Tag Archives | Medicare

The question was asked, when will a nursing home start “taking” a person’s social security check when they are receiving services at the nursing home … and is there anything that can be done to stop this?

Ann Kraemer states, “I want to reinforce that nursing homes don’t “start taking” resident’s social security.  As Brenda notes [below], Medicare & other insurance programs pay for some of the person’s stay in a nursing home.  If the resident’s Medicare days run out, (ref Brenda’s reference to the 21-100 days Medicare & related insurance limitations)  then the resident has to pay for his/her stay in the nursing home. Residents typically “turn over” their social security checks to the nursing home for a portion of their payment. Keep in mind that nursing homes charge on the average $6-7,000/month so most nursing home residents are looking for ways to pay that tab when their health insurance won’t pay.”

Brenda Carney adds, “For traditional Medicare, Medicare pays 100% of the first 20 days, and then a daily co-payment thereafter for days 21 – 100, as long as they meet the criteria for Medicare Skilled Care.  If they have a secondary insurance (besides Medicaid), they may pick-up some to all of the daily co-payment.  If their secondary insurance is Medicaid, then at day 21 they start charging the daily co-payment until all but $60 of their social security check is depleted then Medicaid kicks in.  If they DO NOT have Medicaid, then the co-payment starts at day 21 and continues until discharge from Medicare.  Therefore, it is HIGHLY recommended that they apply for Medicaid should they not have any savings (over $2000) as it could cost them A LOT.  Nursing Home Medicaid is different than community Medicaid, so it is worthwhile applying for …

Having said ALL of this, there is a Special Director or Olmstead exception that they can apply for which will possibly waive part to all off the monthly payment to the nursing home out of the Social Security check.  Below is a link that explains this application process.  The nursing home social worker should be able to assist with this process.  They have to provide supports for all NECESSARY bills that they need to maintain their apartment while they are in the nursing home.  It does not include Cable TV, etc.  I have applied for this on behalf of a resident successfully and partially successfully.  Do not anticipate that the entire social security check will be preserved.

http://www.mplp.org/Issues/mplpissue.2010-05-05.9554801510

As for food stamps and SSI, while you are in a nursing home, these items are items that can be cut.  However, it does not consistently happen, depending on how long the individual is in the nursing home and the speediness at which the billing office at the nursing home submits and the State changes the resident’s status as Nursing Home in the State computer.  There is no work around that I know of … and cannot be applied for until after they are discharged from the nursing home.  There is a code in the State Medicaid system that needs to have them reflected as being community living for them to be eligible for Food Stamps and SSI.  Conversely, it can take a while when the person is OUT of the nursing home to resume these services as it depends on the speed of the billing office at the nursing home to submit and DHS to change the State database.”