The eligible asset balance in my state is $2000.00 . I am in the process of approval for Medicaid , and have less than the amount but will be entitled to a tax refund in 2021 , which is sure to put me over the $2,000.
I have a balance due at the skilled nursing home , which will be cleared up with the refund , and I planned to keep the remaining refund which along with current bank balance will be right around $2000.00
Will I be penalized and have to go through a spend down again ... i am still waiting on the approval.
Anyone have any thoughts on this subject ?
thanks
- as of next week, you will be “Pending” x 4 months. Medicaid rules require the copay of all your income less the state set PNA $. The issue with the copay often is that just how it is enforced is very much state law interdependent. & problems arise if the resident or their family uses some of the income for other noneNH copay. Like some states require the copay starting as of date LTC Medicaid is applied for but other states cannot legally do this but need it all made due day Medicaid gets approved. So in scenario# 2 your building up a good bit of $$$$.
Let’s say scenario #1 if income is $1878 & PNA $60 then you must pay $1818 ea mo; but if it’s scenario #2 & if it takes 5.5 mos to clear Medicaid and your mo income is $ 1,878 a mo and again your states PNA is $60 a mo then in 5.5 mo when Medicaid sends you & cc’s the facility the letter, you have to pay to the NH $9,999.00 to be compliant for Medicaid rules. You have to have the $ to do copay.
- are you absolutely positive that your mo income between SSDI & “sizeable pension” you r within Medicaid income limits? SSDI has community based Medicaid and it’s limits are way more generous. If your over, there’s stuff you can do, like a Miller Trust. But it’s fast easier if you under the income max for your states rules.
- any idea if you are scheduled to move from SSDI to regular SS in the near future? It will likely make a difference in how much $ you get paid ea mo. Which dovetails into how much copay.
AND
when do you become SSDI at the 2 year mark? Are you there already? And you have made the switch from being year 1 to year 2 SSDI Medicaid to being SSDI Medicare after year 2? It may make a difference in what gets taken out of your SS to pay Medicare Part B if that’s how it runs in your state for secondary insurance or to pay towards a Medicaid MCO (managed care organization) if that’s how your state does this.
Yeah it’s confusing and most of what’s out there for reference is based on true elderly going into a NH and onto LTC Medicaid. They already have the traditional over age 65 MediCARE and a Part B or left Original MediCARE & moved to mediCARE Advantage nonsense. The paths for the over 65 set & thier choices & cost are pretty well defined.
But your not that, your SSDI. You are younger and were working and something happened to now place you into needing Long Term Care in a facility. SSDI usually puts you on regular community based Medicaid for first 2 years, then into Medicare after that with Medicaid added on to cover what medical Medicare doesn’t pay and Medicaid pays the room & board costs (Medicare doesn’t pay R&B). Someone in the NH billing office will have an understanding of what’s going to happen. Medicaid will have to run the #’s each time your income changes and that changes the copay. Sigh! You imho don’t want to get catch short ever in being able to do your copay. Clearly speak with billing, ok.
good luck & really it’s all a tight math problem that you can deal with.
i hadn’t thought that I would be here but my condition related to a spinal condition requires help with daily living activities . I have two spinal operations and months of PT and OT and minimal progress and am confined to wheel chair. I can not stand nor walk, I have restricted mobility in my arms as well. The docs have told me they can do no more and thus I have to accept my life as it is and try to manage the financial responsibilities
i will have a conversation with the Billing office and will report back for the benefit of others who might learn from my experience
AND
if you applied to LTC Medicaid, the $ has to be used for your own personal needs or care. So you’re not supposed to spend it on others or your old home or old car (even if you kept ownership on home/ car).
SO
it kinda becomes a timing issue....of finding enough legit for Medicaid things to spend on within the month and get cleared thru your bank account so that you end your month clearly under 2k. Legit might be a FH preneed, or dental care, or extra pairs of glasses or hearing aides.
But I’m wondering why you have a past due bill if you’ve applied to Medicaid?
As as a first step I’d suggest that you clearly find out if you are considered “Medicaid Pending” for NH billing. Not private pay but pending. If you are Pending, the Medicaid rules are you are supposed to have all your monthly income (like your SS) be a copay to the NH each month. And all the $ you can retain would be whatever the PNA / personal needs allowance is for your state ( maybe $50 a mo).
If your Pending, there should not be past due bills if your current on your monthly copay. The NH will be billing Medicaid retroactively from the date of your Medicaid application a daily room & board rate, it’s not owed by you.
Are you doing this?
I know they can go back 3 months so we will see.
I have been in NH for almost 2 years and receive a sizable pension and SS disability. They have told me I can pay them every month all my income accept for the approved expenses, monthly allowance , RX supplement and Medicare supplement.
One thing you mention and which is now an issue of concern is on the first of the month I go over $2,000 , but pay NH on the same day so it there for 24 hrs max.
I didn’t turn my check over to NH as of yet , they said I didn’t have to do so