Basic documents needed for admissions 1. Personal Identification. Either a social security card and a driver s license 2. Medicare and/or Medicaid

Transcription

1 Basic documents needed for admissions 1. Personal Identification. Either a social security card and a driver s license 2. Medicare and/or Medicaid Card 3. Supplemental Insurance (if needed) 4. Power of Attorney or Durable Power of Attorney documents 5. Guardianship Documents 6. Living Will and/or DNR Documents 7. Medical Records from Primary Physician 8. Physician Admissions Orders If you are applying for Medicaid our admissions team can help you through the process. Please see Am I Covered.

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3 Am I Covered? The Medicare and Medicaid Eligibility Requirements The long-term healthcare industry is changing and so are Medicare and Medicaid eligibility requirements. Here is an overall summary of Medicare and Medicaid eligibility for Texas Long- Term Care coverage. There are exceptions throughout this process, so please consult with one of our highly trained employees to discuss your specific circumstances MEDICARE Medicare: What is it? Medicare Part A is a federal health insurance program that guarantees access to health insurance for Americans aged 65 and older who have worked and paid into the system. Younger people with certain disabilities are also eligible to receive Medicare regardless of income. Medicare Part A: How do I qualify for Skilled Nursing Facility (SNF) Care in a Long-Term Care facility? Must have a 3 consecutive night inpatient hospital stay. Must require skilled nursing or therapy services on a daily basis. Meet with a facility Business Office Manager to verify SNF benefits available. To find your facility, click here. Medicare Part A: What to expect after qualifying for SNF benefits. If you or your loved one qualifies for SNF benefits, Medicare pays for up to 100 days of SNF care. The first 20 days of care are covered by Medicare at 100%, as long as any Medicare days haaven't already been used within the last 60 days. After the first 20 days a copay will be required. After 20 days there is a copay of $152.00/day (set by medicare). *Medicare increases this copay every January. Medicare doesn't pay for private rooms. There is an additional fee associated. If you are interested in a private room please consult a facility Business Office Manager. Note: It is extremely important to consult with the facility Business Office Manager to assess your specific circumstances and needs. MEDICAID Medicaid: What is it? Medicaid is a joint federal and state program that helps low-income Americans pay for long-term care. Medicaid eligibility for Long-Term Care is determined by State of Texas, not by the facility. Medicaid: How do I qualify? Must be a resident of Ohio and U.S. citizen or alien with approved status (e.g., legalized or permanent resident alien). Must be a patient in a Medicaid-contracted long term care facility for 30 consecutive days. Additionally financial and medical necessity requirements must be met. Medicaid: Medical Necessity Requirements. You or your loved one, must require the care of a skilled nurse on a daily basis in order to meet medical necessity requirements. Some examples include: Complex wound care IV therapy Diagnosis of Legal Blindness Cognitive deficits such as Alzheimer's Disease or Dementia Seizure Disorder

4 Other care that requires a skilled nurse daily Custodial care, such as assistance bathing, toileting, eating, mobility alone does not meet medical necessity requirements. Medicaid: The Two Financial Requirements Involve Income and Resources: Income as of 2014 Maximum gross income Individual and individual with an ineligible spouse - $2,163 Couple (if both parties are in the facility) - $4,326 What counts as income? Social Security Benefits Certain Veterans Benefits Private Pensions Interest & Dividends Royalty & Rental Payments Federal Employee Annuities Railroad Benefits State & Local Retirement Benefits Gifts & Contributions Earnings & Wages Resources as of 2014 Maximum countable resources Individual - $2,000 Couple - $3,000 What is a resource? o Bank Accounts & CDs o Real Estate Property o Life Insurance Policies o Burial Funds o IRA o Stocks & Bonds o Oil/Gas/Mineral Rights o Jewelry & Antiques o Cars & Other Vehicles o Boats & Recreational Vehicles What can be excluded? Homestead where the individual intends to return. Life insurance if the face value is $1,500 or less Separately identifiable burial funds of $1,500 (less any excluded life insurance or irrevocable arrangement for burial) Car, regardless of value Burial spaces Protected resources amount for a spouse in the community $23,448 Minimum - $117,240 Maximum (Excludes value of homestead, household goods, personal goods, one car, and irrevocable preneed burial funds). Assets are only protected for 1 year. Within that year the assets can be transferred to only the spouse with no penalties. Meet with a facility Business Office Manager to complete Medicaid Application and discuss your specific situation. The following items are will need to be provided when completing a Medicaid Application: Bank records from the current and past three months

5 Life insurance policies Proof of income Property information (land titles, vehicle titles, etc.) Wage garnishments Note: Medicaid eligibility requirements for a long-term skilled facility is not the same as community Medicaid requirements. Medicaid: What to expect after qualifying? You or your loved one s income will be applied towards care received at the long term care facility with the exception of a Personal Needs Allowance that is determined by the Texas Medicaid Program. Individual o Total gross income less $60 for personal needs. Individual with a spouse in the community: o Total gross couple income less $60 for personal needs, less $2,931 for community spouse, less certain amount for dependents living with community spouse. Couple o Total gross income, less $120 for personal needs. Suggested personal items for admissions 1. Clothing for seven days 2. Non-skid shoes, non-slip socks and/or non-slip house shoes 3. Personal items to make the resident feel at home. EX: picture frames, a blanket or a quilt, etc. 4. Each facility has Wi-Fi and residents have access to a community computer. We highly suggest residents don t bring personal electronics. Unfortunately there are a few items we cannot allow in our nursing homes due to fire codes and the safety of all our residents. Items that are not allowed 1. Medication: prescription and over the counter *The medicine will be given to each resident as noted in their chart 2. Any preparation or substance bearing a warning statement 3. Portable heaters 4. Electric blankets 5. Cooking and ironing equipment 6. Coffee and cup heating elements 7. Throw rugs 8. Sharp objects (razor blades, straight razors, knives, push pins) 9. Chemical products (flammable liquids, laundry and house cleaning products, aerosol cans) 10. Extension cords or power strips 11. Smoking/tobacco products, matches, lighters, or other smoking paraphernalia, or illegal substances *There are designated smoking areas and times, please speak to your facility to find out more details Please note that this list is not all inclusive. The facility reserves the right, after assessing the resident, to deem other items not included in this list as unsafe to be kept in the resident room.