Dad is currently in a SNF on Medicare. His Medicare days will be running out soon. He is in Medicaid pending status, with great likelihood for approval. Can SNF refuse to keep him after he changes from Medicare to Medicaid?
They could but it’s unlikely. In my experience it would be because... - this SNF/NH does not participate in Medicaid. They participate in Medicare, so his post hospitalization rehab since it’s a covered Medicare benefit was ok. But once he goes out of rehab, it’s a problem as facility does not take Medicaid. There should be a discharge planner or SW to help him get placed. - the # of medicaid beds are limited and there are no open Medicaid beds - your parent level of care are beyond what this specific NH can provide. The needs assessment will be central to this. Like he’s needing locked ward or specialty obesity care, and this SNF cannot provide.
Is there a possibility that “great likelihood of approval” will actually not be there? Is there something lurking that may surface to pose an issue? Please keep in mind that the date of Medicaid application starts the look back period. By applying for Medicaid, it provides the state an “all access pass” to their life. If something amiss it will surface eventually.
When your dad entered the SNF didn't they tell you whether they accept Medicaid or not? I would think that if they do not accept Medicaid someone from the SNF would have been coming around to discuss discharge instructions.
Call the facility's social worker. The social worker will know.
Some SNFs accept Medicaid and some do not. It's a business decision on their part. If they do accept Medicaid, the 2nd challenge is to find out if they have any "open" Medicaid beds. Often they designate a specific number of beds as Medicaid, and when those are filled, there is a waiting list.
He has virtually no assets, and all income will be going to the facility in any case. They don't have Medicaid beds available in NH section. They do take Medicaid, but we are looking to keep him in the rehab wing with Medicaid paying until he can be discharged to home care. Our concern is that the facility is not being very forthcoming with information because they don't want to give up the rehab slot to a Medicaid pay. The question is whether they can "force" him out before he is ready.
Just want to say...Medicare does not stop when Medicaid comes into the picture. Health insurance wise Medicare is the primary, Medicaid is the supplimental. Medicaid pays the 20% Medicare Doesn't, prescriptions, vision and dental. If Dad is in Medicaid pending I would think SNF is involved with this and as such they feel they have a bed for him. You need to talk to the admitting person. I don't think you have anything to worry about.
Daisy - if you or other family are planning on taking him home AND you all have let the NH/rehab facility know that this is the plan, I can understand why this place isn’t all over trying to accommodate you. Once he’s discharged from rehab, he has to move out of the rehab bed. He goes back home the day of rehab discharge.
If this is about Medicaid paying the 20% copay due for the rehab stay after the first 20/21 days MediCARE 100% paid days, that is up to the facility to determine what payment acceptable. If this place will accept Medicaid for the copay, then try to have him placed as “Medicaid Pending”. If facility won’t do that then he or you or rest of his family will need find a way to pay the 20%. The copay I think is $185 a day. His SS income can pay some of this.
Have you spoken to rehab staff as to what his progress is like? How soon to probable discharge from rehab?
- this SNF/NH does not participate in Medicaid. They participate in Medicare, so his post hospitalization rehab since it’s a covered Medicare benefit was ok. But once he goes out of rehab, it’s a problem as facility does not take Medicaid. There should be a discharge planner or SW to help him get placed.
- the # of medicaid beds are limited and there are no open Medicaid beds
- your parent level of care are beyond what this specific NH can provide. The needs assessment will be central to this. Like he’s needing locked ward or specialty obesity care, and this SNF cannot provide.
Is there a possibility that “great likelihood of approval” will actually not be there?
Is there something lurking that may surface to pose an issue?
Please keep in mind that the date of Medicaid application starts the look back period. By applying for Medicaid, it provides the state an “all access pass” to their life. If something amiss it will surface eventually.
Call the facility's social worker. The social worker will know.
If this is about Medicaid paying the 20% copay due for the rehab stay after the first 20/21 days MediCARE 100% paid days, that is up to the facility to determine what payment acceptable. If this place will accept Medicaid for the copay, then try to have him placed as “Medicaid Pending”. If facility won’t do that then he or you or rest of his family will need find a way to pay the 20%. The copay I think is $185 a day. His SS income can pay some of this.
Have you spoken to rehab staff as to what his progress is like? How soon to probable discharge from rehab?