housing old folks

January 24, 2006 6:46 PM

My question has to do with MediCal (which terminology doesn't show up as other than "medical" when I search tags.) So. My mother is applying for MediCal for her 90-year-old mother. The problem seems to be that until MediCal comes through, my mother will have to pay for a nursing home. Which luckily enough she can do, but: will she actually be reimbursed by MediCal? And how long will that take? I'd appreciate hearing others' experience in this really murky area.
posted by goofyfoot to Human Relations (7 answers total)

It seems pretty unusual for any medical coverage to pay retroactively for services before such coverage was issued. What evidence do you have that MediCal would do such a thing?
posted by jjg at 7:31 PM on January 24, 2006

I wish you and your Mom well. Here is the page you were probably looking for.
posted by snsranch at 7:44 PM on January 24, 2006

She won't be reimbursed.

When you visit snsranch's link, be sure to scroll down to 'Nursing Home Placement,' the only relevant text on the page.

If you or your spouse anticipate placement in a nursing home, contact your county's Department of Social Services to learn about Medi-Cal eligibility rules for long-term care. These rules are very different from the ones that apply if you are not in a nursing home. For more information about eligibility for Medi-Cal long term care, see the website of the California Advocates for Nursing Home Reform. Note that Medicare does cover some care in a skilled nursing facility for a limited period of time, as long as the individual needs skilled care on a daily basis. See our section on Medicare Part A for more information.

I strongly suggest discussion of these issues, now, before you do anything else, with a knowledgeable social worker who specializes in geriatric care. You might be able to get in touch with this magical person at your local hospital; through the doctor who recommended nursing care in the first place; the AARP; your local ladies' auxiliary; your local senior citizen's center; your church; or various other places.
posted by ikkyu2 at 7:58 PM on January 24, 2006

I would be very cautious about putting money out and expecting MediCal (which is the California implementation of Medicaid) to reimburse you. MediCal has a reputation of being very slow and cumbersome even when reimbursing health care providers for services rendered, which is why so few of them accept MediCal patients. I second the suggestion of others to get this taken care of before entering into the nursing home. You don't say anything about the situation, but you may also want to connect with the local Center for Independent Living about resources that are available to help people continue to live in the community.

If your grandmother is eligible, and has an urgent need to be in a nursing home, it shouldn't take a long time to get certified for MediCal. If she has SSI she may already be certified.

This is a good page about MediCal by some people I used to work with.
posted by jasper411 at 9:55 PM on January 24, 2006

Your best bet is to call your local employment and human services office. My mom happens to work as a MediCal outreach worker, so I'll ask her in the morning. No promises though, because from what I've heard her talk about these things can be very specific so she might not have a blanket yes or no.
posted by JackarypQQ at 10:15 PM on January 24, 2006

Response by poster: Thank you all.
posted by goofyfoot at 1:14 AM on January 25, 2006

So my mom said that when you apply for MediCal you can ask for up to three months back payments, and also if you begin paying for the nursing home, after MediCal kicks in you can go to them and ask them to please bill the state, and ask for a refund. Sorry about the run on sentence. Hope that helps. If you need any clarification email me, or, I'm sure someone at your local office would be happy to answer any questions.
posted by JackarypQQ at 9:56 PM on January 25, 2006