State Would Be Required to Pay Facilities When Medicaid Application is not Approved after 90 Days
Assemblyman Vince Mazzeo has introduced legislation to help seniors and other vulnerable residents get the specialized care they need from various long-term care facilities when Medicaid throws up a road block.
Designated the “Uncompensated Pending Medicaid Beneficiary Payment Relief Act,” the bill (A-3928), would provide payments to certain long term care facilities for residents who have applied for Medicaid but whose eligibility has not been determined more than 90 days after the initial application.
“Anyone who has ever dealt with Medicaid knows how time-consuming and frustrating the process can be, especially if you’re trying to secure benefits on behalf of an ailing loved one,” said Mazzeo (D-Atlantic). “Families can often get saddled with bills while the application process drags out. This will help aging and ailing residents get the care they need at a facility designed for their needs while eliminating stress and hefty bills.”
Specifically, the bill requires the state Department of Human Services to make advance payments to a nursing facility, an assisted living residence, or a comprehensive personal care home, at the facility’s request, whenever the facility is providing uncompensated services to one or more residents whose eligibility for Medicaid has not been determined more than ninety days after an application has been filed.
Any such advance payment would not exceed fifty percent of the estimated amount due for the uncompensated services.
No later than 30 days after a Medicaid application is granted and payment has been made to the facility, or after any such application has been denied, the department would be required to provide reimbursement for any balance due to the facility; or recover any advance payments made on behalf of an applicant deemed ineligible for Medicaid by reducing any payments due to the facility.