Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

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Kennedy
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Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by Kennedy »

I have a family member who is in a skilled nursing facility for rehab after a fall. The tab is paid in full by Medicare for the first 20 days. Days 21-100 are subject to a co-pay of just under $200 per day.

It's unclear as to how long they will be in rehab. If the 100 days pass without being discharged, I'm just wondering how Medicaid could play a role. This person is of limited financial means, and it won't take much to spend down their savings to meet the maximum allowed... something like $2000 dollars in assets. After that, it's possible Medicaid will take over, I'm assuming, if they meet the financial and medical criteria.

Their current facility in a large metropolitan area is lovely. I was surprised to see the facility is on a list provided by the state of Medicaid-approved skilled nursing facilities. There were several other lovely facilities of which I am familiar on this list as well.

The family member is currently in a large, private room. I'm assuming that would change to a shared room if in a Medicaid bed. Is there a catch other than having to share a room? I presumed Medicaid facilities would be horrid, and this facility is not. The current facility seems to have a bunch of empty rooms and the state list states the facility has 90ish Medicaid beds.
Last edited by Kennedy on Thu Aug 30, 2018 9:05 am, edited 1 time in total.
Nissanzx1
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by Nissanzx1 »

I have a close relative in one in NE. The Medicaid section of the home (my relative has means) is very sad. Small rooms, with 2 patients per room. Not the sort of setup anyone I know would enjoy...
Rookstar
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by Rookstar »

As a emergency physician I see these patients everyday. There is a HUGE difference in the care provided depending on the nursing home/rehab center. In my experience the medicare/medicaid funded ones are by far the worst.
Scrapr
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by Scrapr »

Our company cleaned out all the beds & furniture from a nursing home that was closing. Actually i think we did 2 of them. 2 weeks before there were patients in there. It was awful. I will never forget it. But...they moved to a brand new facility a few miles away. I would have no issue staying in the new place. Trust your eyes
Spirit Rider
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by Spirit Rider »

My mother went to a skilled nursing facility and then stayed there after transitioning to Medicaid. Yes it was a semi-private room shared with another resident.

I don't know what is so horrible about that. Yes, it is not the separate apartment of an assisted living facility, but my mother was very happy there.

It was not luxurious by any standards, but was clean, there were recreational activities, she liked the food and the staff was competent and friendly.
Gnirk
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by Gnirk »

Skilled nursing facilities and memory care facilities vary as to whether or not they accept Medicaid. Some only accept after a period of private pay. In our area, there can be a distinct difference between those who have a large number of Medicaid beds and those with fewer, just as there are differences in the LTC and memory care facilities themselves.
Just do your due diligence when researching them.
drawpoker
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by drawpoker »

The way it works, the skilled nursing care facilities are designated a certain no. of beds for short-term (Medicare/or reg. insurance paying) rehab and a certain no. dedicated to long-term (both Medicaid and private pay)
Its very possible those empty beds you saw were the ones designated as short-term/rehab only, that's why no occupants, just a temporary situation in their census that day.

FWIW - When I was discharged from the hospital after a 13 day stay in 2010 following extensive surgery, my insurance approved 3 days of rehab at a nearby nursing home since I was certified too weak, unable to manage by myself, and should not go straight home.

After arriving at the place by ambulance around 9 PM, Yikes , had seen (and heard) enough by 6 AM next morning to know to get the hell out of there. It was very, very scary and unsafe. For multiple reasons. So called a friend to come and get me, which he did by 7 am. Although it was very difficult for me to walk (I used one of their filthy wheeled tray tables as a walker to get to the door) my instincts told me to get out a.s.a.p.
I really believe I would have passed away before the 3 days were up if I had hung around. True story, no embellishments.
carolinaman
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by carolinaman »

My mother went from rehab (Medicare paid) to private pay in a nice nursing home. She soon exhausted her funds and went on Medicaid. She remained in her private room with no change in service until she died several months later. So I guess it depends upon the facility and situation. I know the facility was very much in demand and always full, so it was not a lack of patients that resulted in the level of care my mother received.
SimonJester
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by SimonJester »

The answer is that it is going to vary from facility to facility, and has to do with the company running things.

My Wife is a RN working in one such facility and has worked in a couple of other facilities as well as various hospitals. The one she works in now has a very long waiting list to get into as a patient. They have a low staff to patient ratio, are not profit driven, and care deeply for their residents and their health care.

Just because a facility accepts medicare / medicaid doesn't make it automatically bad, and just as if the facility only accepts private pay doesn't make it automatically good.

I think one of the biggest aspects that effects care is staff to patient ratio.
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Mitchell777
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by Mitchell777 »

It is very specific to the institution as you can read in the other posts. My experience was there was no difference between private pay and Medicaid in the facility I experienced. I even recall asking if my mother would lose the private room if and when she moved onto Medicaid and was told they do not move people in that way. Not to say it's guaranteed not to change. In the facilities and lawyers I spoke to in my area I never heard of a Medicaid section and private pay section. Again probably location and institution specific. You do need to be sure the facility accepts Medicaid when private pay runs out.
westie
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by westie »

My mom was in 4 different nursing homes during her 4 years in that situation. The one that was the best, also cost the least, and it was 74% Medicaid patients. She was there 3+ years
Liberty1100
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by Liberty1100 »

Have you considered anything other than the condition of the room?

While in a SNF, the patient may be receiving PT or OT therapy sessions. Talk to those therapists to get a good understanding of how they treat their patients depending on what kind of insurance the patient receives. They do treat them differently in terms of what they are required to do vs not. There are requirements of 1-on-1 time frequency vs group therapy sessions frequency. You may also want to understand the SNF management environment.

It seems like insurance is determining the care the patient receives. The PTs/OTs are graded by their efficiency rates and how many billable hours they have with patients. If insurance determines that the patient doesn't need more PT or OT, the therapist would have to argue their point in writing to the insurance company, which may also go denied. The managers of the PTs and OTs don't want them to write them due to the lost billable time. This applies more and more to doctors as well, from what I understand. Interesting read: Physician burnout can affect your health - Harvard
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samsoes
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by samsoes »

In my younger days as a Emergency Medical Technician, we made a good number of calls to nursing homes. Some are quite nice, others have residents marinating in their own waste for hours and hours, we had an unexplained mid-diaphysis fractured femur on a non-verbal patient, pressure ulcers (bed sores) on many, etc. There is a high concentration of Medicaid patients in these hellish facilities.
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sailaway
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by sailaway »

Nissanzx1 wrote: Wed Aug 29, 2018 10:56 pm Small rooms, with 2 patients per room.
If that is the worst you have to say about it, it doesn't sound bad at all.
Nowizard
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by Nowizard »

Not the best circumstance, but will vary depending on staff and, frankly, the monetary goals of the owners. At the same time, there is a degree of sadness typically involved in nursing home placement of a loved one that can translate into a variety of feelings of guilt, necessity and satisfaction with their placement.

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TheDDC
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by TheDDC »

I have yet to visit a "facility" (which is a fitting word) that did not smell like pee, with one exception. I know they did not take Medicaid.

Elder care homes and the entire system behind them is a mess in the U.S., which mostly contribute to living conditions you would not wish on your worst enemy and resemble prisons. The owners should probably try staying in their own facility for a week and see how long it would take until they want to bust out of the joint.

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123
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by 123 »

Over the years we've had a number of relatives and friends in nursing home, some insurance/private pay and some medicaid. In a number of nursing homes the standard was 2 patients per room, but in one facility the medicaid area had 3 patients per room. The whole nursing home experience is hugely dependent on the patients condition and circumstance.

I had one elderly aunt who was in a medicaid placement in a nursing home for a few years and absolutely loved living there (I know that's hard to accept!). But she had lived her entire adult life on the same family farm and the idea of someone else doing the cooking and serving her meals in bed was pure luxury to her.

Though some nursing home sitations can seem like bedlam this is often due do to patients who also have psychiatric or pain-mangement issues. When I've visited nursing home I'm often surprised by the number of patients who can get around by themselves, either with a walker or a wheelchair, though I would expect that most of these are (post hospitalization) "rehab".

If the roommates don't cause disturbances I think that 2 or 3 residents in a room is likely better than a private room if a resident is in a long-term custodial care (not "rehab") situation. The biggest problem for many nursing home residents is loneliness and having more people around, including visitors and staff who are dealing with the other residents in the same room, seems helpful in reducing the feeling of isolation.

The nursing homes I've visited residents in seemed to specialize in either custodial care or "rehab" patients or some blend. Whie some of the custodial care patients may have started out as private pay I'm sure over time most of them went on medicaid. While individual "rehab" patients bring more revenue to the nursing home due to payments for physical therapy services etc they of course don't stay as long as the custodial care patients.

I don't think that presence of medicaid patients is really that much of an issue since I'm sure the vast majority of nursing homes have them.

In California when I visited relatives in nursing home I often saw the local "Ombudsman". The ombudsman was from the local county government and served as an advocate for the patients and handled all formal complaints received by the county regarding assigned nursing homes. The ombudsman made usually daily rounds among a number of nursing homes and became quite familiar with the individual needs of various patients. The ombudsman had the authoity to immediately require correction to unsuitable conditions that she found as she made her rounds.

From my experience that biggest factor that improves nursing home care is the amount of visitors that individual residents have. The visitors provide more social contact for the resident but just as importantly establish that someone is looking out for and concerned about the welfare of the resident.
Last edited by 123 on Thu Aug 30, 2018 12:27 pm, edited 1 time in total.
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Doom&Gloom
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by Doom&Gloom »

It depends upon whether the patient is you, someone you love, or someone you really don't care all that much about.

Beauty is in the eye of the beholder.
drawpoker
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by drawpoker »

Kennedy wrote: Wed Aug 29, 2018 10:24 pm I have a family member who is in a skilled nursing facility for rehab after a fall.....
Is this family member the M.I.L. that your husband wants to move into your home? The one you wrote about in the other thread that got locked?
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Kennedy
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by Kennedy »

drawpoker wrote: Thu Aug 30, 2018 1:06 pm
Kennedy wrote: Wed Aug 29, 2018 10:24 pm I have a family member who is in a skilled nursing facility for rehab after a fall.....
Is this family member the M.I.L. that your husband wants to move into your home? The one you wrote about in the other thread that got locked?
Yes, it is. She is currently in rehab, and it is quite possible she will not be ready to go home (or to our house) once the 100 days that Medicare will subsidize is up. I'm just thinking ahead as to what will happen when Medicare benefits are exhausted and MIL's own money is used up.

If she can stay in this lovely facility using Medicaid benefits until she's physically ready for discharge, that would be optimal. I don't want to see her in a substandard facility, and we would pay her needs as required to keep her safe and comfortable in a different facility if necessary. However, I was quite surprised to see this nice facility on the Medicaid list, and I was wondering what the catch is.
Mitchell777
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by Mitchell777 »

Kennedy wrote: Thu Aug 30, 2018 1:54 pm
drawpoker wrote: Thu Aug 30, 2018 1:06 pm
Kennedy wrote: Wed Aug 29, 2018 10:24 pm I have a family member who is in a skilled nursing facility for rehab after a fall.....
Is this family member the M.I.L. that your husband wants to move into your home? The one you wrote about in the other thread that got locked?
Yes, it is. She is currently in rehab, and it is quite possible she will not be ready to go home (or to our house) once the 100 days that Medicare will subsidize is up. I'm just thinking ahead as to what will happen when Medicare benefits are exhausted and MIL's own money is used up.

If she can stay in this lovely facility using Medicaid benefits until she's physically ready for discharge, that would be optimal. I don't want to see her in a substandard facility, and we would pay her needs as required to keep her safe and comfortable in a different facility if necessary. However, I was quite surprised to see this nice facility on the Medicaid list, and I was wondering what the catch is.
Just my experience. Not saying it applies elsewhere. When my parent was in rehab the atmosphere was great. Often a doctor in the area. You could get a nursing assistant in minutes. Daily therapy sessions and much encouragment. Large single rooms. When she needed to move directly to full nursing it was different. Smaller rooms. Two to a room until I could get a single. Much longer wait for help. Everyone much sicker. Dining area smaller and dimmer. Fewer food choices. Might want to ask to see the full nursing area especially the area whwere the sicker people are.
drawpoker
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by drawpoker »

.... "was wondering what the catch is"

________________________________________________________________

Well you can be sure there is a catch somewhere.
Nursing homes that take Medicaid LTSS are so universally bad places that the few very good ones out there (good in the sense of not as bad as others) have long waiting lists. The word quickly gets around, either thru family members, employees, physicians, etc and the better ones stay full up.

Care of the residents is delivered 95% by poorly-paid CNAs (or GNAs). With low pay and unpleasant working conditions there is little motivation. The RN, or charge nurse, for each wing is usually far away at the desk writing reports and other paperwork. She/he may never see or interact with a resident except once a day when giving meds out.

State inspections are often infrequent and less than thorough. Fire and other safety checks done locally are little better.
(Ex: The alarm to emerg. exit stairway in dementia section is checked and found to be in working order. However, when the alarm is set off by confused patient in wheelchair pushing it open, no one from staff responds. Patient is killed when wheelchair tumbles down the stairs around 10 minutes later. True story, happened here)
irish17
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by irish17 »

Good luck finding an RN, from three different nursing homes (rehab ctr, assited living ctr) I have recently visited do not have RN but LPN on staff even the D.O.N. Director of Nursing. An LPN has a one or two yr degree. I was so surprised at this. But it is yet one other way to cut down on costs. Hard to believe when it was also the set up at private assisted living ctr.
startwithtruth
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by startwithtruth »

My mother was in a skilled nursing facility with dementia for 2.5 years, and except for the first few months her care was covered by Medicaid (she was initially Medicare, then private pay for a few months). It was a well run non-profit that looked/smelled clean, and had brightly lit hallways and dining rooms, and nicely furnished common areas. My father took a senior bus every day to be with my mom and the staff treated him like family, frequently offering him rides home in the evening. My mom shared a room with another resident.

My sister and I toured many places (and called even more), read reviews, and studied statistics on the Medicare website before making our choice. I was amazed at the variation among places that would accept Medicaid shortly after admission. There were also a few places that required a substantial period of private pay before accepting Medicaid, and they were certainly appealing with newer buildings and very large rooms; my parents had little in the way of assets though so those weren't an option.

I think it's worth looking closely at non-profits.
Reubin
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by Reubin »

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littlebird
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by littlebird »

My experience: Hospital social worker gave me a list of Medicaid-approved assisted living and nursing homes. That’s the only list they had; private-pay only facilities have to be found a different way. I started off visiting the highest rated homes within a 35 minute drive, since I wanted to be able to visit my spouse every day. I am more than a decade and a half younger than him; had I been older, my range would no doubt have been shorter.

The highest rated homes were run by non profits. They were old, decrepit ( bare plywood foot-and headboard bolted to the bed frames with u-bars, cutting into toe space, for example) and cramped. The newer facilities were lower-rated and notorious in the community as death traps. Until a social worker told me about family-based assisted living group homes, I was thinking I’d slit my beloved spouses throat, and my own, before I’d leave him in any one of the places I’d seen. Would I leave a parent with dementia in such a place? Honestly, maybe, if that was the only way to give them care. But a fully-sentinent spouse, never.

The group home was located with the assistance of a freelance consultant (I think of him as the “fixer; only his first name was on his card). I was extremely satisfied with our 2 year experience there. Paradoxically, as my spouse’s condition deteriorated, his care became easier, and I was able to bring him home with 6 hours of caregiver help/day, costing about the same as the group home had, ~$50,000. Although our assets and income are very modest, by boglehead standards, this has not been a hardship, and our net worth has slightly increased over the 2 1/2 years, so far, of long term care.
vested1
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by vested1 »

There are perhaps 20 such facilities in our area, and when my MIL became too disabled to stay at home her son and I visited every one. We ended up choosing a very nice facility that was medium priced for our location at $8,500 a month. We made sure that the facility would transition to Medicaid if/when her substantial savings were exhausted. Most of the others who accepted transition to Medicaid were cesspools that employed non-caring "care-givers", with the odor and volume level of complaining residents an unavoidable and tragic tableau.

At my MIL's facility, there was no difference in the care provided and no change in attitude by the staff or management when she transitioned to Medicaid. When she died last month at age 95 I wrote two obituaries that expressed the family's appreciation for the care she received, naming the facility and suggesting donations.

When vetting a facility I would ensure that they provide not only required, but extra services, such as physical therapy, group interaction, regular face-to-face meetings with relatives and management, and an on-site physician. Her facility also had a hairdresser who came several times a week to provide services and lift the spirits of residents. Regular visits by volunteers who brought along comfort animals to interact with the residents was also appreciated.

It's vital to stay involved however to ensure the quality of care is maintained. My MIL's facility never smelled (OK only temporarily) of waste and was very clean. The staff were always in a great mood and it was obvious that they really cared for the residents. Several cried when my MIL passed.

Perhaps the most important aspect of maintaining the happiness of the one in the facility are visits from friends and family. That, more than anything else has a positive effect.
Tango
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by Tango »

My mother was in two skilled nursing centers for 4 years. Both accepted Medicaid. Neither was dirty. First one would call me if they gave her so much as a Tylenol.She wanted to move to a different one closer to where she used to live. Against my better judgement, I let her move. The second one killed her by giving her drugs for Alzheimer's, which she did't have (she could not walk due to osteoporosis and she had some hardening of arteries and TIA's with a bit of dementia), and then denying that they were giving her anything. She got so disoriented that she fell twice getting out of bed and hit her head. Then they sent her to a hospital where a feeding tube was inserted and only afterward was I told by the doctor that she was "now a vegetable." Oh, and someone stole her diamond wedding band. I made certain that the nursing home was not to send her to the hospital again and that she was to die in her bed at the home. She lived another 6 months. The day after my mother died, I went to the home to gather her things and was told by the doctor that my mother was resting comfortably. Not kidding. And, yes, I reported them to the state. A year later I was told that there was no finding of maltreatment.
Dan999
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by Dan999 »

A side question on Medicaid funding and recouping.
If anyone has had a parent in a nursing home under Medicaid, have you or do you know of an instance where the home or Medicaid tries to come to the child after death and impose the familial law to recoup some payments.
I know some states have this law, but apparently is hardly ever pursued. The Medicaid patient has no assets and never did, other than the $2,000? they had when admitted.
Thanks
Dan999
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Reubin
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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by Reubin »

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Re: Are Skilled Nursing Facilities that Accept Medicaid Really That Bad?

Post by Artsdoctor »

Kennedy wrote: Wed Aug 29, 2018 10:24 pm I have a family member who is in a skilled nursing facility for rehab after a fall. The tab is paid in full by Medicare for the first 20 days. Days 21-100 are subject to a co-pay of just under $200 per day.

It's unclear as to how long they will be in rehab. If the 100 days pass without being discharged, I'm just wondering how Medicaid could play a role. This person is of limited financial means, and it won't take much to spend down their savings to meet the maximum allowed... something like $2000 dollars in assets. After that, it's possible Medicaid will take over, I'm assuming, if they meet the financial and medical criteria.

Their current facility in a large metropolitan area is lovely. I was surprised to see the facility is on a list provided by the state of Medicaid-approved skilled nursing facilities. There were several other lovely facilities of which I am familiar on this list as well.

The family member is currently in a large, private room. I'm assuming that would change to a shared room if in a Medicaid bed. Is there a catch other than having to share a room? I presumed Medicaid facilities would be horrid, and this facility is not. The current facility seems to have a bunch of empty rooms and the state list states the facility has 90ish Medicaid beds.

I can speak to this directly although I'll preface it by saying that I'm not a nursing home specialist. I have personal experience with my grandmother, MIL, FIL, and several friends' parents.

Medicaid-eligible doesn't necessarily mean you'll get in right away. There can be a waiting list, and you'll need to apply. The application process will include financial information.

There is a spend down process to qualify for Medicaid. Usually, not always, a Medicaid-eligible facility would prefer to bring someone in who can pay full price for some time. Then, if the patient spends down and will be able to qualify for Medicaid, the facility will then continue providing care. These facilities can be relatively nice, and not just in the way it looks. The care can be fine, and I do want to underscore that that comes from over a decade of experience at a variety of places.

The facilities that accept Medicaid patients from the get-go can be quite different. When you think about it, how could it be otherwise? The state is not going to pay full price and if you have enough patients who are only Medicaid, you're going to be restricted by cost.

I was actually surprised to find that many non-Medicaid eligible places charge a hefty price (say, $7,000 per month) but this can be less than the full price of the Medicaid-eligible places (I've seen up to $12,000 per month). Again, when you think about the finances, it makes sense. If someone's going to pay $7,000 from the beginning, you're assured of a certain income. If you're going to charge $12,000 per month but the person is going to run out of money and be on Medicaid, then you're going to want to calculate just how long the person can pay full price. Hence, the waiting list can be relatively fluid.

Again, this has been my personal experience and I can't speak for the industry as a whole. My experience has included CA, OH, TX, PA, NY, and FL.
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