Failure to Assist Resident with Medicaid Application After Change in Payor Status
Penalty
Summary
The facility failed to provide a resident with information and assistance regarding how to apply for Medicaid benefits when her skilled care Medicaid coverage ended. The resident, who had multiple complex medical diagnoses including chronic respiratory failure, severe malnutrition, COPD, substance use disorders, and mental health conditions, was admitted to the facility and later received a notice from the Medicaid provider stating she no longer required daily nursing care and could be cared for at a lower level. Despite this change in payor status, the facility did not offer or assist the resident in applying for long-term Medicaid services, as confirmed by interviews with the Business Office Manager and the resident herself. A review of the facility's policy indicated that residents who continue to need LTC services should be provided with the necessary assistance to apply for Medicaid coverage. However, documentation and staff interviews revealed that this assistance was not provided to the resident in question. The facility's failure to act was further highlighted by the lack of explanation from staff as to why the application process was not initiated, despite the resident's ongoing need for care and the facility's stated policy.