What must be apparent and factual before long-term care facility services and room and board are paid for by a dual complete insurance plan?

Based on your profile you are trying to figure out if you should apply for Medicaid and if the doctors can force you to place your mom in a facility.

Is this correct?

When talking about a dual complete insurance plan are you talking about a Medicare Advantage plan which covers Medicare A,B & D and a supplimental? If so, these type of plans do not cover LTC. No health insurance pays LTC.

I have straight Medicare with a supplimental. Medicare will pay for Rehab after 3 days (I think or 4) in a hospital if recommended. Medicare pays 100% the first 20 days, 50% from 21 to 100 days. A suppliment may pay for the balance of 50% or not. Medicare determines the length of the stay.

Medicaid helps pay for LTC. There is a criteria that has to be met. The need for 24/7 care is one of the criteria. Your assets have to be spent down to the asset cap ur State Medicaid allows and the monthly income can go over a certain cap. The persons Social Security and pension will need to be used to help offset the cost of their care. If there is a spouse, they will not be made impoverished.

Medicaid should pay for SNF or for Rehab which includes meals and housing. If they are not there is some reason. Some SNFs function as a "Nursing home" and want pay for that. SNF means Skilled Nursing Facility. They are paid when MD orders a person placed who requires SKILLED NURSING care. They are not paid if they are just placed there. That is private pay.So this falls under it all depends on who is admitted, why admitted. This is a question for Social Worker and Medicaid.