Medicaid Beds In Nursing Homes

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How It Works: Out Of The Nursing Home For At Least 30 But Less Than 60 Days

NH hopes to encourage hospitals, nursing homes to make mental health beds available

Your uncle received 20 days of Medicare covered skilled nursing care after he’s hospitalized with a stroke. The Medicare coverage ended when he stopped needing skilled care.

He chose to stay in the nursing home and pay for 2 days of custodial care. Then he went home. After 34 days, his doctor readmitted him to the hospital for 4 more days because of his stroke.

Even though your uncle was out of the nursing home for more than 30 days, he had a new qualifying hospital stay. Medicare pays this nursing home stay. He has 80 days of coverage left in this benefit period.

  • If the break in skilled nursing care lasts for – at least 60 days

Medicare won’t cover additional skilled nursing care unless the patient has a new 3-day qualifying hospital stay.

The new hospital stay need not be for the same condition that someone’s treated for originally.

Since the break in skilled care lasted for at least 60 days in a row, this would end the current benefit period and renew the skilled nursing benefits. This means that the maximum coverage available would be up to 100 days of nursing home benefits.

What Happens To Income When They Enter A Nursing Home

Beneficiarys Income

While Nursing Home Medicaid beneficiaries are permitted to earn a certain amount of income each month, all of that income must be surrendered to the nursing home in which they are receiving care. If the beneficiary is married, some of their income may go to support their spouse provided that spouse is not also a Medicaid beneficiary and their spouses income is under a certain limit.

The personal needs allowance, or PNA in most states is between $50 and $200 per month.

The amount allowed to be transferred to a spouse depends on the year, the state in which they reside and the spouses income. Generally speaking, a spouse can be transferred up to approximately $3,435 per month in 2022, but that would only be for a spouse that had zero income of their own. Note this is a simplified view, actual transfers may take into consideration housing and utility costs and other state-specific nuances. More on spousal income transfer.

Spouses Income

A Medicaid applicant spouses income is not taken into consideration provided that spouse is not applying for Medicaid as well. The non-applicant spouse is allowed to retain all of their income. Again, some state-specific minor rules may impact a spouses income.

How Your Assets Impact Eligibility

Besides income, your assets will be counted toward meeting eligibility requirements. Countable assets include checking and savings account balances, CDs, stocks, and bonds.

In most states, you can retain up to $2,000 as an individual and $3,000 for a married couple outside of your countable assets. However, these amounts may vary depending on the state in which you live.

Your home, your car, personal belongings, or your savings for funeral expenses remain outside of countable assets. If you can prove other assets are not accessible , they too are exempt. A house must be a principal residence and does not count as long as the nursing home resident or their spouse lives there or intends to return there.

Upon becoming eligible for Medicaid, all of the applicant’s income must be used to pay for the nursing home where the applicant resides. However, you may be allowed to keep a monthly “allowance” and a deduction for medical needs, such as private health insurance. The amount of the allowance varies depending on your living arrangements, type of nursing facility, and state rules. If you are married, an allowance may be made for the spouse still living in the home.

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What If The Nursing Home Has A Waiting List For A Medicaid Bed

Transcript:

Hi, Im Wes Coulson from Dent-Coulson Elder Law with offices in St. Louis Missouri and OFallon Illinois and serving people throughout Southwestern Missouri and Southern Illinois. In order for someone to be eligible for Medicaid benefits to pay for nursing home care, two things have to both be true.

First, they have to meet the financial requirements for eligibility, thats something we can help with through planning. The second requirement is that they have to be in whats known as a Medicaid bed. Now, that term doesnt have anything to do with the quality of care, its a financial term that simply means that the facility will accept Medicaid as a form of payment for somebody occupying that bed.

Nursing homes vary. Some have all Medicaid beds, other have only a limited number. In the case of a nursing home that has only a limited number of Medicaid beds, and thats frankly more common in St. Louis county than otherwise in the St. Louis metropolitan area, theres some special considerations. First of all, you need to have a handle on whether you can pay the nursing home during that waiting period or it may not be a good choice. But, there are some things that we can do by way of planning that can make it so that if you are transferring assets out of harms way in order to protect them, you can actually have that penalty period start to run before the person has been placed permanently into the Medicaid bed.

Your Trusted Advisor on the Elder Care Journey

Nursing Homes With More Medicaid Beds Get Lower Ratings

Tychemed ICU Bed for Patient (Manual Three Function Bed)

The reality is that money equals quality. When a nursing home has money, it can hire more employees to take care of residents, provide more enriching activities, and invest in equipment and facilities that help them provide better care. According to the federal governments ratings of skilled nursing facilities, the nursing homes with the worst overall quality ratings have the highest numbers of Medicaid beds. While facilities with one-star ratings have an average of 69 percent of residents on Medicaid, five-star facilities only have 49 percent of their residents on Medicaid. Because the facility is making about 25 percent more on private-pay residents, this is not surprising. However, just because you require a Medicaid bed, that doesnt mean you have to settle for a nursing home with a low overall quality rating.

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Selecting A Nursing Home Or Long

Please use the questions below as a guide in selecting a nursing home or another long-term care facility for you or a loved one. It’s also a good idea to ask the home for a copy of its latest inspection and whether a volunteer ombudsman visits regularly. An ombudsman will advocate for your loved one and other residents. And remember, if you have a complaint about a home, or suspect an elderly or disabled person who lives there is being abused or neglected, call the Adult Abuse and Neglect Hotline, 1-800-392-0210.

Types Of Medicaid That Cover Nursing Homes

Nursing home Medicaid is also called Institutional Medicaid and is available for eligible Americans in every state. Nursing Home Medicaid is different from the other forms of Medicaid long term care, specifically Medicaid Waivers and Aged, Blind, and Disabled Medicaid . HCSB waivers and ABD Medicaid can cover the some but not all of the costs of medical and personal care services in a home or assisted living community, but not room and board.

Different states have different names for Medicaid . Eligibility is based on need, meaning which specific Activities of Daily Living a person cannot do on their own, and financial limitations like monthly income and countable assets.

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Too Many Medicaid Beds Costs Texas

The quickest, easiest way to improve nursing home care in Texas wont cost a penny. In fact, it will use taxpayer dollars more efficiently.

As many as 30 percent of the Medicaid beds in Texas nursing homes are empty on any given day. And when a long term care facility cannot fill its beds, fixed costs must still be covered, while regulatory and licensing requirements must still be maintained. All of this can and does leave staff stretched thin and makes investments to improve care difficult.

Texas oversupply of Medicaid beds is expensive. Excess beds create health care price inflation and contribute to staff turnover, healthcare worker shortages, and lower quality care. These higher costs are passed on to private payers and public programs, like Medicaid.

Limiting the growth of Texas Medicaid Bed Allocation Program wont cost a penny, and will make more efficient use of tax payer dollars while helping improve the quality of care in Texas skilled nursing facilities.

Key Facts:

How To Select A Nursing Home

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When a person can no longer live independently, a decision must be made about the best alternative arrangement for care. Such a decision often must be made during a time of crisis, frequently when the person is ready to leave the hospital after a serious illness or operation. This booklet serves as a guide for those faced with the test of selecting an appropriate care setting for a person who no longer is able to live independently.

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Illinois Law On Advance Directives

You have a right to make decisions about the health care you receive now and in the future. An advance directive is a written statement about how you want medical decisions made when you can no longer make them. Illinois has three advance directives: health care power of attorney, living will and mental health treatment preference declaration. Read more about advance directives and access the forms you need to fill out for each.

Medicaid Benefits In Nursing Homes

For those who are assessed as needing Medicaid , all costs including room and board are covered. What follows are the services that must be provided at nursing homes and covered under the Medicaid Long Term Care benefit.

Medicaid is Not for Short-Term Rehabilitation

Services Paid for by Medicaid in Nursing Homes

Nursing and medical services: Very broadly, this means health care provided by a registered nurse to maintain as high a standard of living as possible. Examples of services a nurse would provide include intravenous therapies, wound dressing, pain control, and ostomy care.

Medically related social services: In many communities, there are local resources that can help someone who needs nursing care, and Medicaid can help find those programs and get your loved one engaged in them. Medicaid will also cover counseling for emotional issues, which has been shown in studies as effective for helping nursing home residents.

Assistance with acquiring and administering medications: As someone ages, unfortunately, the number of medications they need increases while it becomes harder to actually take those medicines. Medicaid considers help taking medications as one of the most important benefits.

Meals to meet the dietary needs of each resident: Nursing Home Medicaid will cover the cost of serving your loved one foods that are healthy and considerate of dietary restrictions.

Emergency dental services

Service Not Paid for by Medicaid in Nursing Homes

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Residents May Be Charged For:

  • Private room, unless medically needed
  • Specially prepared food, beyond that generally prepared by the facility
  • Telephone, television, radio
  • Personal comfort items including tobacco products and confections
  • Cosmetic and grooming items and services in excess of those included in the basic service
  • Personal clothing
  • Gifts purchased on behalf of a resident
  • Flowers and plants
  • Social events and activities beyond the activity program
  • Special care services not included in the facility’s Medicaid payment

Medicaid’s Coverage Of Nursing Home Care

Maidesite Hospital Metal Elderly Home Care Rotating Bed

For better and for worse, Medicaid is the primary method of paying for nursing home care in the United States. But navigating the Medicaid system is complicated and confusing. Here are the basics.

Medicaid is a joint federal-state program that provides health insurance coverage to low-income children, seniors, and people with disabilities. In addition, it covers long-term care for those who qualify. This coverage has traditionally meant care in a nursing home, although coverage of care in an assisted living facility or at home are possible .

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City, State

In the absence of any other public program covering long-term care , Medicaid has become the default nursing home insurance of the middle class. Lacking access to alternatives such as paying privately or being covered by a long-term care insurance policy, most people pay out of their own pockets for long-term care until they become eligible for Medicaid.

Each state operates its own Medicaid system, but this system must conform to federal guidelines in order for the state to receive federal money, which pays for about half the state’s Medicaid costs. This complicates matters, since the Medicaid eligibility rules are somewhat different from state to state and they keep changing. To be certain of your rights, consult an elder law attorney in your state who can guide you through the complicated rules of the different programs and help you plan ahead.

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A Daytime Program In Your Community

Whether you live alone or stay by yourself when your family goes to work, you do not have to be lonely. If you go to a daytime program, also called adult day care, you can have fun, learn and be with others. You also may get help with some tasks, such as taking medicine.

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    Why Would I Need Long

    Reasons for needing long-term care include:

    • Age. The older you are, the more likely you will need long-term care.
    • Gender. Women outlive men by about 5 years on average and so they are more likely to live at home when they are older.
    • Disability. Having an accident or chronic illness that causes a disability. 69 percent of people age 90 or more have a disability.
    • Health status. A chronic condition such as diabetes or high blood pressure makes you more likely to need care.
    • Living arrangements. If you live alone, youre more likely to need paid care than if youre married or living with a partner.

    Medicaid Nursing Home List

    Medicaid cuts could affect nursing homes

    For over a decade, Wright Abshire has published a list of all Medicaid certified nursing homes in Harris and surrounding counties to support families searching for a facility to suit their unique situation. Included on this list are Medicaid facilities accepting children, as well as those accepting ventilator care patients.

    Choosing a nursing home for a loved one is difficult for all who are involved. Many things must be considered, such as location, cost, room availability, appropriateness and quality of care for the individual moving in. Another important consideration is whether or not the facility is certified to accept Medicaid. This is significant when an individual or a married couple is in the process of Medicaid planning or when all of their assets have previously been exhausted.

    Our new interactive map features the ability to connect to the Texas Department of Aging and Disability Services Long Term Care Reporting System and its report for each of the listed nursing facilities and details of each cited deficiency. To do this, click on the Website link under the facilitys address. You will be directed to the QRS page for that particular facility.

    Interactive Maps

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    What Is The Cost Of Facility Care

    Nationwide, the cost is around is $64,000 per year for a skilled nursing home. The average cost in a residential care facility is around $24,000. When selecting a facility, find out which services are included in the basic daily charge and which are not covered. Ask whether a deposit is required and the procedure for return of the deposit. .

    What Is A Medicaid Lookback Period

    The Medicaid lookback period is a period of time in which any transfers of assets to family members may be subject to scrutiny for Medicaid eligibility. If it’s determined that you specifically transferred assets during the lookback period in order to qualify for Medicaid, this can affect the benefits for which you’re eligible.

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