Monthly Income Payments Under Medicaid. The Resident understands that if he/she receives monthly income and also qualifies for Medicaid, the County Department of Social Services will require most of such income (referred to as “Net Available Monthly Income”) to be paid to the Facility. In that event, the Resident guarantees that such income will be delivered to the Facility on or before the 7th of each month or that it will be sent directly to the Facility from the income payor. If the Resident’s liquid assets are exhausted or unavailable prior to a determination of Medicaid coverage, the Resident agrees to pay his/her monthly income to the Facility as partial payment for the Private Pay Rate.
Monthly Income Payments Under Medicaid. The Resident understands that, upon Medicaid eligibility, DSS will require most monthly income (the “Net Available Monthly Income” or “NAMI”) to be paid to the Facility as part of the Medicaid rate. If DSS sets a NAMI, the Resident agrees (1) to pay the NAMI by the [10th] of each month, or to require the monthly income to be sent directly to the Facility (Addendum II); and (2) if the Resident disputes the NAMI amount, to place the disputed portion in an escrow account, and pay the undisputed portion to the Facility by the [10th] of each month. The Parties agree that funds held in escrow will be released according to the determination of the entity adjudicating the NAMI dispute.
Monthly Income Payments Under Medicaid. The Resident/Resident Representative/Sponsor/Financial Agent understands that if the Resident receives monthly income (i.e., retirement benefits, Social Security benefits, pension, required minimum distributions from qualified accounts, interest income, etc.), and also qualifies for Medicaid, the Department of Social Services will require most of such income (the “Net Available Monthly Income” or “Client Share/NAMI”) to be paid to the Facility as the Resident’s contribution towards the overall cost of care. Under the formula for the client share/NAMI, the Resident will only be allowed to retain a personal needs allowance ($50.00 per month) for deposit in the Resident’s personal account and that the Resident’s NAMI, budgeted by the Department of Social Services, is required to be paid to the Facility. The Resident/Resident Representative/Sponsor/Financial Agent further guarantees that:
a. such income will be delivered to the Facility on or before the 10th of each month; or that it will be sent directly to the Facility from the income payor pursuant to an Agreement in the Addendum;
b. During the period when a Resident’s Medicaid application is pending approval by the Department of Social Services, all income of the resident shall be paid over to the Facility minus $50.00 per month, and said payment shall be applied to the cost of care of the Resident;
c. That if any of the client share/NAMI amount is disputed, the disputed portion of the client share/NAMI will be paid directly to a responsible escrow agent, or into the Resident trust account, or the Court on or before the tenth (10th) of each month and that the portion of the client share/NAMI which is not in dispute will be paid to the Facility by such date. The Parties agree that the funds held in escrow will be released according to the determination made by the reviewing body or by the Court, or by mutual consent of the Resident/Resident Representative/ Sponsor/Financial Agent and Facility.
d. Failure to remit these funds may result in involuntary discharge for non-payment. Nonpayment for a Medicaid covered Resident occurs if the budgeted monthly NAMI is not paid and the amount is not in dispute, or funds are actually available or would be available and the Resident or the Undersigned Agent with access or control over the NAMI fail or refuses to pay, arrange for payment of, the NAMI to the facility. All such failure or refusal to pay or arrange for payment of the NAMI to the facility are breaches of the ...
