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Patient Pay Offsets

Posted by Andrew Byers | Oct 22, 2012 | 0 Comments

In my last post, I discussed the patient pay amount, which is a special type of co-pay for nursing home residents who are eligible for Medicaid nursing home benefits in Michigan.  The patient pay amount is the amount the nursing home resident has to pay to the nursing home out of his or her income each month.  Income is usually Social Security, pension and, in some cases, annuity income.

There are some offsets from the patient pay amount.  By offsets, I mean the nursing home resident can keep some of their income to use or pay other bills.  The most well know offset is the $60 per month personal needs allowance, a paltry sum the nursing home resident is allowed to keep which can be spent on any personal needs he or she may have. 

Another offset is the premiums the Medicaid recipient pays for health insurance, including vision and dental insurance, as well as Medicare premiums.  As such, if the nursing home resident has a supplemental health insurance policy or Medi-gap policy, they can keep the policy and continue to pay the premiums out of their income.

If the nursing home resident has a guardian or conservator, the guardian or conservator can pay themselves $60 per month out of the nursing home resident's income for guardianship/conservatorship services that were actually performed.  Note that $60 per month is the maximum that can be paid.  For instance if a nursing home resident's son was her guardian and daughter was her conservator, each cannot receive $60.

Another important offset is for medical expenses not covered by Medicaid that were incurred in the three months before becoming submitting the Medicaid application.  This is important because the nursing home resident often was treated in the hospital before having to move to the nursing home and, with the way billing and insurance works, the nursing home resident may not receive the bill for co-pays and services not covered by insurance for many weeks or months after the treatment occurred.  If these expenses are large, the patient-pay may need to be offset over a number of months.  Michigan's Department of Human Services limits these pre-eligibility medical expenses to those incurred in the three months prior to submitting the Medicaid application.

This post is by Andrew Byers, an elder law attorney in Auburn Hills, Michigan

About the Author

Andrew Byers

Andrew Byers' elder law practice focuses on the legal needs of older clients and their families, and works with a variety of legal tools and techniques to meet the goals and objectives of the older client. Under this holistic approach, I handle estate and longevity planning issues and counsel cli...

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