Receiving Care

At each Gamble Guest Care facility, you'll find helpful people who will be more than happy to assist you in exploring issues concerning receipt of care. Listed below, you'll find enlightening information regarding methods of payment and admission procedures.

PAYING FOR CARE: 4 WAYS

Private Pay. Private pay essentially involves paying for services "out of pocket," with private funds.

Long Term Care Insurance. Long term care insurance can provide full or partial coverage. Gamble Guest Care administrators at each facility will be happy to review your policy to determine the level of coverage offered.

Medicare - Qualifying. To qualify, the client must have a 3-day or 72-hour stay in the hospital and must be admitted to The Guest House within 30 days of the last hospital stay. In these cases, Medicare will pay 100% of the cost for the first 20 days and 80% thereafter for up to 100 days. If co-insurance or secondary insurance is not available, payment for the remaining 20% can be made by paying privately at $134.02 per day or applying for Medicaid Co-Pay.

Medicaid. To apply for Medicaid, a notice is sent to the Medicaid Office by The Guest House upon which the Medicaid Office will contact the family for an appointment. Eligibility requires that liquid assets must be less than $2,000.00 for an individual and $3,300.00 for a couple in the facility. This includes cash, checking accounts, savings accounts, annuities, and stocks and bonds. A house, vehicle, burial and burial assets are excluded. Cash value life insurance policies that total less than $1,500.00 are also excluded. Monthly income must be less than the cost of the monthly fee to the facility.

Spousal Impoverishment (not available for Medicaid Co-Pay) is a program designed for couples when one spouse enters the facility and one remains in their home. Liquid assets must total less than $104,000.00, plus a home, vehicle, and $1,500.00 cash value life/burial insurance. Monthly income cannot exceed the monthly facility rate of $3,373.21. The spouse at home can keep $2,610.00 of monthly income.

Documents required to apply for Medicaid:

  1. Proof of Age:(one of the following) birth certificate, baptismal certificate, photocopy of page from family Bible, U.S. Census report.
  2. Marriage License: if applicable
  3. V.A. Claim #: if applicable
  4. Proof of Income: award letters from Social Security, S.S.I., retirement/pension, Veterans Administration, unemployment, alimony, Workers’ Compensation, money/loans from friends or relatives, interest on dividends, oil/gas/mineral leases, rentals, royalties, in-kind income, etc. (not bank statements).
  5. Bank Statements: on all accounts/institutions for the past 3 months which includes checking/savings accounts, Christmas club, stocks, bonds, CD’s, trust funds, credit unions, IRA/Keogh, safety deposit, etc.
  6. Vehicles: Proof of ownership of any vehicles, statement from institution verifying pay-off (minus finance charges and interest) and value.
  7. Life and Health Insurance: copies of all life, burial, pre-need, and health insurance polices with name and address of each company.
  8. Burial Assets: Proof of all burial funds, burial plot ownership, burial insurance, headstones/markers, crypts, caskets, vaults, urns, and mausoleums.
  9. Real Estate: Copies of titles/deeds to all real estate or houses in-state/out-of-state owned by applicant (if other than home property they will need value of property and names of all owners).
  10. Transfer Documents: on any resources (real estate, money, insurance, shares, etc.) given away, sold, or deeded in the last 60 months.

ADMISSION PROCEDURES

At each Gamble Guest Care skilled nursing facility, we work extensively to make admission as simple and convenient as possible. The particular steps for admission are noted below.

  1. The resident visits a physician’s office and obtains the following: (1) doctor’s examination and history, (2) completed and signed Statement of Medical Status & PASARR & Certification, forms required for admission, and (3) PPD skin test and/or chest x-ray to screen for TB. Note that if the resident is in the hospital, the hospital will see that these items are completed.
  2. The resident or his or her family member selects the items that will be brought into the facility.
  3. The new resident moves into the facility. If the resident is in the hospital, arrangements can be made for the resident to be transported by our van or a transportation company.
  4. The resident's family member completes an admission interview and paperwork with our Admission Coordinator. This usually takes 45 minutes to 1 hour.
  5. Documents needed for admission: Medicare/Medicaid/Insurance and Social Security Cards.
  6. Financial arrangements are made.

As always, feel free to contact any Gamble Guest Care skilled nursing facility for additional information concerning care receipt issues. We will be more than happy to provide assistance.