Mom is laid up in extended care hospital, doesn't have medicaid

March 14, 2019 3:36 PM

My mom, who is on disability, suffered a fall towards the end of January. Now after multiple weeks of hospital stays and transfers she has been informed that she doesn't have medicaid by her hospital case worker.

After a fall in January, she has been hospitalized until now. She was hospitalized by the main hospital because a kidney stone and infection ultimately caused the fall. The county's main hospital kept her and crushed the kidney stone and worked to heal the infections enough and then transferred her. Her case worker at the main county hospital said that they had taken care of billing, that she had both medicare and medicaid, and that any bills would be covered.

She was then transferred to a rehab facility , where she is undergoing physical therapy and preparing for another surgery and has been for almost 3 weeks. Her caseworker at this facility came to her a day or two ago and has informed her that she doesn't have medicaid, and now they are questioning her about how she is going to pay for all of this. Naturally, she is now terrified that she is going to be thrown out on the street. I'm personally terrified that she won't be, and they will simply do what needs to be done and then come for her home and land after everything is said and done.

The only thing that I have been able to find out from anyone about why she is not eligible for medicaid is that she has a life insurance policy. This was said by a caseworker after multiple calls to try to find out why she won't be covered. I am not even sure about this, but I think my grandmother did take out a life insurance policy on her, some decades ago.

I don't believe it, but is this something that can be stopping her from getting medicaid? Does anyone even have any ideas about what to do next? Should she be trying to cash this policy out if that is even the problem? I don't even believe a life insurance policy that someone else took out on you decades ago could effect this, but I don't know how any of this works.

Any suggestions would be greatly appreciated, because I'm basically at a loss and tearing my hair out here, and I can only imagine what my mom is going through at the hospital now.

Thanks.

posted by FireballForever to Health & Fitness (14 answers total)

You might want to see if there's a language issue. According to my wife, who is a rehab nurse, Medicaid coverage for rehab stays is somewhat different than for general hospitalization. This could be a "Medicaid will not cover this" scenario rather than "She doesn't have Medicaid." Or "We don't take Medicaid."
posted by jgreco at 3:44 PM on March 14, 2019 [2 favorites]

I don’t think the life insurance has anything to do with Medicaid.

However, she may have too many assets to qualify for Medicaid. Google “Medicaid spend down.” Then contact an elder law attorney in your state for assistance in finding out if your mother qualifies for Medicaid, and what will happen with the bills she has incurred to date.
posted by amro at 4:08 PM on March 14, 2019 [1 favorite]

Your mom needs a social worker, who should have LOTS of experience with this kind of scenario.

I agree with the observation above that rehab is its own animal, and there are lots of specific rules around rehab facilities. Basically, if you are not making progress you can't continue to be in rehab and need to move to a less therapeutic-intensive environment. The rules are extremely specific and picky, down to the number of minutes of nursing and therapy care per day.

The Medicaid eligibility issue is also key, and once again a skilled social worker will be very helpful. Can you assist by interacting yourself on her behalf? It will need her OK for you to do this.

I would also suggest that if you are at an impasse, you contact the office of her Federal House representative. Her local state rap might also be helpful. This kind of issue is frequently taken up by Congressional aides, and can really make a difference. Your mom is a constituent, and you can figure out which rep is hers based on her mailing address.
posted by citygirl at 4:16 PM on March 14, 2019

What state are you in? Medicaid coverage for physical therapy differs by state.
posted by whimsicalnymph at 4:26 PM on March 14, 2019

You very much need a social worker or other professional who works specifically with Medicare/Medicaid (also called Dual Eligible in some places) cases. A lot of this will be state-specific. In CA we have California Advocates for Nursing Home Reform, who have a huge amount of resources around Medi-Cal and paying for care. You might search for a similar program in your state.

Feel free to MeMail me if you would like to share what state you're in and I may be able to give more specific links.
posted by assenav at 4:33 PM on March 14, 2019

Response by poster: She is in South Carolina, she has been repeatedly told she didn't qualify, and has been paying 125 dollars a month out of her disability check for medicare and never had medicaid. She was taken into the hospital and the hospital's social worker said that she had gotten her onto both medicare and medicaid, even to the point where they said she should even be paid back the 125 dollars she had been paying in, because she should have always qualified and shouldn't have been paying anything. The insurance information came from a social worker who refused her previously, that was the -only- thing we have ever been able to find out about why she may not qualify. She only has a disability check that is 525 dollars a month. We also went through a process of cashing out her retirement accounts and things like that, I guess that was the "spend down" part.

We figured the social worker at the main hospital said that it was taken care of, so it wasn't anything we worried about until the social worker at the rehab said that she didn't have it again. Also, these are both hospitals that are under the wing of the county hospital. One was the main county hospital, another was an arm of the county hospital that specializes in rehab. I think they both have their own sets of social workers who do patient outreach.

I assume the government is just repeatedly rejecting her because some line on some spreadsheet somewhere doesn't line up, but nobody will answer why, and I'm legit getting more and more fed up and angry the more I think about it.
posted by FireballForever at 4:58 PM on March 14, 2019

Can you get back in touch with the initial case worker? They seem to have a theory under which she’s covered, and might be helpful figuring out what’s gone wrong.
posted by LizardBreath at 5:23 PM on March 14, 2019 [2 favorites]

We just dealt with something like this with my partner's grandmother (but in California) and he had to go to the Social Security Administration to sort out which Medicare she was on (part a, b, c, etc.) and make sure she re-enrolled in part b when the open enrollment happened, etc.

1) I would start with finding out how the rehab facility specifically bills physical therapy, etc. (For example, my partner's grandmother was rejected from a hospital's in-house physical therapy because they only billed under part b, but a local retirement facility was able to take her and bill under part a for some reason.)

2) You also need to find out what coverage she actually has, either from the social worker or directly from the government.

3) What services her current coverage actually cover in your state.

After you have those pieces of information, you'll be in a much better position to start making decisions and communicating clearly with the facility (and/or finding a new place, should she not qualify for their care under her current coverage).

Also: if her only income is that $525 a month disability check, she probably qualifies for Medicaid and should be enrolled as soon as possible. (IDK about the insurance policy, but I do know that many assets can be used to prevent a person from qualifying for Medicaid.)

This is going to be a pain in the ass. But your first step is gathering more info. You can do that. Bring a list of questions to every conversation with a social worker or nurse or administrator. Take notes. Proceed accordingly.
posted by whimsicalnymph at 5:29 PM on March 14, 2019

You can try to find a community health worker, because they may be able to help fix Medicaid issues. The National Provider Identifier Database offers a searchable directory, and there are additional resources, including for Medicare, listed at the MeFi Wiki ThereIsHelp page. In addition, some legal aid programs offer assistance with a variety of public benefits issues, so you could also try to help your mom apply for free legal assistance, and they may be able to quickly figure out what is wrong and how to fix it.
posted by Little Dawn at 6:30 PM on March 14, 2019

Life insurance policies with cash out values can go over the asset limit for medicaid .

If she has one, check the value against the asset limit.

Local area senior centers deal with sort of thing all the time. Call one to see if they can help you out as well.
posted by AlexiaSky at 6:31 PM on March 14, 2019 [1 favorite]

Medicaid is retroactive up to 90 days, so if she is eligible your current stay will be covered.
posted by AlexiaSky at 6:32 PM on March 14, 2019 [1 favorite]

My MIL had life insurance that definitely had to be cashed out and spent down before she was able to qualify for Medicaid. Caveats: Not South Carolina, and about 15 years ago.
posted by molasses at 8:27 PM on March 14, 2019 [2 favorites]

FWIW, I'm pretty sure Medicare pays for rehab stays up to a certain number of days. Has anyone looked into that?
posted by Thorzdad at 5:40 AM on March 15, 2019

Here are some links to resources for seniors in South Carolina:

https://www.sciway.net/org/columbia-sc-senior-resources.html

https://aging.sc.gov/programs-initiatives/legal-assistance-seniors

http://centralmidlands.org/about/aging-services.html

https://scaccess.communityos.org/zf/taxonomy/detail/id/468033

Look through them and call a couple of them for help. Good luck!

(PS: I'm a reference librarian at a college in South Carolina, feel free to memail me.)
posted by mareli at 6:11 AM on March 15, 2019