Maryland and D.C. Are Falling Short on Paying for Pre-Eligiblity Medical Expenses

The Maryland and D.C. Medicaid programs are supposed to help new Medicaid beneficiaries pay for nursing home care received before they qualify for Medicaid, if still unpaid at that time they first qualify.

But neither program is doing so fully, and in any case you have to ask for '“ insist on '“ this benefit.

In the typical case, the resident is spending down while on private pay, but for some reason does not qualify for Medicaid for a few months even though he or she does not have enough to pay for their care. They finally qualify with say $2,000 in their bank account, but they have an unpaid bill for $15,000, and from that point forward all but about $64 per month of their current income ($70 in D.C.) goes to pay for current nursing home charges.

Medicaid should help. Under Federal law its formula should allow the resident to use all current income to pay the old nursing home bill, while Medicaid pays 100% of the current bill. The resident still pays his or her current income to the nursing home, but now it is relieving him or her of a liability; Medicaid is paying the current bill in full.

Maryland reluctantly adopted this rule as of April 2004, but it does not allow the deduction unless the applicant specifically asks for it. Even then, its current practice is to allow a deduction only for nursing home bills incurred in the three months prior to the month of application. Both that limitation, and the 'you have to ask for it' rule, are being challenged in a suit in Baltimore City Circuit Court, called Smith v. McCann.

In the meantime, individual claims can be made and proceed.

D.C., by contrast, properly spells out this rule in its Manual, but nobody follows it. Even after asking, the case worker will ignore the request. The applicant has to appeal. Article Last Modified: 02/09/2007