What happens after insurance coverage ends?

Approximately six weeks prior to the end of insurance coverage, a facility representative will contact the resident's Power of Attorney (POA) or Responsible Party to discuss future payment arrangements. Generally, the options are a secondary insurance coverage, private pay and Medicaid (medical assistance).

• Secondary insurance - If available, this would have been discussed during the admission process and would be a smooth transition through the Business Office.
• Private Payment - If personal funds are available to cover the care at the current private pay rate, an invoice would be sent to the POA/Responsible Party at the beginning of the month.
• Medicaid - If no personal funds are available according to the Department of Public Welfare regulations, the facility representative and POA/Responsible Party would begin the Medical Assistance (Medicaid) process approximately thirty days prior to the end of insurance coverage.

My family member already has medical assistance, why do I need to apply again?
Long term care services are provided by a Department of Public Welfare (DPW) grant generally referred to as a nursing home grant. The DPW eligibility requirements are not the same as the requirements for medical assistance (MA) in the community. A resident can be eligible for MA while living at home but not be eligible for MA in a nursing home.

My family member has already been approved for a nursing home grant, what do I need to do?
Initially, you need to provide a copy of the Notice to Application (PA-162 form) granting approval. If you do not have a copy, provide their Recipient Number, Record Number or information for the County Assistance Office that approved the grant. If your family member's grant is active in Montgomery County, the facility will request a Change of Address and nothing else needs to be done. If the grant is active in another county, you will need to complete several forms and sign a Release of Information, which a facility representative will forward to the Montgomery County Assistance Office (MCAO), part of the Department of Public Welfare, along with a Desk Review Request. The facility will then keep you informed of any documentation that the MCAO requests, such as current bank statements that they will need to issue an approval notice.