PRIVATE PAY REIMBURSEMENT NOT FORTHCOMING FOR PEOPLE WHO GET MEDICAID IN A NURSING HOME

In late 1998, the Health Care Financing Administration announced that it would begin policing the responsibilities of nursing homes to reimburse patients or their families for periods of care covered by Medicaid. Here’s how it works. When a person is determined to be eligible for Medicaid, the "pick up date" is usually much earlier than the date that the application is approved. Who is supposed to pay from the pick up date to the date of determining the eligibility of the applicant? Medicaid! What frequently happens is that the nursing home does not effect that reimbursement and the family is left unreimbursed and whats more it doesn’t realize it. The private pay rate is higher than the Medicaid rate. Thus the nursing home is somewhat reluctant to reimburse since it will make less money that way. We can go a step further. Nursing home residents and their families are unaware of the fact that Medicaid coverage can be retroactive to up to three months before the application is submitted provided that the applicant would have been eligible during that period or some portion of it. Many clients and family members are unaware or too weary to focus on this benefit. KNOW YOUR RIGHTS.