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Kenton Zink, EBS in Dane County, helped a client get nursing home care covered by Medicaid. The client was covered by MAPP when she went into the nursing home. She initially elected hospice benefits but later revoked the hospice election when her condition improved. She then returned to full benefit coverage under MAPP. However, rather than bill Medicaid for the remainder of her stay, the nursing home billed the client directly, threatened collections, and even pursued her family members for payment. When questioned why the claim had not been submitted to Medicaid, it turned out that the nursing home billing office mistakenly thought that it was not allowed to bill Medicaid due to specific procedural requirements. Medicaid requires a nursing home to submit a level of care request when a resident revokes a hospice election and continues to reside in the nursing home. The billing staff thought that a level of care request could only be submitted for a person enrolled in long-term care Medicaid. With some advocacy from Kenton, the nursing home agreed to submit the claim to MAPP and the entire stay was covered, saving the client from more than $30,000 of debt.
Monetary Impact = $30,000
11/30/2022
Story #41
Nyna Frelich, EBS in Brown County, recently helped a client get approved for Family Care, allowing the family to keep all of their assets without having to spend any down, thereby saving the family over $150,000. The couple's countable assets were around $160k, so they would have to spend down to half. However, Nyna discovered that the couple's long-term care insurance policy had been paying for care and, that after the asset assessment, if they continued with the application for Medicaid, any amount the LTC insurance policy paid out (about $100k) would be disregarded pursuant to MEH 35.1. Essentially, they wouldn't have to spend down anymore because the $100k exemption already put them below the asset limit. This made it so that the client could get Family Care services right away without spending down any more than necessary.
Monetary Impact = $150,000
9/30/2022
Story #33