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My parents are in a nursing home on Medicaid ,the pharmacy they use says I need to pay the co pays. Originally I was told to hang on to the bills, but now they say I need to pay them. If they only get $30 a month for incidentals how are they supposed to pay it. They also have Tricare which they say I should cancel. The bill is now several hundred dollars!!!! Am I legally responsible as POA?

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If a person has Humana for their primary insurance and Medicaid as their secondary insurance and has a power of attorney is that person responsible
for the copayments to the hospital they were admitted to and is demanding
payment for the copay but the person is now in assisted living and has verylittle
income to work with or cannot afford to pay
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It depends on the state!
Please note the following:
The following services must be offered by all states :
• inpatient hospital services
• outpatient hospital services
• physician services
• medical and surgical dental services
• nursing facility services for individuals age 21 or older
• home health care for persons eligible for nursing facility services
• lab and x-ray services
• family nurse practitioner services

The following services are optional , but most states will offer them, also:
• ambulatory services to individuals entitled to institutional care
• home health services to individuals entitled to nursing facility services
• prescribed drug coverage
• optometrist services and eyeglasses
• prosthetic devices
• dental services
• in-home assistance
• physical therapy
• (there are other optional services, too)
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Why don't you contact Medicaid and ask them?
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Maybe the person at the pharmacy is not up on these matters. Next time ask for a manager but also have a legal statute with you as well in case they put up a fuss.
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Does anyone know if Medicaid pays for hearing aids when your in the nursing home.
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As for coverage of prescription drugs while on Medicaid, you may want to review this helpful chart: http://kff.org/medicaid/state-indicator/prescription-drugs/

However, if you are in a nursing home receiving Medicaid, there is NO co-pay required at all. According to a federal government document, "Dual-eligible beneficiaries are eligible to receive both Medicare and Medicaid coverage. Prior to Medicare Part D, Medicaid paid for most of the prescription drugs for dual-eligible nursing home residents. Under Part D, these residents now receive drug coverage through Medicare, and are eligible to have their premiums, deductibles, and copayments fully subsidized." http://oig.hhs.gov/oei/reports/oei-02-06-00190.pdf
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In California there is something called "Share of Cost" and if your parents have a bit of money or not enough expenditures they say you have to pay a certain amount towards medications. Your parents probably have a case worker and you need to see if they are any help or call Medicare and speak to them.
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There is no co-pay with Medicaid. They pay entirely for meds. If you are stuck in a place like Tennessee with a waiver, their Medicaid program will be called something else and have slightly different rules. In Tennessee, the medicaid program is called TennCare and they will pay for 2 brand name meds and 3 generics a month free,. Beyond that, you pay the whole thing. Something sounds fraudulent about that pharmacy. Call Medicaid and report this. They may be fraudulently be collecting money illegally and pocketing it.
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To NIK2R3 I live in Wisconsin and when I worked in the Dental Office am now retired for 2 years our Nursing home patients did NOT have to pay co payments.
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remark to K.Gabriel Heiser;
The question is 'does medicaid pay for medication' , should the patient have to pay a co-pay for medications ???
Your reply seems to indicate that you are referring to Dr. co-pay.
The question implies " medication co-pays "
??
Thank you for your knowledgeable assistance.
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Don't forget everyone that there is still a deductable to be met on Medicare. Sometimes the billing is actually what has not been met on the deductable and has been applied to that.
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A person may have Medicare Part D. This will allow you to have a considerable discount on your prescription drugs, both generic and non-generic. This is not a stand-alone product. You must have Medicare first.
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I too was told to save all medical bills and not pay them when my husband was pending medicaid. He entered a nursing home in September, 2011 and it took 6 MONTHS to get him approved for Medicaid. We found out at the end of March 2012 that he was approved for Medicaid as of 10/1/2011. The pharmacy could only submit bills incurred after 10/1/2011 to Medicaid. The pharmacy didn't write off anything for us. He has Medicare, a Blue Cross/Blue Shield supplement and Medicaid.
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I have Tricare also, but one does not "cancel" it. Tricare is a military benefit for someone who has served in the military. Either you get your prescriptions FREE from a military base, or if the medication is not on their formulary, then you would go to a pharmacy and pay the co-pay of $5 for generic and $9 for Brand drugs. If the pharmacy's price is lower, then you would pay that. Medicare does not cover prescriptions, unless you are enrolled in an HMO and pay the HMO's co-pay. It is less expensive to have Tricare in most cases.
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Do not cancel tricare! It is probably the primary insurance for their prescription drugs. They probably did not elect prescription coverage under medicare. The coverage first goes to Medicare, then tricare, then medicaid. I do not understand why there is a copayment if they have medicaid. Tricare would pay first then medicaid. If there is a copayment it has to be a type of medicine your parents are taken that falls into the tiered coverage prescription system. You are not responsible to pay for those copayments yourself. I would investigate further, something doesn't seem quite right because most pharmacies would not give you the prescriptions without paying up front the copayments.
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CMS, the federal govermenl agency in charge of Medicare and Medicaid says this:

Q: I have Medicare and Medicaid, both of which pay for most of my health care. But my doctor is telling me I still owe money. Is this right?

A: If you have both Medicare and Medicaid, and the service you received is covered under Medicare, your doctor's office cannot bill you for any Medicare co-pay costs. If you have Medicare Parts A and B (also known as Original Medicare) or are in a Medicare health plan, AND Medicaid helps you pay for Medicare premiums deductibles, and coinsurance, you are probably a Qualified Medicare Beneficiary (QMB).

Note: your doctor may bill you for Medicaid co-pays. Please check with your local Medicaid office to find out more about your Medicaid status, including Medicaid co-pays. If you are still being told to pay a Medicare co-pay and the service is covered by Medicare, please contact 1-800-MEDICARE to file an anonymous complaint.
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Medicaid is a state-sponsored program, very little federal. I do believe that you are required to pay the co-pay for your state. Sorry.
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I am a social worker in N.Y. Most people on Meidcaid should be eligible for "extra help" through medicaid and should not have to pay a co-pay. Speak to the S.W. at the NH who should be able to direct you. Also, $30 sounds too low. I forget the exact amount, but it should be higher. Check with the SW, Medicaid or Dept. on Aging.
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I am sorry to hear that both your parents are requiring some form of Nursing home facility whether its assisted living or a nursing home itself. At least they had the good insight to prepare for the Nursing home care if that truly happened, meaning that they are not spending down all their assets to pay for their assistance. In some cases you can't avoid this happening. Unfortunately, my wife (age 57) was diagnosed with early on-set Alzheimer here a year ago after having several emergency surgeries with regards to other issues. We had previously gotten her on ss disability which paid for her medicare plan B. We were getting huge medical bills regardless and I found perhaps some good info for you on the back page of the medicare handbook (Medicare and You--available on-line or at your local Social Security office.) The Agency is called (SHIP) State Health Insurance Assistance Program with a provided toll free number. Through this agency we get the vast majority of all our medications for her paid.past and present. We pay roughly 1% of the cost of the med's. They were a God send!! Hope this can give you some direction and help.
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My mom is on Medicaid but lives with me. We are in Pa. My mom pays no copays for her meds. Dont see why it would matters if she is in a nursing home . My mom isn't on any highcost drugs so perhaps that makes a difference. Perhaps there are certain higher cost drugs that medicaid wont pay the copay for..I dont know.
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In WI they only get to keep $45. from their SS. but when your in the NH there is no copayments.. That is in Wisconsin
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Oops, I mean Medicaid.
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I would contact Tricare and Medicair as their POA and find out exactly what is what. You are not responsible for their bills, they are, you help them pay them as a POA and sign as such.
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Medicaid pays for meds. TRiCare told me that all the bills go to Medicare, TriCare and then Medicaid, so you should not have to pay anything. Hope this helps.
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Do not cancel TriCare, find a pharmacy that accepts Tricare and have the prescriptions filled there. It will save you lots of money
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Wow, that is exactly what I went through. Fortunately, my mom had an elder-law attorney and I would highly recommend, if you can afford, to get one to assist you with Medicaid; that is what I ended up doing. Not sure how it works in your state, but our lawyer told us to hang onto the bills and not pay them as my mom was Medicaid pending. So, as far as I know, you would not have to pay those Medicaid bills as the pharmacy has to write off the rest (again, this is only as I understand it, however, would consult an attorney). Also, our lawyer told us NOT to cancel my mom's other insurance, which, as our history shows, to date, this was a good choice NOT to cancel my mom's other insurance. So, as it went, my mom had Medicare, then secondary insurance, then Medicaid and all went well. As concerning the question are you legally responsible, not according to our lawyer, as you are acting on behalf of your parents. The only time you would be responsible is if you signed as a beneficiary, which would mean, essentially, their bill is your bill. I think it is a good idea to have an elder-law attorney to help you as this is what essentially helped me through all the rough times with the nursing home/Medicaid issue. Hope this helps and good luck. It is a tough time in your life with all this going on - I know - I am living it now.
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My son is in a Nursing home & all residents have to pay a small co-pay for their meds.
I am his POA.
I'm not sure what state you are in but here in CT the patients are allowed $68./monthfrom their SS pensions.
I would want to believe that this amt. is equal, no matter where you live.
Yes, I do believe that with recieving such a small monthly stipend, there should be a fund to help pay fo rco-pays.
It seems unfair that this allowance has to be used for anything other than their own personal needs.
But then, the system is not all fair nor reasonable.
Have you checked to see if there may be other avenues of financial help, such as the Soldiers, Sailors & Marine fund ?
The Nursing home should have some info , if there is indeed any other help for the residents.
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