Nursing home residents presently face some of the biggest obstacles as Medicaid revenue shortfall has caused a change in whose nursing home bills Medicaid will help pay for and will not.
Both nursing homes in Logan County have not received any notification that any of their patients need to be discharged due to the overhaul in the Medicaid program. Administrators of both nursing homes, however, say the screening process has become a little more stringent. One of the reasons for this is to keep from having to have a resident discharged later because the screening process did not catch a possible problem with Medicaid.
Amy Arnold of Baptist Homes on Boyles Drive in Russellville (formerly Bee Hive) says her assisted living facility stays at full capacity. This home, however, is not beneficial to Medicaid recipients but those who were fortunate enough to realize a possible need for long-term insurance and who can take advantage of this alternative to nursing home care.
Residents at Baptist Home basically live independently with assistance from the staff. That assistance includes cooking of their meals if they choose to eat in the community kitchen, assistance with walking or bathroom needs, reminders to take medicine, laundry assistance; these residents are able to keep their independence with assistance.
Presently, Russellville Healthcare Manor also has eight personal care beds, which translates basically into the same benefits as residents of an assisted living unit. Persons occupying the personal care beds are more independent than those who require nursing care with a little assistance each day.
But some residents of nursing homes across the state are receiving those notifications that Medicaid will not continue to pay for their nursing home care.
Persons who receive letters, however, from Healthcare Review Corporation stating that Medicaid has determined them not to meet criteria for admission of a nursing home or for continued Medicaid payment have certain rights.
Those rights are:
1. If they believe that the services they need should be covered by Medicaid under the existing guideline they can appeal the decision. To appeal, the resident or their legal surrogate must send a letter requesting a hearing to appeal Medicaid's decision. The request must be mailed and postmarked within 30 days of the date of notice they received from Medicaid.
The request must be mailed to: The Department for Medicaid Services Division of Member and Provider Services; Program Integrity Section; 275 East Main Street; Frankfort, 40621. They will be notified of the date and location of the hearing.
2. The notice from Health Care review is not a notice of discharge. It is notice that Medicaid will no longer pay for the resident's care. A resident must be allowed to remain at the facility unless a legal reason for discharge exists. The facility must issue a separate notice if they intend to involuntary discharge a resident.
3. Non-payment is a legal reason for discharge. However, a resident can only be discharged for non-payment after they have received a service for which they have been billed and after a reasonable time have not paid. Even then the facility must provide 30 days prior notice of their intent to involuntarily discharge.
4. The facility can also involuntarily discharge if the resident's condition has improved such that they no longer need the services of the facility. In this case the facility would have to serve a notice but not a 30 day advance notice.
5. Some facilities have been advised that if Medicaid determines a resident does not meet the criteria for Medicaid covered nursing facility care, that also means that the resident no longer need the services of the facility. This may not be true. The resident may still need the same services that the care plan team at the facility assess them to need prior to Medicaid's decision not to pay for their care.
6. If the resident chooses to leave the facility, the staff should assist them in developing a safe and appropriate discharge plan. If they are not able to make safe arrangements the facility should contact Adult Protective Services who should assist the resident in finding placement.
7. Some persons who do not qualify for nursing facility level of care may be appropriately placed in a personal care facility. However, a personal care facility may not provide all the care that some people need.