I will spare the whole big mess and try to keep it brief: we placed my dad in the nh to receive some PT and speech therapy to regain some strength, however the nh called and said his Medicaid will not pay for anything, not even room..he's been there 5 week and now he's getting bill for room! I don't know why they accepted him without a proper pay source...isn't it there job to see if his Medicaid will pay so the pt can receive proper treatment before they accept him? I know nothing about Medicaid and told SW at hospital that when they were trying to get him placed...,I talked with admin today and she said they were just being compassionate and had a bed so took him. I'm not sure I believe that. Why wouldn't they tell me up front then that his Medicaid would not pay and he wouldn't receive therapy AND he would have to private pay? That doesn't seem very caring to me, but want another opinion. Also, she told me once he did get approved for nh Medicaid it would pay for therapy but it would NOT improve his quality of life ad the disease is progressive? What?? I'm pretty surf learning how to chew ANC swallow properly would possibly help with choking issues and therefore not choking would improve his quality of life. However, I didn't know what to say at the time. I know it's progressive but I thought therapy could help with hd. Am I wrong on this way of thinking? It's been a hard day and would appreciate thoughts. Thank you all!

Ps. My dad is still ambulatory

Sorry for typos, I'm on my phone, lol

I wouldn't believe they were being compassionate either. Medicade is welfare, and you have to be down to less than $2000 in assets in most cases. However if he has Medicare, they should pay some of that.

Tell them to bill your dad, then don't pay it. They should have had the funding worked out pretty fast. To do medicade you have to go to the DHS and qualify for it, they usually start that process.

Apparently they don't have any social worker there worth their salt.

No he doesn't have medicare and does not qualify, tried 3 times. He has Medicaid, just not the kind that pays for NH care, very confusing, I know! They already told me they were led to believe he had medicare, and my question to them, was "shouldnt you have made sure?" thanks for your response Fred. Also, will/can PT and speech therapy help an HD pt to improve their quality of life? They told me No, but then again they don't have s HD pt!

Does he get SSI? and he has Medicaid that goes along with that? Even if he has Medicaid and enters a LTC facility someone still may have to go to the local DHS office and do the application for Medicaid to pay for LTC facility. You need to call the DHS office and see what the steps would be to get Medicaid to cover the Vendor Payment for the LTC facility. (Usually, it a seperate application for LTC and if that wasn't done yet someone needs to do it)
Something is missing in the details here?

Regarding pt/speech therapy, we never tried it as we were advised by dr & other HD caretakers that it did not really help, I could see more where physical therapy might help as to help balance and to keep muscle's moving..... the problem is Insurance or Medicaid and Medicare consider coverage on these therapies to be for a short term period of time. Ongoing long term therapy would be required for HD as it is progressive.
Any other comments or advise I would be glad to hear about.



Edited 1 time(s). Last edit at 04/11/2012 04:34PM by LizzieAnn.

Lizzie Ann, thanks for responding. Yes, he gets SSI, and we have applied for nh Medicaid, he had community based. My frustration is that he's been there for 5 weeks and has only received room and food, yes, and I will admit the security of someone checking him, however he had lost weight and the dr. Told us he needed about a month of therapy to give him some strenghth. The nursing home even told me the first week that even though his Medicaid didn't pay, they would do what they needed to take care of the pt they took on, even if it meant eating the cost! He still hs received nothing, and I just wish they would have communicated better and not told me things that were never going up happen. I fill nearly wrong but I called corporate yesterday, I'm not being vindictive and this is not my norm to "get people in trouble" but I fo not want this to happen to someone else.

Also, we are now using his SSI to help cover the cost of his room, but it's not near enough, but we know it's his responsibility to pay, just wished we would have known up front that his Medicaid was not going to pay, not getting bills 5 weeks later informing us of that. We were told it wouldn't pay for therapy the 2nd week not the nh room and board.

Also, does any others have advise regarding therapy too? Thanks!

my mom had medicaid and the nursing home took her with no questions asked. never sent a bill or anything.
they had physical therapy but she refused it so i dont know if it helps.
Laura

My guess on this LTC/medicaid non-payment is that your father just entered the LTC facility because someone wanted him to have "therapy" of some sort. Not that he met the criteria for needing skilled care/ therefore medicaid is stating they will not cover the cost as he doesn't meet the criteria for skilled care. They probably would have paid for speech or physical therapy in the home or at a provider's office? Not sure if that's the case. All you can do is call Medicaid Services and ask why it's not covered? They will tell you if you ask Why?

If he is approved for Medicaid to pay the nursing home they will go back 3 months and pay the back bill. They will probably take his SSI or apply it towards his contribution. You dont normally get back anything you've paid out though.