Retroactive Medicaid/ Medicaid pending--When is the start date?
I suspect the answer to this question may vary by state, but what would be considered the start date for Medicaid coverage once the initial application is submitted? My husband has POA for his sibling, and submitted application for Medicaid. Sibling has been self-pay in a nursing home for over 2 years, assets all spent down. Medical eligibility evaluation process was started last week, being done by phone and documents instead of in person due to Covid-19 shut down. We sent the big packet of requested financial documents a few days ago. If found eligible, is the start date the date of the initial application? The date he is found medically eligible? Some other date? I'm sure this must have been asked and answered before but I can't readily find it. Thanks!
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Your situation is different as your mom has been a resident for quite a long time & basically on a spend down. I would guess that your moms approval will be pretty fast as it’s likely very very clear where the $ went with a preset pattern of spending over past 2 years. I’d suggest you ask & reask admissions at the NH as to their submitting the whatevers needed from their end to the state to get her approved as efficiently as possible.
As an aside on this, please review your mom’s secondary insurance policy. If she is still using one to pay for health care copays, once she goes onto LTC Medicaid and she gets approved and retro’s to date of application that old secondary policy will either be suspended or more likely cancelled outright. Everything now bill to Medicaid. Secondary usually have it where WHEN they become eligible for another insurance (Medicaid) THEN secondary stops the date Medicaid takes over. For my mom, she was on sPouse benefit FEHIB as dead dad was a fed, this was with BlueCrossBlueShield. For the 5.5 mos to get her LTC application thru, any vendor billing to BCBS was paid as she was still on it. BUT once she went onto Medicaid & it retro’s back 5.5 mos, BCBS clawed back all payments to vendors done over that 5.5 mo period of time. BCBS sent a notice on suspension of FEHIB abt 90 days in (FEHIB is pretty organized & does match ups); & I sent NH a letter as to this with xerox of FEHIB notice, so NH was clearly on notice & aware on this. Long story short, many many months later mom gets billed from 2 PTs seeking $ as they got a BC clawback & could not rebill to MedicAID as they did not participate in medicAID. It was a bit of a clusterF; why a PT seeing residents of a Medicaid participating NH would not accept Medicaid is beyond me to phantom.... Anyways, I mention this as this was something that never ever would have occurred to me to be on the alert for in the Medicaid/ Medicare LTC maze. So ck your mom’s secondary insurance and ask billing & SW at your moms place as to if all service providers at her NH fully participate in Medicaid.
Good luck in getting her eligible quickly.
It was retroactive to the date of application.