Q: My grandma died of neglect in a Pennsylvania nursing home recently. A representative for the nursing home told us we would be wasting our time suing them, because any damages we won would just go to pay back Medicaid. Is this true?
It sounds as if the nursing home representative is confusing his facts, either by error or deliberately to mislead you. Let’s look at what he’s mixing up: the role of Medicaid and the principle of subrogation.
In all likelihood, Medicaid was paying for your grandma’s stay at the nursing home.
Medicare—the federal health insurance program for older Americans—does not provide coverage for what’s called “long-term care,” such as residential care in a nursing home. Medicare will only cover brief nursing home stays for patients making the transition from a hospital back to home. Some people buy special insurance policies to pay for residential care in their later years, but this is too expensive for a lot of people. If they become infirm in their senior years, they must turn to Medicaid to pay the costs of nursing home care.
Medicaid is the government health coverage plan for people in poverty. To qualify for Medicaid, your grandmother would have sold most of her possessions and signed all her assets over to the federal government. The government even withholds her monthly Social Security benefits, except for a token amount for personal expenses. In exchange, the Medicaid program paid the nursing home’s fee on behalf of your mother.
Subrogation is an insurance principle that prevents claimants from “double-dipping”—from collecting from two different payers for one injury.
The classic illustration is when you or someone—we’ll call him Mr. Smith—gets hurt in an auto accident. Mr. Smith goes to the hospital after the accident and has a splint put on his fractured arm. He has coverage from both his personal health insurance and his auto insurance claim, but Mr. Smith isn’t going to be allowed to collect twice for his medical bills. His health insurance company will be able to claim the part of the auto insurance check that represents the medical benefits already paid.
If you want a deeper understanding of this topic, download our FREE report from this website, Navigating The Subrogation Nightmare: What to Do When The Insurance Company Says You Have To Pay Them Back.
Where the Nursing Home Representative Gets it Wrong
The nursing home representative seems to be claiming that, because Medicaid was paying for Grandma’s residential stay, Medicaid will be able to use the subrogation rules to seize any money your get from a lawsuit.
That’s not true at all. A wrongful death in a Pennsylvania nursing home isn’t the same as any other personal injury claim, because the person filing the claim isn’t the one who was hurt the worst. Your grandmother died, but she (or, rather, her estate) is not seeking compensation from the nursing home. Your and your family are demanding compensation because you have suffered your own individual losses when Grandma died.
Subrogation doesn’t apply, because Medicaid hasn’t paid any benefits to you or on your behalf; it’s paid only for your grandmother. Medicaid will have no legitimate claim on any money you get from the nursing home in a settlement or damages award. The nursing home representative is just trying to persuade you not to file a legal action by convincing you it would be futile.
Don’t let nursing home bullies push you around. Our nursing home neglect lawyers in Harrisburg are standing by to answer your questions about whether you have a valid claim. Get answers to your questions by calling Schmidt Kramer at 717-888-8888 or 888-476-0807 toll-free to schedule a free, confidential case review, or use the contact form on this page to tell us about your needs.