A common challenge people face is finding a Medicaid Pending nursing home. This happens in Montgomery County and even in bigger cities like Houston. If you have almost no assets this is usually your only option. Trouble was, there haven’t been many of these types of facilities around. But now, thanks to a new regulation you have a lot more options.
What Was Medicaid Pending?
A Medicaid Pending nursing home is one that does not require payment while a Medicaid application is pending. It’s as simple as that. After all, very few of us can afford to sit around and bleed money while fighting through the government red tape.
If the HHSC approves your application for benefits without a gap in payment, then you don’t have to pay for the months covered by Medicaid. That might not cover everything though.
It DOES NOT mean that they waive any fees. If you make a mistake and there is a gap in payment, then the nursing home can and will pursue whoever they can to get that money. Too many people think Medicaid Pending means “free” and end up with a huge nursing home bill they weren’t expecting. That can be a huge problem after all the money is already gone.
It Helped Everyone Where It Was Available
Even people who can afford to pay the nursing home for a little while still benefit from the Medicaid Pending option. This is because your loved one must be under the asset limit before they get benefits. If they are single that means having less than $2,000. That can be a problem when the nursing home is barking at you for $5,000 or more and threatening eviction. So, everybody benefited from this.
Involuntary Discharge Before the new Rule
Before this new rule there was a gray area that some facilities chose to exploit. The gray area was if a nursing home could legally discharge a resident while a Medicaid application was pending. This happened a lot to families that did not hire a law firm.
The previous rule simply hinged on non-payment. If you ran out of money while waiting 45-60 days for an approval, then nursing homes could claim nonpayment. Once they could claim nonpayment they could try to evict your parent from the nursing home. So, until now, you had many facilities still demanding payment even during the application process.
The New Medicaid Pending
The new rules clear up that confusion. Now your Medicaid lawyer can successfully protect your family from an illegal discharge for nonpayment while there is an active application for benefits. In effect, this turns every facility into a Medicaid Pending nursing home once you gain admission. This helps a tremendous amount of people struggling with nursing home demands.
You Still Have to Pay for Your Mistakes
This new rule does not make anything free. If you mess up and create a gap in payment, then you can still owe the nursing home money. In that case, they would still be able to force your parent out if someone doesn’t pay the balance because that would be a case of nonpayment. However, as long as you get through the process correctly the first time, you can avoid that surprise bill.
What About Appeals?
I’m glad to see CMS expressly addressed appeals in their new rule. A nursing home cannot claim nonpayment if there is pending appeal as well. It is the same as with the application itself. This is welcome relief considering the growing number of mistakes from the HHSC that require appeals to fix.
You Might Know More Than the Nursing Home
The people running nursing homes make mistakes. They are not always on top of the latest developments like we are (and now you are). So, don’t be surprised if you run into many places that either aren’t aware of this or try to spin it a different way. If that happens, discuss your case with an elder care attorney in The Woodlands immediately to fight an illegal discharge.
How to Use This New Rule
Previously you had to find a nursing home that you could afford for a lot longer. That was because they could claim nonpayment while you were wrestling with the HHSC. This could be anywhere between 45-90 days on average. That gets pretty expensive.
Now, your primary concern is to gain admission to the nursing home of your choice. Your nursing home Medicaid attorney can put together a plan to take care of the remaining months.