My mother in law has been put into a full care facility, because her doctor said she could no longer live alone after a short hospital stay. Medicare cut off payment to the facility after 30 days. My sister in law was presented with bill for the months of Nov/Dec '09 in the amount of $9000.00 plus $1720.00 for medication. Without knowing that Medicaid would not pay, no information about the cost from the facility was given until the bill was presented. Medicaid is not paying for Nov/December 2009, because there was $5000.00 in her bank account. Apparently Medicaid will start paying from January on. The $5000.00 is needed to cover expenses incurred before she went into the hospital and then nursing facility. My sister in law is distraught, afraid she will be sued for this money that she did not know would be billed to her mother.
My sister in law (my husband's sister and mother) is frantic. My mother in law can walk with a walker and can feed and bath herself. She is 88 and has arthritis in her knees and fingers, but is very lucid. She apparently shows signs of early Alzheimers, but otherwise is doing pretty well.
Everyone was totally uninformed before this all happened. The doctor chose the facility and made arrangements for her to go there. We just took the doctors word that this needed doing.
How do we cover expenses when the money is not there and the $5000.00 must be paid to cover previous living expenses? None of the adult children have the money to cover the $10,000.00 being billed??
What possible options are there?
Thank you so much for your kind consideration of this matter.
1 Answer from Attorneys
Your questions raises many issues. The first relates to Medicaid eligibility and payment. In response, if Medicaid will begin January 2010, then the Department of Human Services (Medicaid agency) has determined that your mother-in-law's countable assets is now below the allowable limit ($2,000). Since she had excess assets when the original application was submitted she is ineligible for those months (November and December). However, there is a special rule that will allow her patient pay amount (the amount she is required to pay from her Social Security and any other income) to first pay down her outstanding debt to the nursing home and for her prescription drugs. The nursing home should issue a request to the Medicaid agency to adjust the patient pay so that her pre-eligibility medical expenses can be paid for. Sometimes, nursing homes are unaware of this rule. So, if you have difficulty, I recommend contacting an attorney with expertise in this issue.
Second, your sister-in-law's concern about personal financial liability is unfounded unless she also agreed to act as a personal guarantor for her mother. Even if she did, the personal guarantee agreement may not be enforceable. She will likely not have any personal liability under the facts as you describe them. She is nonetheless well advised to check with an attorney who has expertise this type of issue.
Third, you seem to be raising the question as to whether or not your mother-in-law continues to require nursing home care. I suggest you contact the local Area Agency on Aging and ask to speak with the Home and Community Based Services Waiver agent. It may very well be possible for your mother-in-law to leave the nursing home and reside back in the community with the added supports that the Waiver could provide.
I hope all this helps. The best of luck to you and your family.
Sanford J. Mall, JD, CELA*, VA Accredited Attorney
*Certified as an Elder Law Attorney by the
National Elder Law Foundation
30445 Northwestern Highway, Suite 250
Farmington Hills, Michigan 48334
Telephone (248) 538-1800
Facsimile: (248) 538-1801
Toll free: (866) 699-1800
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