Nursing home billing in Connecticut?

[laureano97]

I believe a general practice of nursing homes' billing is to suck every penny from the person being admitted...such as $20k/month...and then when that money is gone, the nursing home looks towards Medicare/Medicaid/Insurance/Government for future payments. My questions are regarding a nursing home in CT:

1)Can someone elaborate on my statement above. Are there accounts that the nursing home cannot touch such as 401k or IRA or???

2)If someone wishes to give away quite a bit of their money before going into a nursing home, how many years in advance must they do it so the nursing home can't say "hey, we saw that you gave away $50k to your daughter last year...either get it back and fork it over or we will not admit you".

3)If you unfortunately realize that you need to move into a nursing home immediately, how much of your money can you give away and to whom (just immediate family? grandkids? friends?)

We are not looking to skirt any laws...just looking for guidance on the policies so we don't have any "oh no!" moments 2-10 years down the road.

Thank you very much in advance.

[kendrix]

All nursing homes have various costs and fees. In the U.S. nursing home care is not considered a "free" service unless one has little or no resources, which individuals can apply for Medicaid. Most nursing homes (unless VA and some places with county owned nursing homes) are run by either for profit or profit businesses. So the nursing home is not a government instituition. Medicaid will provide a daily per diem for nursing home for individuals who qualify for Medicaid. So with saying that the nursing home does not go after your money. The individual who wants to reside in a nursing home would of course need to have the appropriate resources to pay for his/her care if they do not qualify for Medicaid. Medicare only pays for short term stays after a qualifying 3 day hospital stay. Usually individuals in those cases are receiving skilled therapy (physical, occupational); some may need speech therapy or skilled nursing services (i.e. antibiotics via IV).

1) Nursing homes don't touch "accounts". Either you have the money to pay for services or you don't. If you are not on Medicaid, you will have to be private pay. As mentioned above, Medicare only provides short term therapy in an eligibility beneficiary period...so Medicare will cover....20 days at 100% coverage, then day 21- 100 there will be a daily co pay required (approximately $128) per day. Once the 100 days of eligibility ends, then the individual is responsible for the costs. Also, therapy may discharge before the 100 days due to improvements or also when there is no shown improvement or benefit.

2) I think you may be getting the role of the nursing home and the role of Medicaid and assests mixed up, which is easy to do because it can get complicated. Medicaid does look at gifting, and gifting amount of money within a certain time frame will disqualify one for a certain number of years for being able to get Medicaid. Five years for look back seems to be the magic numbers in some states. In a nut shell, Medicaid is looking at is for individuals who have resources who are looking to make him/herself appear as if they have no resource so that tax payers can then pick up the bill for their nursing home care. So this is where the look back period comes from. So giving away $50,000 one year before entering a nursing home will penalize for a certain number of years for being able to apply and receive Medicaid for nursing home care.

The nursing home is a separate entity from Medicaid. They will give residents information on insurance, how to apply for Medicaid, etc, but they are not involved with the Medicaid rules/laws for long term care for payment.

3) Refer to answer #2


And looking at the system in the U.S., I highly doubt any time in the future that nursing home care will be "national coverage" where all citizens qualify for free nursing home care. Look at all the grumbles with the things in the national healthcare laws right now lol I am not going to get politicial, but just saying since nursing home care is not free, that we have to pay when we have the money. For those who don't have the resources they qualify for Medicaid. Keep in mind also that not all nursing homes accept Medicaid.




Medicare Coverage in Skilled Nursing Homes: http://www.medicare.gov/publications/pubs/pdf/10153.pdf