Moving to a Nursing Home? Ask About Ratio of Medicare to Medicaid Beds

Here is a serious problem that elder law attorneys encounter all too often: A person goes into a Medicaid facility on Medicare days, pending acceptance into the long-term care Medicaid program. She is assured that the facility is a Medicaid accepting facility; however, when her family decides to move forward with applying for Medicaid, the facility says there are no more Medicaid beds. This may be after the resident has spent a considerable amount of money paying privately for her bed.

When a person reaches “medical necessity,” meaning that the person has a serious medical condition requiring an elevated level of nursing care that can only be provided in an institution, it is important to find out how many Medicaid certified beds are available.

Although a nursing home is Medicaid-certified by the State, this doesn’t mean that every bed in the facility is a Medicaid certified bed. Some beds are only for residents paying with Medicare, or the beds may be “dual certified,” which are certified for both Medicare and Medicaid residents.

Finding out the exact number of Medicaid certified beds in a facility may save you or your family thousands of dollars and the inconvenience of moving.

For example, Jim’s mother Wanda needed full time care after falling too many times at her assisted living apartment. Jim looks for a Medicaid accepting nursing home in his area of town. Wanda is not yet eligible for Medicaid benefits but Jim plans to hire an elder law attorney to assist in attaining government benefits for his mother.

Jim expects that his mother will have to pay with private funds each month until she is Medicaid eligible. What he does not realize is that if there are no Medicaid beds available at the facility when Wanda is ready to apply for Medicaid, she will have to move to another facility where a Medicaid bed is available or continue to private pay until one is vacant in the current facility. If she does not have the funds to private pay while waiting for an available bed, the facility will evict Wanda.

Although the facility represented to Jim that they were a Medicaid accepting facility, what they did not disclose was that the facility was certified for only an extremely limited number of beds and that there was a long list of residents waiting for them.

Rather than continue private paying while waiting for a Medicaid bed, Jim moved Wanda to another facility where she had to readjust to new surroundings, medical staff, and non-medical staff.

Before deciding on a facility for you or your loved one, it’s best to seek the advice of an elder law attorney who is familiar with the negative issues that may arise in the journey your family member is on when going into a nursing home.

You may visit our website at www.wrightabshire.com. Nothing contained in this publication should be considered as the rendering of legal advice to any person’s specific case but should be considered general information.