The Nursing Home Bill You Don’t Know About

You may be on the way to receiving a nursing home bill for tens of thousands of dollars and not even know it. How can that happen?

Every nursing home is different, but some are more careless than others during their admissions process. I get plenty of calls from families who admitted a loved one into a nursing home in the category of “medicaid pending” when anyone knowledgeable of the Texas nursing home Medicaid rules can tell the person is not currently Medicaid eligible and should be in the “private pay” category. This means that while the Medicaid application is pending the nursing home normally only bills the Medicaid co-payment amount rather than the full private pay amount which the person will have to pay while they are not eligible for Medicaid benefits.

So what happens when someone is admitted into a nursing home as “medicaid pending” when they really shouldn’t be? Eventually the HHSC will send you a denial of Medicaid benefits for the period of time the nursing home resident was ineligible. I say eventually because all the families that have contacted me in this situation did not hire a Medicaid attorney which in my experience leads to it taking a lot longer to get the first eligibility ruling from the HHSC.

So what happens when the HHSC makes that Medicaid denial?

First is the nursing home will give you an invoice for all of the charges that have accrued in the months while the application was pending. On average this is 3 months worth of charges but it is different in each case. You may have thought Medicaid was going to pay those charges and the nursing home may have thought so also, but once Medicaid is denied they will be looking at you.

This is the surprise nursing home bill I am talking about because I meet a lot of families who report the nursing home tells them to not worry about the charges that are accruing while the Medicaid application is pending to find themselves hit with a bill for $20,000-$30,000 once Medicaid is denied. This can be a big problem when the Medicaid applicant’s funds were already exhausted before or during the application process.

You can probably guess the next step after the nursing home gives you that big bill – they send an eviction notice for non-payment. The nursing home staff may have been nice, friendly, and accommodating before, but once that Medicaid denial comes be prepared for things to change. You can appeal and fight the eviction, but non-payment is a legally recognized reason for eviction so you may not get as far as you think. Medicaid mistakes are costly and stressful, do it right the first time and call me at (832) 592-7913 to put the power of experience on your side.