Is there a way to file a Medicaid complaint?
Specifically Georgia?
My mom moved into a nursing home from Georgia to Alabama the end of May. I did not know about the QMB program so it was never closed out in Georgia, I thought it was only long term care Medicaid she was on. Well now I am trying to go back and close out the Georgia QMB Medicaid and I am having many problems. When I call the only number I either get someone who tells me to go to the DFAS office, which when I went they told me no one can help and I need to call the number who referred me to them. The next time I called and got someone who closed out my moms account but did not close out the QMB in the past like I asked. And when I just called now, they told me my moms account is closed and there is nothing they can do at all. I am getting very frustrated. My moms case worker in Alabama Medicaid told me that Georgia has gone back and closed QMB for previous months. But I have no clue how to do it. Is there any way I can get a hold of someone above all these workers who can help me? I have researched online and can't find anything. I have asked to speak to managers but they only just repeat what the person I called said.
I hope this made sense. I am trying to write when frustrated and my two year old is here hanging on me. Please ask questions if I need to clarify something better! Thanks.
then in Feb, after a fall mom does hospital stay & then sent to rehab @ a NH & has 21 days rehab @ LTC/NH which Medicare pays. But mom stays there till April 31 & so mom applied for LTC /NH medicaid (a separate application than that for community based orograms medicaud) to pay what Medicare won't. 7K due for the nonMedicare paid time of Feb & March. Mom is "medicaid pending" in GA and still not approved for LTC Medicaid at the time she moves out on may 1, so rehab has not gotten paid in full. Did mom pay a SOC? Was anything in either the admissions contract or the discharge agreement as to the terms for outstanding bills or the settlement of moms 7K outstanding bill?
As an aside, My moms first NH required family to personally sign off a financial responsibility contract if at mo 5 they had not been determined Medicaid eligible & if not a 30 day notice to leave was sent certified mail to family.
May 1, mom moves to private pay personal care home in GA.
Did moms GA LTC/nh application stay active? and still in the pending group? I'd call GA Medicaid to see what the status is of her application done March/April. Do you have any idea if all documents needed for Medicaid LTC/NH program were submitted to GA? Hopefully GA application is working it was to approval and NH gets eventually paid. But could be that if there were items needed for GA, they weren't done and her application closed out for noncompliance. I'd be concerned since mom is no longer a GA resident that her file is closed out. The GA NH is owed 7k either way.Whether they can collect is a crap shoot - if you signed responsibility, they or collections will hound you.
May 27, mom moves from GA to a AL to a Nh and applies for AL LTC / NH program. Has mom been Medicaid LTC/NH approved for AL? Or is she still pending. What does her admissions contrac read as to payment due if there is an issue with her AL Medicaid pending status?
Really I'd spend my energy to get her approved for AL - the new state. Each state has their own requirements and application & standards for Medicaid. Ask clearly about paying to the new NH moms co-pay & if mom being in a private room is an extra charge or an issue for AL medicaid. Medicaid usually requires shared room unless medically needed or room is too small or odd shaped to have 2 residents with 2 beds. Good luck.
1) Mom has MS and is in scooter full time. She moved by us in GA into a section 8 home so I could help with her meals, laundry, etc. She was still able to transfer herself and dress herself so it worked out. She received Medicare and Medicaid (I always figured there was only one type of Medicaid so I don't know exactly which one it was).
2) In February of this year, she fell and broke her hip. After her hospital stay she went into rehab. After the 20 days (20 day may not be correct, maybe 30) of where medicare pays 100%, I applied for her long term care Medicaid so they could cover the rest of rehab. The nursing home/rehab she was at has a Medicaid specialist so she helped me apply.
3) In April, we were told that she was not improving in rehab so it was ending soon (we had a three day notice to figure out what to do). They all recommended a personal care home. I found one that my mom moved into on May 1st. She did not receive Medicaid for the home because the state program for that kind is on hold, she was on a waiting list, so the home was paid out of pocket (fortunately my grandma was able to assist with that). The personal care home ended up being horrible for her. She needed assistance at night to go to the bathroom or be changed, and they just would not do that for her. Also, the live in CNA was just not a nice person and my mom was miserable there. I had a social worker come to the home, and he found the place not a good fit for her. He highly recommended a nursing facility.
4) The only nursing facility with a private room was in Alabama (only about 15 minutes from our home). She moved in May 27th and has been there since. Right away I applied for Alabama long term Medicaid, which is where the problem started. Alabama Medicaid has told me that Georgia Medicaid was paying for her QMB Medicaid for the entire time she was in AL, I assumed her Medicaid stopped when she was out of the nursing home and we didn't get her other Medicaid renewal completed for this year.
The $7,000 was from the rehab, the Georgia long term Medicaid is STILL pending from back in March. So the rehab sends me the bill and tell me I'm responsible since they haven't been paid by Medicaid.
I hope all that made sense!
1. mom was living in GA and been in & out hospital and rehab in GA past few years. These would have been filed for and paid by MediCARE as the incidents probably were within the 21 - 100 days that Medicare would pay for hospital & rehab stays. The bills & payments related to these stays would have been summarized in letters from CMS that mom received to her GA address. CMS is Centers for Medicare & Medicaid and they are the central hub for all federal payment of programs both for individual Medicare payment but also for federal payment to the individual states Medicaid program. Medicaid is a joint state & federal program: administered uniquely by each state but within an overall federal guideline that CMS provides.
Understanding how the M & M's are similar yet different is important. Heiser's book is really most excellent at all this & the overview of issues related. Buy the book.
These stays paid by Medicare, so settled & no billing. Is that correct?
2. mom was in a personal care home that took Medicaid in GA for a few weeks AND applied for GA Medicaid & was "Medicaid Pending" in GA to pay for the home. Bill for this $ 7K. Is that correct?
If Medicaid pending, mom would have been required to do a co-pay or her "SOC" (share of cost in Medicaid speak) of all her income to the home under Medicaid's rules. Did mom do the co-pay? Was mom accepted by GA Medicaid?
If the answers are NO, then she needed to do the co-pay to be OK for pending in the old state; AND she needed to follow-through to make her eligible for GA Medicaid. Right now since she has moved to another state, she is going to be found ineligible for GA Medicaid unless you make it a point to dog the GA application.
My MIL was Medicaid pending for months in a NH in TX (she was already low-income housing and blind benefits before) and got septic and moved to a hospital and then an in-unit hospice where she died about 3 weeks later. Hospital & hospice are Medicare benefits. BIL & SIL just dogged the Medicaid application even though she had died and she finally got approved for Medicaid almost a year after initial application filed. During this pending phase the NH did bill BIL at private pay rates which they did not pay as the Medicaid application was still active.
To get the old GA facility paid the 7K, you or family in GA will have to complete the GA Medicaid application. If it's rejected & mom ineligible, the home can go after whomever signed off to be financially liable for paying for mom's stay. If you signed to do this, they will come after you & could turn it over to debt collectors. If mom signed all herself, then just too bad for home as mom has no $.
If a good bit of time has passed in all this, mom could be beyond the point of being eligible as she may have missed deadline to get items in for GA Medicaid and so has had her GA Medicaid application denied. If so, the home can bill the 7K to whomever they can pin financial responsibility upon, like you.
3. mom has been low-income and because of this she has qualified for QMB. QMB is "Qualified Medicare Beneficiary" program in which the co-payment needed for the different parts of Medicare is waived or the individual qualifies for another program - like Medicaid - to instead be billed for a service that Medicare would have paid for.
QMB is great to cover paying for things covered by Medicare. BUT the room & board bill at a facility is NOT a covered Medicare benefit.
4. mom moves to AL and goes into a NH that accepts Medicare & Medicaid and has applied for AL Medicaid and is Medicaid Pending. Her Medicare - since it is federal - moves with her to AL to pay for whatever can be billed to Medicare. But she needs to apply for AL Medicaid for other costs @ NH like the room & board costs.
Is mom paying the required co-pay/SOC each month to AL NH?
Has AL Medicaid gotten all for mom's Medicaid application to be done?
Any issues (property, assets, etc) that would make her AL Medicaid ineligible?
Really getting mom approved and all ok for AL Medicaid needs to be your top priority.
5. at this point, the 7k as that is either going to be paid by GA Medicaid or turned over to collections or written off. It's a valid debt. The old GA facility knows they are likely out of luck in ever getting paid and really a 7K debt is kinda low to be of much interest to debt collection agencies. They could use a debt seeking attorneys but since she is in another state…. so if the place uses a GA attorney to go after unpaid, they have to be licensed in AL to do squat. It's really uncollectable unless you signed off to be financially responsible in the admissions contract.
Do you have the admissions contract from GA? and what does it read?
If you didn't sign off to be responsible, it's not your problem. If you get debt collections letters then you respond to them within 30 days in a certified letter that it's not your debt and you consider the matter closed.
Really make getting mom eligible for AL Medicaid your priority. Good luck.
I am pretty sure QMB is Medicaid, it's listed under aging, blind and disabled Medicaid. Igloo572, what is CMS? Also, I didn't add these details to my original statement, my mom was not in a nursing home in GA immediately before her move to AL, she was in a personal care home for a month, who did not care about anything, which is why we moved her to a nursing facility.
I haven't' talked to the business office in Alabama but that is a good idea to try before an attorney if it's not resolved with my email. With my experience of a nursing home in Georgia (my mom was in rehab and has moved around several times, bad experiences), I received a bill for $7,000 and called and told them that Medicaid is pending for it, so I am only paying our portion, and she told me, that I am still responsible for the 7,000. So that place could care less if Medicaid goes in or not, they will just bill me. But that is another story and Medicaid for it is still pending after applying in March.
Thank you again everyone. It is a very nice feeling having all of this support.
Did mom apply for Georgia Medicaid and has she been ruled eligible?
Several have been on the accounts for other's that never received what they were charged for , as well as for myself being charged for procedures I never received.
I do not get any responses. Rather sad state of affairs.