If your loved one requires a Medicaid bed in the Chicago metropolitan area and the payor source is Public Aid Pending (PAP), you may be in for a difficult encounter. What do I mean by Public Aid Pending? It means that an individual needs the support of the Medicaid program (Federal system administered by each state that grants assistance for long term care to people who can’t pay privately.), but his/her application is in the process of being prepared. Or, the application has been prepared, filed, but isn’t approved with a case number. Due to the implementation of the SMART Act (Save Medicaid Access and Resources Together), Illinois is now one of the toughest states in which to obtain Medicaid.
Right now, the nursing homes aren’t too willing to accept residents who are in PAP status. That’s because if a resident enters in this status, the nursing home receives no reimbursement for their care until the case is approved and stamped with a number. In addition, it can take up to three months or longer to get an application approved. Plus, many of the nursing home representatives that I deal with are reporting that reimbursement from the state is currently nine months or more in arrears. In total, you may be looking at a year before a nursing home receives payment for a public aid resident. Therefore, most nursing homes are asking that a resident has at least one or two years of funds to pay privately before filing a Medicaid application.
Here are some issues I have encountered while searching for Medicaid beds for my clients. many of the nursing homes are simply not accepting anyone in Public Aid Pending status because their censuses already have too many residents applying or waiting for approval. Please don’t panic. You will find a bed for your loved one, but it may not necessarily be at your first choice of communities. If your loved one is currently at a nursing home for a Medicare stay (That is the federal program for short term rehabilitation at a long term care community.), and you know there is no way the senior can return home permanently, begin your application process immediately. Ask the Admissions Director if there is a Medicaid bed available so your loved one can transition from Medicare to Medicaid. If a bed will not be available, use your loved one’s remaining Medicare days as a bargaining tool with another community that might have a Medicaid bed available. That way, your loved one can transfer and their new home can be reimbursed by Medicare while you are filing the Medicaid application. The Admissions Directors are more likely to help you if they know the community is going to get some payment from Medicare while waiting for the Medicaid application to be approved. I will also note that many of the nursing homes want the prospective residents to use their, “financial specialist,” to file a Medicaid application, rather than using an alternative source. If the resident uses their resource, the home is assured of collecting as much private pay from the resident as possible.
In addition, I am seeing more stringent financial requirements from the Illinois Supportive Living communities. There are several of these communities that always required one year to eighteen months of private pay before a resident could file for Medicaid. As of late, some communities will not let a resident enter unless they have at least $20,000 in assets to pay privately. I actually had one client declined for an admission because his wife’s medical needs in a nursing home would deplete his assets too quickly,
As a senior living advisor who works with clients of all income levels, I have completed hundreds of public aid placements since the opening of my business in 2006. I can still assist people with finding the best public aid placements for their loved ones. I can help you and your friends identify the right places too!