Pending Medicaid

One of the most frequent questions we are asked is, “who will pay for Dad’s care while the Medicaid application is in process.”  There are a number of outdated and often difficult to understand rules that guide the answer to this question.

First, Medicaid eligibility is only judged as of 12:01 AM on the first day of any given month.  This is the “snapshot” date.  So, if your family member is disenrolled from Rehabilitation under Medicare mid-month, someone will have to come up with a payment source to cover the remaining days of the month in Long Term Care (Skilled Nursing) UNLESS that patient was clearly eligible for benefits as of the 1st day of the current month.

Second, A nursing home is not a public hospital.  They have no obligation to keep someone in a bed unless they are being paid.

Third, Medicaid applications cannot be submitted until someone has been in a bed, in a Medicaid licensed nursing facility, for at least 30 days.  Rehabilitation days count. 

Fourth, Medicaid applications for the current month are not even opened, reviewed, until after the first day of the next month.

Fifth, Medicaid applications usually take at least 45 days to process, more often than not 90 days, and can go even longer.

Sixth, when an application is finally acted on, if it is granted, the Nursing Home is paid back to the 1st day of the Month, the snapshot date.

Seventh, the Nursing home cannot collect twice for the same patient, so, if HHSC pays the nursing home back to the snapshot date, the Nursing Home MUST reimburse whoever paid them while the case was pending.

Enter into this mix, “PENDING MEDICAID.”  Pending Medicaid is a business decision on the part of the Nursing Home.  It is, in essence, a loan.  The Nursing Home keeps the patient in care while the application for Medicaid benefits is pending in hopes that the application will be granted and they will get paid.  Not surprisingly, Pending Medicaid is often NOT offered at nursing homes that have wait lists for admission and relatives ARE often asked to sign a personal guarantee of the charges just in case HHSC denies the application.  Whether to take advantage of pending Medicaid is actually a strategic decision and should be carefully considered in light of all of the application and estate recovery variables.

This article is written by an attorney at Attorney Donald Wyatt PC. Always consult an attorney before making any legal decisions. To make an appointment today, please click here to contact us.