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What You Need to Know About Medicaid and Nursing Homes

Medicaid covers nursing home care but being accepted into a nursing home as a Medicaid beneficiary is not always straightforward. There are a variety of options to consider depending on your circumstances.

With a nursing home room costing more than $250 per day, most families require assistance paying for long-term care. In the United States, Medicaid is the primary way to pay for nursing home care. Still, Medicaid has strict requirements for applicants’ finances and property ownership before they can qualify for coverage. 

Nursing homes generally accept patients who can afford to pay for their care. In contrast, Medicaid will not pay for nursing home care unless the applicant already lives in a facility. This creates a problem: How may I get my loved one into a nursing home so they can receive Medicaid? The following are some of the strategies you may utilize.

  • Private Pay. The simplest method to enter a nursing home is to be able to pay for care while the resident’s assets deplete to qualify for Medicaid. Residents who can pay for a few months privately may submit a Medicaid application once they are in the nursing home and begin receiving benefits as soon as the resident’s funds fall below their state’s “countable assets” threshold. It’s crucial to ensure the nursing home accepts Medicaid patients and that you have timed it correctly so that the patient does not run out of money before their Medicaid application is approved.

The resident’s family might pay if the resident lacks the money to pay for their care. However, this is a high-risk situation – if the resident qualifies for Medicaid, the family will not get reimbursed. The family may be able to loan the money to the nursing home under a formal agreement that specifies that the nursing home will repay the funds once the resident qualifies for Medicaid.

  • Medicare. Medicare covers 100 days of skilled nursing care for each illness. The patient must go to a nursing home no more than 30 days after a hospital stay that has lasted at least three days (not including the day of discharge). The nursing home must also treat the same illness that caused the hospitalization (or a related medical condition). The patient must receive a “skilled” level of care in the nursing home that is unavailable at home or through outpatient therapy. Finally, Medicare covers treatment only for those who will likely get better. Once a resident meets these criteria, a loved one may be admitted to a nursing home and immediately apply for Medicaid while Medicare pays.
  • Medicaid Pending. Some nursing homes will take in a resident who has applied for Medicaid and is awaiting a decision. Unfortunately, only a few nursing homes will take Medicaid residents without some financial backup in case of application rejection. Medicaid-eligible nursing homes with pending residents tend to have lower-quality ratings.

When you enter a nursing home, be careful about signing a nursing home admission agreement. If Medicaid denies the resident’s application, the nursing home may pressure families to pay their loved one’s bills.

Navigating the Medicaid process can be difficult. Before coming into a nursing home and applying for Medicaid, it’s best to consult with an attorney to ensure all of your bases are covered.

RSA Law Group provides legal information, not legal advice. Our information explains general legal concepts and principles which may or may not be applicable to a particular person’s situation. No attorney-client relationship exists between the site and any user. RSA Law Group makes no claims, promises or guarantees about the accuracy, completeness, or adequacy of the information contained in or linked to this site. Because legal advice must be tailored to the specific circumstances of each client case, and laws are constantly changing, nothing on this site should be used as a substitute for the advice of competent counsel. If you require legal advice, we encourage you to contact us to develop an attorney-client relationship.


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