Having a loved one receive a Medicaid approval notice normally provides the family the chance to breathe easily. However, some responsibilities don’t stop once someone is approved.
A Medicaid Approval/Denial Notice looks like this in North Carolina. The first section, marked “Approvals”, outlines who has been approved, the program for which they have been approved, the months that are being covered and, most importantly, how much the person covered is responsible for paying to the nursing home each month. That’s right, even with Medicaid a person may still have to pay something for his or her care.
This amount is called the “Patient Monthly Liability” or “PML”, and it applies to both the long-term care and special assistance programs. It is based on an individual’s income, but there are certain allowances: personal needs ($20 or $66 per month, depending on the program), supplemental health insurance and, in situations where there is a spouse at home there may be an allowance made for that spouse to keep some of the other spouse’s income. The PML has to be paid every month, or the person may be discharged from the facility, regardless of Medicaid status.
It is important for spouses to remember that none of their income needs to be paid as part of the PML. If the PML assigned to the Medicaid recipient exceeds the income of that individual, contact the caseworker for clarification.
The bank account of the Medicaid recipient has to have a balance of less than $2,000.00 on the last day of every month. Many times clients are concerned because the Medicaid recipient’s monthly income will push the account balance over $2,000.00. That income is supposed to go to either the nursing home or the at-home spouse, meaning that it should be leaving the account at some point during the month it came in, so just because the account balance may exceed $2,000.00 at some point during the month is not a problem – it is the end of the month that counts. If the Medicaid recipient’s account happens to build up to the point that it exceeds $2,000.00 even after payment of the PML or transfer to the at-home spouse, some of that money should be spent of the personal needs of the recipient to bring the balance back below $2,000.00 Failure to keep the person’s “reserve reduced” could result in termination of benefits.
Finally, Medicaid conducts annual reviews of each of its recipients. These reviews are conducted via mail, and involve reaffirming the person’s eligibility, providing any updates needed, and providing copies of bank statements. These reviews must be completed and returned, or coverage may be terminated.
As outlined above, Medicaid approval does not mean an end to paperwork or responsibility. If you have questions about approval or ongoing eligibility, please don’t hesitate to contact us.
