My mother has been approved for Medicaid benefits starting April 7th. We have been private pay in a memory care area up to this point with monies in a Miller trust to cover the cost. 3 weeks ago she had a fall, was hospitalized and now back on Medicare while getting therapy. We have received a bill from the attorney who worked with the Medicaid application on my mothers behalf . Can I use monies in the Miller trust to pay this attorney fee or is it for medical use only?
but first on the Miller, I’m guessing NO, but you need to carefully read how the Miller is written as to “beneficiary”. I bet it reads something like “Ann Smith Jones as recepient with State of Iowa as beneficiary”. Miller has the state as the ultimate beneficiary, so while on LTC Medicaid all her income whether it’s freestanding SS$ or income paid via the trust must be paid to the facility to offset states costs. But.....
now onto the other issue on the horizon..... the Miller is all about dealing with her income and having her excess income be ok for her to be on LTC Medicaid. That’s what a Miller does.
BUT by her having a fall & then going in for a hospitalization & now discharged from hospital onto rehab, these are all MediCARE benefits.
Shes right now not a LTC resident on LTC Medicaid, she’s a rehab patient on MediCARE. MediCARE paid for her hospitalization and MediCARE pays 100% for her first 20/21 days in rehab. That required Medicaid copay of her monthly income via the Miller not needed to be paid as she in NOT on LTC but is in rehab of which MediCARE should be getting billed. Yes, it’s confusing but it’s mucho importante.
MediCARE pays like double or triple for services, the facility will - believe me - be billing whatever they can to MediCARE. If she stays “progressing” in her rehab past the initial Medicare 100% paid 20/21 days, she stays on with Medicare paying but only at 80%. The 20% remaining can be paid by her secondary insurance policy (like she has a Medicare gap or advantage plan, or has BcBS), or to can be private paid by her from her income. The 20% is a fixed amount, like abt $185 a day.
The point in all this is, those days or weeks on MediCARE, there is no required LTC Medicaid copay to the facility. That $ is hers, she’s not on LTC Medicaid yet. MediCARE is paying. Her income is still hers and can
pay the atty bill from this $. It’s gonna be confusing. You as her DPOA need to get with NH billing office and become tight & friendly with them to go over all this as there's going to be billing, then refunds, then billing, then refunds cycling through between Medicare and Medicaid and then possibly her secondary insurance if it’s was still in effect at the time of the hospitalization.
How it might run could be this: mom gets $1500 SS & $1k pension = $2500 mo. LTC Medicaid max $2100 mo. SS placed into Miller as the pension isn’t “qualified income”. But all into same banking & paid to NH less a small personal needs allowance of $50 mo (held in an acct at the NH). But since mom is on rehab post hospitalization, first 21 days paid 100% by Medicare. So $1,750 of her income is totally hers to keep cause Medicare paid those days ($2500 / 30 = $83.33 x 21 = $1750). She can use it to pay atty bill. Whatever the case, she has to spend it down ASAP and legitimately as she cannot let the $ sit and become an asset that takes her over the 2k Medicaid asset limit the next month after she gets the $.
I’d suggest you send a brief letter to the atty, that due to mom’s hospitalization and rehab that you are waiting for Medicare and Medicaid and secondary insurance (if there is one) to work thru their payment and compliance before the bill can be paid by your mom.