Medicaid Eligibility Loss from Unmonitored Resident Trust Fund Balances

$1,200-$2,400/month per resident who is incorrectly coded as Medicaid when private pay; incorrect billing to Medicaid (denial/clawback risk); bad debt write-off • $1,200-$3,500 per resident (lost Medicaid coverage for readmission; facility assumes uncompensated care or bills patient) • $1,500-$4,500 per resident per month (gap between Medicaid daily rate ~$150-250 and private pay ~$200-350)

Admissions director collects initial asset declaration (paper form); hands off to social worker; no follow-up verification at 30/60/90 days; no alert if trust balance approaches threshold • Admissions director processes VA documentation; no systematic check for intersection of VA aid & attendance and Medicaid asset limits; manual followup if issue surfaces • Compliance officer discovers via audit; manually reviews resident accounts in arrears; creates corrective action plan; no proactive monitoring system in place