In this Elder Law Minute, Wes Coulson explains the laws preventing nursing homes from forcing one to pay for care and services that are already covered by Medicaid.
Hi! I’m Wes Coulson from Dent-Coulson Elder Law, proudly serving clients throughout the St. Louis metropolitan area and beyond. I’d like to welcome you to our Elder Law and Estate Planning Minute. We do these to help educate people, give them some little tips, and especially to let them know the questions they need to ask, things that they’ve maybe not thought of. Our thought on that is that we can help you best if you realize the things that you need help and that we can help you with. So I hope you enjoy. Thanks!
It’s not uncommon when someone is in a nursing home and applies for Medicaid, that the nursing home will insist that they pay initially out of pocket and, unfortunately, in an increasing number of situations, nursing homes are requiring people to continue to pay out of pocket while the Medicaid application is pending, until it is approved.
Well, when Medicaid applications are approved, let’s say that someone has applied for Medicaid in June, but their application isn’t approved, or isn’t processed and approved, until September, that doesn’t mean that they’re not eligible until September. If they were eligible at the time they applied, they’re eligible starting in June. When that’s the case, and I’m talking here about Illinois because there is a particular statute on point, Medicaid will pay the facility for that person’s care retroactively to June. So, at that point, the nursing home has essentially been paid twice for those same months, once by the resident and once by the state of Illinois.
Nursing homes, again, at least some of them, seem to have a policy of “well we’ll just hold that extra money and it’ll be a deposit we can apply later if you haven’t paid your account on time. We’ll hold it as security.” They can’t legally do that, okay? I’m going to read, again, from a statute; the name of the statute is “Prohibition Against Double Payment”.
“If any resident of a nursing facility or ICF/DD is admitted to such facility on the basis that the charges for such resident’s care will be paid from private funds, and the source of payment for such care thereafter changes from private funds to payments under this Article, the facility shall, upon receiving the first such payment under this Article, notify the Illinois Department of such source of private funds for such recipient and repay to the source of private funds any amounts received from such source as payment for care for which payment also was made under this Article.” -Illinois Statutes Chapter 305. Public Aid §-5.6b.Prohibition against double payment
So, it’s an expressed prohibition against double dipping. If you are a nursing home resident, or family member of a nursing home resident, and you’ve paid initially out of pocket, whether it was for several months, or even for a month, and there’s a Medicaid approval that’s covering that same period of time. Know that right, and enforce it. Tell the nursing home “No, you’re not holding this money on account. It needs to be paid back, and it needs to be paid back now.” Thanks!
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