While Medicaid helps pay for nursing home care, getting in as a Medicaid recipient is not always easy. There are several ways to navigate the process, depending on your situation.
With the median cost of a nursing home room being more than $250 a day, most families need help paying for long-term care. Medicaid is the primary method of covering the costs for nursing facility care in the United States, but in order to qualify for Medicaid, an applicant must meet income and asset standards.
Generally, nursing facilities will only accept patients who can pay for their care, while Medicaid will not pay unless an applicant is already living in one. This creates a predicament:
How to get a loved one into a nursing home in order to receive Medicaid?
Private Pay for Nursing Home
The easiest way to get into a nursing home is to be able to pay for care while the resident’s assets are spent down in order to qualify for Medicaid. Residents who can pay privately for a few months can file a Medicaid application once they are in and start receiving benefits when the resident’s funds are below their state’s threshold for “countable assets.” Make sure the nursing home accepts Medicaid patients — and get the timing right so that the resident doesn’t run out of funds before the Medicaid application is approved.
Medicare nursing home coverage
Medicare provides coverage for up to 100 days of “skilled nursing care” per illness. The patient must enter the facility no more than 30 days after a hospital stay that had lasted for at least three days (not counting the day of discharge). The care provided must be for the same condition that caused the hospitalization (or a condition medically related to it). In addition, the patient must receive a “skilled” level of care in the nursing facility that cannot be provided at home or on an outpatient basis. And finally, Medicare covers care only for people who are likely to recover from their conditions. If a loved one meets these conditions, it is possible for them to enter a nursing home and immediately apply for Medicaid while Medicare pays in the meantime.
Medicaid Pending
There are some nursing facilities that will accept a resident who has applied for Medicaid and is awaiting a response. Unfortunately, there are only a few nursing facility that accept Medicaid pending residents without some type of payment guarantee in the event the application is denied.
Other considerations
When moving into a nursing facility, be careful about signing a nursing home admission agreement. Read any agreement thoroughly. If you are signing the agreement on behalf of your loved one, always make sure you are signing in the capacity as his or her Power of Attorney or other legal representative, rather than personally.
Navigating the Medicaid process is complicated. If possible, consult with an attorney before entering a nursing home and applying for Medicaid. Contact the Stinson Law Firm at 317-622-8181 or info@stinsonlawfirm.com to assist you with you Medicaid plan.