over 5 figures for so many months of stay, they had her sign over her social security check. After they found out she was moving on to a high rise. which only leaves her with less than 50 dollars, she was not in her right frame of mind, felt very intimated, was told that she would get kicked out if she did not pay, my question is why did they not take the SS money when the medical was not paying them, if that was the case, so theoretically if she was there for 5 years would they waited then gave her a bill
something don’t sound right any Info would be appreciate
A year and a half since she filed, correct?
The facility she is in, exactly what type of facility is it? Like a general Nursing Home that provides some on site rehab?
Or
Is it actually a true extended care rehabilitation center so it’s very much specialized rehabilitation care? Like for really bad auto accidents or other trauma - like a Traumatic Brain Injury - so need months and months of rehab & hands on daily care? These not designed for long term custodial care.
Imo what type of facility will matter once she is written up as “now lacking progress” in her rehabilitation and she needs to be put into custodial care for how her care is billed. I’m going to guess it’s a Nh with a rehab sector she is in and my answers below based on this path.
And
Sister is younger, right? Like she is not even close to being 65?
if I’m correct on the above, Sissy is not on MediCARE yet as she’s not 65+ and she is not the full 2 years under the SSDI so she is still on only Medicaid for health insurance coverage. Sissy is getting SSDI disability income based on her work history. As she is not yet FRA full retirement age, her work history may be smallish so her SSDI disability income is also small. And Sissy is very disabled so cannot function on her on at all, is my guess as well. So long story short, the amount of $ a NH can get is pretty low once Sissy gets her $50 a month allowance to her for her personal needs.
For usual NH that has a rehab sector, they are set up for all residents to be “duals” so on Medicare and Medicaid for health insurance AND also have filed for LTC Medicaid program which will pay for custodial costs at the NH. 3 different ways for the NH to bill. For most NH billing is preset for a resident being on all 3 unless they are private pay (even if having LTC insurance). Even if private pay, the facility is still billing Medicare for some services, like for on staff MD to review care chart, for immunization stuff. Being on Medicare is super important.
So for a NH having to deal with this type of individual (young needing beyond the usual just custodial care) is hard as they cannot do any of their “dual” + LTC Medicaid billing. For those on just Medicaid, they in the past would go to a big long term residential care facility with dorms and grounds to live with cost billed to Medicaid. But States don’t do these facilities like in the past as States having switched to placement in group homes or other sm congregate living spaces. The families of Younger folks who need LT custodial care find themselves caught in a $ gap as the NH can’t bill their usual way and there’s very limited long term residential spots in a facility that accepts only Medicaid. But I digress….
Puppy, I’d suggest you
- find it the billing history for your Sister as to who paid for care and when it stopped. Then see if any can be appealed and file an appeal. If she is not far enough into her SSDI time, find out exactly when she will be able to be eligible for the swtich from onky being on Medicaid to being able to be on Medicare for her health insurance. Fwiw it’s usually 2 years after being on SSDI unless a special disease category (eg Lou Gehrig disease). See if the Nh will allow her to stay till she can fully be on Medicare and what they need her to do to have this happen.
- Now if it’s that she has a very involved care plan, a regular NH may not be able to provide the level of care she needs. If this Nh tells you this, then family needs to try to find long term residential care that takes Medicaid entire for all costs that are geared to those under 65 that still exist in your State…. & may not be at all nearby.
- see if she filed for LTC Medcaid & status on that application. Can take 5 months but usually cannot be filed till out of any health insurance paid rehabilitation.
She may be in a filing “gap” till Medicare.
My nephew has SSD with Medicare and Medicaid. He is 30.
Medicare pays for 100 days of Rehab. 20 days 100%, the other 80 50%. Who paid the 50% that was sister's responsibility? After 100 days, its private pay, who paid that? She has been there 15 months over the 100days thats more like 150k if not paying not 5 figures. Someone had to be paying her bill. Medicaid for health is different than Medicaid for NH care. You must apply and show need. And as soon as Medicare stopped, she would have been asked to pay privately or if she had no money, hand over her SS and any pension she received. She would have also needed to apply for Medicaid.
Who is transitioning her to an efficency? Your discription of her makes me think she is not able to be on her own. She has no idea who her supplimental is.
I think your sister was on Medicare with Medicaid as her supplimental. She could be on a Medicaid Medicare Advantage. You can call Medicare to see what she has. She may have to be present for you to get her permission to get the info. When she entered the hospital they would have required all her health insurance info. They have the ability to see what insurance your sister has.
What happens with SS disability when it comes to Medicare when turning 65 is it becomes regular Medicare.
First, sit down with the billing dept to see who has been paying sisters bills. What I think is once the 100 days was done she was told she needed to pay privately. Since she did not have the money, the NH started the Medicaid application process but...at that time she was asked to turn over her SS and did not do it. It takes at least 90 days to get Okd. So thats 3 months that sister is not paying. You'd hope that Medicaid would pick up that 3 months when they start payment, but they might not. So Sis owes that 3 months and the 15 months of SS. And she owes it. You may be able to make a deal with the NH, but she owes them. You may need a lawyer to help her get this straightened out.
Please update and tell us what u found.
- dealing with SSA on SSDI paying income till can file till for regular SSA retirement income. Sissy just turned 65 this January, so I think her SSA should have switched last month. But I’ve never had to deal with this. Do you have any insight…., is it automatic or is filing needed by Sissy or her representative payee needed by SSA to do the change over from SSDI to SS retirement income? Her posts sound like the NH is the rep payee.
AND
- filing / billing issues for the health insurance switch that happens once on SSDI for 2 full years to go off Medicaid only for health insurance to being able to have both Medicare and Medicaid as health insurance. And then again to add Medicare age 65 enrollment for Jan this year.
If Sissy actually was 2 full years SSDI then she got onto Medicare and Medicaid for health insurance but if under 2 years, was only Medicaid. My guess is Sissy was SSDI under 2 years, the NH did not bill appropriately to only Medicaid because their billing set to dealing with “duals” on the M&Ms, so health insurance billing not getting paid. Then add in that now for 2024 as she’s turned 65 in January, she can enroll in Medicare. Hopefully someone filed her Medicare enrollment Oct-Dec 2023 to start it 1/1/24. So new billing paths needed for anything this year.
AND
- It sound like a LTC Medicaid application for custodial care was filed. But that system too is geared for 65+ that are “duals”. I think it’s a different application and approach for those needing long term supportive care under 65.
My guess is the NH billing did all filing as if she was traditional elder who is a “dual” and on SSA retirement income now impoverished enough to file for LTC Medicaid. But she was under 65, and on SSDI with Medicaid only, so wasn’t that and billing being rejected by the State.
Adding to all this, Sissy has a feeding tube and verbal issues so cannot be much of an advocate for herself.
When my mother did rehab, Medicare paid for it. Depending upon coverage, they pay 100 percent.
Was your sister on Medicare? Did she have any supplemental insurance? If you stay longer than the allotted time, you will have to pay out of pocket for the additional costs.
Can you give us a bit more background information on your sister’s situation?
i am trying to get all pertinent Information and it’s been a chore. Ty
ombudsman?
tyn