Nursing home bill after death for partial month: Should it be prorated?

Bumping up for others to answer. There is a very knowledgeable poster on here called igloo. I hope that she will see this and answer your question.

Best wishes to you.

You will owe the April SS bill, I think. Don't think Medicaid will pay until the SS is paid. So Moms SS payment goes to the home. But I would ask about it being probated. Call Moms Medicaid caseworker and see how Medicaid works since Mom died 6 days into the month.

First of all condolences for the loss on your mom.
Yes it’s owed but only for the days there. But couple of issues tho: if mom was new to the NH so was LTC Medicaid Pending you will need to continue the process to get her LTC Medicaid eligibility so you need to make sure that happens & this will be cumbersome. There was no private pay contract in force as mom was either an applicant on Medicaid system or actually on LTC Medicaid and either way it’s on it’s terms, don’t let the NH or it’s billing Dept. buffalo you on this. Hopefully you did not sign off in any way to be financially responsible for her. Plus there’s another glitch and hang with me on this as it is not at all straightforward: as mom applied for or was on LTC Medicaid program, and she did not live the entire month of April, that months (April) copayment from her SS income would have / should have been clawed back from her bank account if still direct deposited to a bank account or to the NH if it was made her representative payee.

so did that happen? I’ll guess that it did get clawed back and in the after death flurry just wasn’t noticed by you. SSA pays forward so they have to live the entire month and if they do not, then $ clawed back within maybe 2-4 weeks. Not prorated either, but full amount. This too happens for any federal / civil service type of annuity as well although those take a bit longer. (My mom had both, can we say FUN!) So if you wrote a check for her from her bank account and she had the $ in her bank acct even after the clawback, it’s all good. But if not or if the NH was made representative payee, it’s a problem as those 6 days in April they did not get paid for due to clawback. And if they did not get paid, they cannot seek the copay from the State for their room&board & custodial care Medicaid reimbursement.

Nevertheless Mom would have technically owed the NH her copay aka the SOC share of cost for those 6 days in April. NOT THE WHoLe MoNTH. So yes, the $ is owed. For example, If copay was $1234.00 a mo & April is a $39.8065 a day & that’s $238.84 technically owed by mom when she was alive and now by her estate.

Did mom have a PNA set up at the NH and have $ in it? If mom had enough $ in her PNA at the NH, if it were me, I’d send a note to the NH with the last PNA statement and write on it to let the Nh take the $ from the PNA account to cover the 6 days due and send you the balance. Case closed. They are supposed to have sent you a statement as to the balance with interest on that PNA every 90 days.
Now I can’t tell by your post if she just entered the Nh in April so all this just started for you and there is no PNA at all OR if she was there for a while so likely had a PNA with $ in it and then died in April.

Whatever the case the 6 days balance is a DEBT of HER ESTATE. It is not your debt. If mom died with $, and that checking account is still active for her estate, you can pay from that $. Or if that’s closed and you want to be all nice and get this put away, you can pay it, but if I were you, I would NOT pay it by my personal check but instead by money order or cashier check so that they do not have your banking info. Send it all certified mail with the return registered receipt so you have a definite paper trial with a signature. This might sound as overkill but it’s a small actions to do to CYA. This can go hostile IF they are trying to shove this as to being your debt, and at private pay rates for a full month. That is B.S. & you need to respond to that accordingly. You can play nice or be “this is a debt of her estate as such we anticipate probate will be opened according to the laws of our State. So you need to be on the look out for Notice to Creditors which will be posted and file this debt accordingly”. That is your stock answer should it go hostile.
Rinse & repeat.

Ok this is way confusing, so it’s:
- 3 different NHs PLUS a hospitalization
- no POA; no will
- Mom had existing LTC Medicaid approval
1. Mom was approved & on LTC Medicaid in a NH (let’s call this the OG NH) and all fine prior to March, 2023. No issues on her bills, right?
OGNH stay ends when brother moves mom into NH#1 in March.

2. Mom in NH#1 for 1 week then mom goes into the hospital and DOES NOT RETURN to NH #1.

How was it set up to pay the OG NH?
Did mom or brother write OG a check for her copay each month? OR
Was OG NH her representative payee for SSA income? If so, was that changed after she moved to the next NH#1?
Could OG NH possibly gotten SSA income after mom moved out?
Did OG have any $ for her in a personal needs account?

Your mom did NOT live the entire month of April, so there either was a SSA clawback done for April $ or April was never ever paid. You or your brother imho should try to find out from OG NH if either happened on your moms old acct at this NH & also possibly any $ in a personal needs account there as well. It can take weeks for this to shake out and as mom moved out and then moved again, mail could have gotten lost. & her $ is sitting at the OG NH for months now.

2. Mom hospitalized in March. Taken from NH#1 to hospital.

3. Mom discharged to new NH#2. Brother did not want mom taken back to NH#1. ((Do you know if this is accurate or could it be that NH#1 did not want to take her back? Perhaps a paperwork issue existed?))

When she was discharged, what were her discharge notes / care plan?
If discharged for rehab, that is Medicare Part A health insurance bill. Not LTC Medicaid custodial care bill. If you are not getting any bills from NH#2, then mom was still on post hospitalization MediCARE benefit. Hopefully this is it & no bills from NH#2 ever. Yeah!

But back to OGNH & NH#1, there should have been paperwork done from both to have OGNH exit as LTC custodial care provider and by NH#1 start being LTC custodial care provider. A transfer of care document done by facilities to the State. It’s on the NHs to do in a timely manner. I bet Nh#1 didn’t & have timed out… and why they are trying to get the $ from family. But unless you or your brother personally signed to be financially responsible for mom, not your debt.

It is a debt of your mothers estate. Which there is no will.

As there is no will, this is a whole other level of Butt rash. Hopefully that bank lets you get the $ out. But if they don’t, then with no will and if no POD or TOD on the accounts, you’ll likely have to do a lineal heirship in my not an attorney but been an Executor more than once opinion. You have to prove heirs if no will. And those have costs & take time, plus need an attorney who does these. It may not be worth it for under 2K allowed in assets under LTC Medicaid rules. Just wait till it comes up eventually in abandoned accounts by your Secretary of State.

My father had only just moved to a NH when he died a week later. At this point we were self pay and I only paid for the days he was alive.

I would look at the contract. Some places won't prorate. Others will.

In addition, there might be "termination" fees.

I would try to find the contract.

Perhaps it should although likely that isn't the way they manage their contracts. I thought the same when my companion died on the 23rd of the month ... shouldn't he be entitled to his VA benefits for 'most' of that month? (I say YES although the VA said NO). Basically, in this / my situation, my friend would have had to die on the 1st of the month to get the benefits he was entitled to.

While you can ask / check with the administrator about this, check with the institution that monitors / manages / insures that nursing home follow the rules required for them to be licensed, and remain licensed.

Gena / Touch Matters

Seek Elder Law Attorney input.

You have two choices to get an answer to your question — you can speak to the case workers at the nursing homes where your mother was a patient, OR you can speak to an elder law attorney to clarify this problem, the latter being the better of the two.

Dont Pay it let them go after medicaid .

It has worked for me to call the Nursing Home and/or Rehab to advise of the last day of care. With recent rehab and nursing home bills for Mom and Nana, the information does not reach the billing department and overbill is done. I'm going to be kind and assume the company made a mistake. It's easier and cheaper than paying an attorney to handle the call yourself to request a corrected bill. If the Nursing Home will not adjust the bill, try to either speak with a manager or write a letter a second time. You can always consult an attorney later. Good luck and hopefully it is resolved quickly.

lion12345: Retain an elder law attorney.

I haven't done this yet. My bf sister works for aging center. She complained and won dispute over 1day over charged when their mom died. I think she was in hospice unit. She was self pay. Thanks for this thread. Its an issue I will probably face.

For those suggesting elder law attorney, imo this really cannot really work because the elder who was on LTC Medicaid is DEAD. There is no elder for an elder law attorney to represent, they are dead. And for more fun in this, while they were alive they had no will and had no POA done; so no previous established legal path was in place.

Imo if the OP was to get an attorney, they would need an attorney who does after death work and that means hiring a probate attorney and specifically one that does intestate (no will) work.

Just how involved and how costly that would be really depends on her State laws on this. (And on a side note how flexible that bank who has the now deceased moms bank accout are on releasing funds in it.) Some States have small estates affidavits that are pretty loose on requirements so could be simple & cheap; others could involve having to establish lineal heirship (series of public filings along with a timeline type of document as to marriages, divorces, kiddos, etc ) which flat takes time & $. If there’s really no $ to speak of, it’s maybe not worth doing.

I think this has gotten a bit out of control. My question was simply whether her NH bill should be prorated given that she was there only 6 days.

This is what the admin from the NH told me (bill is for slightly less than her SSA benefits):

"This is a Nami bill. She was in the facility in April and we billed Medicare/ Medicaid for her. This is her portion to be paid. Her Social Security is the Nami and is due even if she was in the facility one day within the month. Medicaid automatically takes this off the payment that we receive from them and the resident pays the Social Security amount and other income to the facility. She did not have her full 100 days of Medicare, so we billed co-insurance to Medicaid, and this is why there is a bill."

I would never go to an attorney over such a small amount BTW. Not worth it.

Thanks everyone.

Nope. You do not pay them a cent if your mother was not in their facility.

The nursing home tried to pull this crap on me with my father. He died the first week of the month and they expected his entire SS check and pension to be handed over.

They were told to go pound sand.

You pay what the daily cost is for six days. Not a penny more. This what I did because I would not allow them any access to bank accounts.

You demand a written bill for six days cost. Then before you even pay one cent, you send it to Medicaid. They might pay it. If they don't, then you pay the six days.

Think of it like this. If you go on a vacation for a week, do you pay the hotel bill for a month?
No.
If you move out of a rent the first week of the month, do you pay the whole month?
No again.
Your mother wasn't there for a whole month. She was there for six days.
So you pay for six days.