NURSING HOMES AND SOCIAL SECURITY

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NURSING HOMES AND SOCIAL SECURITY

By: Helga Niesz, Principal Analyst

You asked if state or federal laws or regulations allow a nursing home to gain access to a resident's Social Security check. If not, you want to know whether the state becomes involved or whether it is a private issue between the nursing home and the resident.

SUMMARY

The law does not require nursing home residents to allow their Social Security checks to be sent directly to the nursing homes. Both state and federal law give residents (or their conservators or other representatives) the right to manage their own personal funds, and they allow nursing homes, with the residents' authorization, to manage their personal funds for them. People who have exhausted their own funds and are receiving Medicaid generally have to apply all of their Social Security check (except for a $52 a month personal needs allowance) and other income to the costs of their nursing home care; Medicaid pays the balance. The law does not specify the actual mechanism for how the funds are paid to the home. The nursing home can ask the resident to have the Social Security payment sent to the home (which appears to be the norm for those receiving Medicaid assistance in Connecticut), or the resident or her representative can receive the check and pay the home. Once the nursing home receives the Social Security payment, it will either pay the personal needs allowance directly to the resident or her representative or, at the resident's request, establish a separate personal funds account that it administers and deposit the $52 in it.

SOCIAL SECURITY CHECKS

If an individual is paying for nursing home care privately, neither the state nor the federal government apparently becomes involved in the mechanics of how the payments are made. The home can request that the Social Security check be forwarded directly to the home, but the resident or his representative or conservator does not have to agree to it and can, instead, pay the entire bill directly.

If the resident is single, has assets not exceeding $1,600, and does not have enough income to pay for the nursing home, she can apply to the Department of Social Services (DSS) for Medicaid. In that case, DSS informs the applicant that she must first apply her Social Security income (minus a $52 monthly personal needs allowance) and other income to the cost of the nursing home; DSS will pay the rest (DSS Uniform Policy Manual § 5045.20). Neither the state nor the federal government has any particular requirements about how the Social Security check gets to the nursing home. Usually, in this situation the nursing home will request that the check be sent directly to the facility, but the resident does not have to agree to it. One potential problem with having the resident or her representative handle the check is that if the check is large and gets deposited in the resident's bank account, it could bring the account above the $1,600 asset limit. This could make her temporarily ineligible for Medicaid.

If the resident is married and the spouse is still living in the community, the spouse may be eligible for a minimum monthly needs allowance out of the resident's Social Security check or other income. In that case, the check could come to the resident or the spouse in the community and they would be responsible for paying the balance to the nursing home. Or it could come to the nursing home and the facility would split the check and send the required amount to the community spouse. OLR Report 2000-R-0911 discusses Medicaid eligibility and community spouse allowances.

CONNECTICUT PERSONAL FUNDS MANAGEMENT LAW

The state's nursing home residents' bill of rights allows residents to manage their personal financial affairs and requires nursing homes to give them a quarterly accounting of financial transactions made on their behalf (CGS § 19a-550 (b)(7)). The statutes also require nursing homes, on or before a resident's admission, to give her or her legally liable relative, guardian, or conservator a written statement explaining (1) her rights regarding personal funds and (2) listing the charges the home can deduct from those funds. Upon a resident's or her representative's written consent or request, a nursing home can manage the resident's personal funds, but if a physician has determined her to be mentally incapable and she has no conservator, her consent is not valid unless cosigned by a legally liable relative or guardian. The nursing home has to maintain a separate account for each resident or an aggregate trust account for residents' funds to prevent commingling them with the facility's own funds (CGS § 19a-551). Violating these provisions is a class A misdemeanor, subject to a fine of up to $2,000, imprisonment of up to one year, or both. Residents or their representatives can also sue in court and the nursing home can be liable to the injured party for treble damages (CGS § 19a-553).

FEDERAL PERSONAL FUNDS MANAGEMENT LAW

Federal Health Care Financing Administration regulations state that nursing home residents have the right to manage their financial affairs and the facility cannot require them to deposit their personal funds with it. But if the resident agrees in writing, the facility can hold, safeguard, manage, and account for the personal funds deposited with it. The regulations prohibit commingling funds with the facility's own funds, require certain notices, and limit what the facility can charge to the account (42 C.F.R. § 483.10(c)).