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Boy I had no idea there was ever this kind of mess. Not surprised though. So look out everyone. Just found out that after 20 days of rehab when you start using the extra 100 days allowed there is a hefty daily co-pay.
When my mom was accepted by Medicaid, I believe all her other insurance was cancelled. Medicaid will now pay for everything your mom needs at the facility. Just to be sure, you may want to remind the social worker or financial department at the facility to cancel her other insurance.
Your mom now has what is known as, Medi/Medi. As Sue stated, she doesn’t need Blue anything anymore. Between Medicare and Medicaid/cal, all should be taken care of.
The NH did not cancel Moms supplimental when Medicaid took over. Since it was handled by the employer I had to call to cancel it. Both with the exchange the employer used and United Health. Her suppliment will be billed before Medicaid pays, as long as she has it. So it will be, Medicare, supplimental, Medicaid. But you can drop her supplimental.
Couple of suggestions: - If the BcBS was due to FEHIB and the monthly premium is paid from their civil service annuity / retirement ask for it to be “suspended”. Not cancelled but suspended. You never know someone may leave her $ and she goes off Medicaid. She can get the bcbs reinstated & at whatever probably excellent coverage she had & at the old premium.
- this is the sticky part.... it’s involved but kinda important: if she entered the NH as “Medicaid Pending”, then she entered it with Medicare and bcbs as her active insurance coverage. So what may happen when she asks for bcbs to stop due to the new Medicaid coverage, BcBS may due a clawback and take the end of the policy to the first of the month that Medicaid started. They can do this as they will not pay as Medicaid is now the secondary. Now mom will get the premiums paid returned as a check & it’s income/assets. So if that happens (as it did for my mom as my dad was a fed with fehib bcbs), Blues can also clawback any vendors paid between the month Medicaid started and when it gets suspended. If any vendors billed Blues & got paid by them, they get the payment clawed back. Fun! And for more fun in this, could be a weeks & weeks of delay till done or till vendor realizes it. Vendors have to rebill Medicaid & rebill in whatever timely manner Medicaid requires to get paid at Medicaids much much lower rate. And that could pose unhappiness for them. For my mom it revolved around the therapists at the NH. 1 was not at all Medicaid & didn't notice till months later & the other didn’t notice till past Medicaid submission deadline. That a clawback happened never ever occurred to me. I had no idea it happened. Sheer out of luck I sent a letter & email to mom’s NH informing them that blues was being suspended, so they were notified. As vendors & staff is under their purview, it’s on NH to notify vendors of the change. The blues premium cancellation $ went into my mom’s checking account and was spent on RXs that fell though Medicare & Medicaid and for her homeowners insurance (she still owed a home), so she started & ended the month of the Blues check within Medicaid limits. Months go by...... Then the no Medicaid pt sent bill almost a year later & he was some kinda pissed and didn’t want to accept partial payments over a few months, but then relented, got paid & was ok (why a PT would be an outside vendor is a wth & to not take Medicaid at a NH where residents are like 70-80% Medicaid is another wth). The other was too late on rebill to Medicaid and billed mom over a year later & in the interim mom had moved to another NH. So when that finally surfaced, he said just forget about it. Apparently clawback are super common when switching insurance. Even more fortunate was the month before entering the NH, mom had a big final work up at her gerontologist with lots of lab work which bcbs paid as still under policy. Whew!
So I’d suggest you send a clear letter to the NH as to the switch to Medicaid. As a cya.
My MIL has Blue Cross/Blue Shield and Medicare and recently went on Medicaid to pay for nursing home care. We were told to keep the Blue Cross/Blue Shield and she is allowed to pay for it (from her social security, which is her only income). The rest of her income, except for a small personal care allowance, goes toward her nursing home costs with Medicaid picking up the rest. Medicaid figures they come out ahead with Blue Cross/Blue Shield paying some of the medical expenses, even though it means they have to pay more of the nursing home costs. I don't know if this varies by state or not. You should probably check with Medicaid before canceling her Blue Cross.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
Now Medicaid is the secondary insurance (that pays the other 20%).
No she would not need to keep Blue Cross, (especially if she's paying for it) because she was accepted by government sponsored Medicaid.
Medicaid (or Medi-Cal in California) is for low income people.
- If the BcBS was due to FEHIB and the monthly premium is paid from their civil service annuity / retirement ask for it to be “suspended”. Not cancelled but suspended. You never know someone may leave her $ and she goes off Medicaid. She can get the bcbs reinstated & at whatever probably excellent coverage she had & at the old premium.
- this is the sticky part.... it’s involved but kinda important: if she entered the NH as “Medicaid Pending”, then she entered it with Medicare and bcbs as her active insurance coverage. So what may happen when she asks for bcbs to stop due to the new Medicaid coverage, BcBS may due a clawback and take the end of the policy to the first of the month that Medicaid started. They can do this as they will not pay as Medicaid is now the secondary. Now mom will get the premiums paid returned as a check & it’s income/assets.
So if that happens (as it did for my mom as my dad was a fed with fehib bcbs), Blues can also clawback any vendors paid between the month Medicaid started and when it gets suspended. If any vendors billed Blues & got paid by them, they get the payment clawed back. Fun! And for more fun in this, could be a weeks & weeks of delay till done or till vendor realizes it. Vendors have to rebill Medicaid & rebill in whatever timely manner Medicaid requires to get paid at Medicaids much much lower rate. And that could pose unhappiness for them. For my mom it revolved around the therapists at the NH. 1 was not at all Medicaid & didn't notice till months later & the other didn’t notice till past Medicaid submission deadline. That a clawback happened never ever occurred to me. I had no idea it happened. Sheer out of luck I sent a letter & email to mom’s NH informing them that blues was being suspended, so they were notified. As vendors & staff is under their purview, it’s on NH to notify vendors of the change. The blues premium cancellation $ went into my mom’s checking account and was spent on RXs that fell though Medicare & Medicaid and for her homeowners insurance (she still owed a home), so she started & ended the month of the Blues check within Medicaid limits. Months go by...... Then the no Medicaid pt sent bill almost a year later & he was some kinda pissed and didn’t want to accept partial payments over a few months, but then relented, got paid & was ok (why a PT would be an outside vendor is a wth & to not take Medicaid at a NH where residents are like 70-80% Medicaid is another wth). The other was too late on rebill to Medicaid and billed mom over a year later & in the interim mom had moved to another NH. So when that finally surfaced, he said just forget about it. Apparently clawback are super common when switching insurance. Even more fortunate was the month before entering the NH, mom had a big final work up at her gerontologist with lots of lab work which bcbs paid as still under policy. Whew!
So I’d suggest you send a clear letter to the NH as to the switch to Medicaid. As a cya.