while my mom is pending, only the estimated patient liability amount because we do not have a back date for Medicaid yet. Well her AL facility is threatening eviction if I don't pay the full amount because she is technically private pay until Medicaid approval. Attorney says no, according to Ohio Administrative Code Rule 3701-61-02 (A)(3). "Until her application is denied and if there is no appeal to the denial, she is unable to be discharged from the facility for failure to pay." Attorney and AL Director are sending heated exchanges to each other about this. While I feel protected by this code, that does not stop someone from trying to evict my mom. I am so stressed about this. Director does not seem to want to communicate about this at all. He claims he cannot make a prorated monthly bill for her (to pay the estimated liability payment), it's either pay in full or get out. But he is able to credit whatever she overpays to future months rent (say she fully pays for two months and Medicaid is back dated to those two months so he can take the extra she paid off future months). No trust has been established that he will uphold this (that is what worries the Attorney). Attorney is also worried said credit will mess with the process: "The issue with a credit at the facility is that it can be considered a resource for Medicaid, meaning that even if that money is not in her account, Medicaid could count the credit as part of her assets."

For my own mental health at this point, because I am sick with worry about this, I am wondering if a compromise will do. If we get a written statement signed by the Director he will credit her account to match Medicaid date and mom continues to pay full amount. They are both fervent in their stances, but I am the one left with the choice/risk. I obviously have months ahead of me until approval I assume because there is also a possible penalty period.
Has anyone had to deal with this??

Comments

  • Grenah
    Grenah Member Posts: 55
    10 Comments 25 Care Reactions 5 Likes
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    I feel your pain. We have not reached the moving to a facility yet but it is coming. I live in New York and my mother has assets but there are ways she can still qualify. I think they make it complicated so people will just give up. Medicare gives us 72 hours a year for a home health aid and nothing for a facility. Currently we are paying out of pocket for the HHA,

  • JessC
    JessC Member Posts: 6
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    It is all so confusing. I had just moved my mom to AL on Christmas Even 2025 so she hasn't been there long. But I love the facility other than this hiccup with the Director. They never stay long anyway, maybe a new one will move in soon lol! Do you work with any social workers or senior living advisors? They helped me a ton with AL facilities and they are free (at least in Ohio).

  • H1235
    H1235 Member Posts: 2,339
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    How frustrating! I just finished jumping through all the hoops for a Medicaid 6month reevaluation. I’m hoping by the next review I will have the process down. So much work! I can understand your stress. I wonder why the reimbursement would cause trouble for her qualifying if the money is in her account now and not causing any problems with the qualifying. I assume that if you pay for it out of your pocket (not that that ideal) then the reimbursement would come in the form of a check made out to your mom (if the check were made out to you it might work). Obviously cashing a check made out to your mom and paying yourself back would cause all kinds of problems. Nothing is ever easy.

  • JessC
    JessC Member Posts: 6
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    There are reevaluations?! I had no idea! How stressful! I am not sure what to expect in the process honestly. Mom has no assets. So other than the look back I'm not sure what else there is.

    Im confused as well because the credit won't even start until AFTER approval. It won't even go into her bank account. It will just be logged in the facility account somehow. Another issue is Attorney said she has had issues in the past where they don't honor this. If she over pays then oh well, no reimbursement. I can see both sides of this: of course she should pay full amount while she's private pay and of course we should make sure they give the credit to what she over pays. I'm so stressed over this. I don't know what to do or who to listen to. I just want something written that protects mom getting her reimbursement. It's hard because I've never gone through this process before.

  • JesseLee
    JesseLee Member Posts: 42
    10 Comments 5 Care Reactions 5 Likes
    Member

    Not to mention if, using your example, your mom dies just after the 2 months then you're paid for months 3 and 4 and going to play Hell getting that $ back. Most facilities are corporate/ VC owned now. Can you go above the Director to a regional manager? And/or Ohio state regulatory agency? Good luck. I'm in the start of a penalty period, using an attorney, it's rough. It feels like they really don't want people to apply of use Medicaid. They're up my ass about a $200 ATM withdrawal last year. My dad likes to have some cash and offer to buy meals or fill my tank, geez Louise!

  • JessC
    JessC Member Posts: 6
    First Comment
    Member

    I couldn't get a hold of anyone and everyone is apathetic about it. After talking with the director and deciding not to risk her living situation, I decided to pay. Attorneys kicked up this hornets nest and ditched me. So I'm on my own. I do feel better knowing she won't possibly get kicked out at least I'm protecting my mental health for now.

    Im so scared about all of that. I went through all of her bank statements and I think there is like 2 months worth of penalties because of cash withdrawals. Those are almost at the 5 year mark. She has no assets, I sold all of that. Do they get weird about anything else? Did you do any spend down on his money? I took her out to eat a lot and shopping a ton when I had to spend her down so there is a lot of that on there. I'm not sure what they will question at this point. All I was told is every 8k not accounted for is a month penalty.

    I hope it gets better for you, this is so stressful it's so unfair.

Commonly Used Abbreviations


DH = Dear Husband
DW= Dear Wife, Darling Wife
LO = Loved One
ES = Early Stage
EO = Early Onset
FTD = Frontotemporal Dementia
VD = Vascular Dementia
MC = Memory Care
AL = Assisted Living
POA = Power of Attorney
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