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Another Medicaid Cautionary Tale – Part 2

In my blog post last week I told you about John’s call to our office.  John had made several unsuccessful attempts to obtain Medicaid for his mom who was in a nursing facility.  He called because he had been sued by the nursing home where his mom had been residing.  The facility was looking for payment of nursing home fees totaling $100,000 with attorneys fees and costs of the lawsuit added on to that.

He said that during the time he was attempting to obtain Medicaid benefits, the facility never asked for payment.  He wanted to know my opinion as to whether he could be held responsible.  After reviewing the admissions agreement that he signed, I told him that he could  possible be on the hook.

Although John admitted to me that he never read the admissions agreement, he signed it as resident representative on behalf of his mother.  The agreement contained  several pages of language concerning filing a Medicaid application as well as what is expected of the resident representative.  The agreement also stated that the facility “encourages the Resident representative to utilize the assistance of the Facility’s Medicaid representative”.  This is typically a company that the facility uses to process applications.

Other language in the agreement gave the facility the right – but not the obligation – to file the application.  Ultimate, however, responsibility for obtaining Medicaid benefits lies with the resident and the resident representative.  

So, the question to ask is what was the reason the application failed and did John as resident representative fulfill the responsibilities which he agreed to when he signed the admissions agreement?

I’ll address that next week.