I am on Medicaid and my assisted living facility is talking about having us share an apartment. What resources are available to me that would prevent them from doing that?
In my home state (MN) being on Medicaid almost always means a shared room, unless they have a glut of Medicaid-designated rooms and not enough recipients. But I also agree that you should review your contract and make sure they aren't trying to cram 2 people into a room that was designed for 1. If you have problems and admin isn't responsive or trying to resolve the issue, contact an ombudsman.
I would check your contract but... If you are living in an apartment that is suited for 1 person like a 1 bedroom or Studio I doubt they can move another person in. (There may actually be Fire or Building Codes that specify the occupancy of the rooms.) If you are in a Double then I am sure they can.
What does your contract with the AL facility say? Were you accepted as a single person for your AL accommodations? If there is a contract like this, then no they cannot force you to share your living space. If you don't have this kind of contract, unfortunately they can make you share.
I'm pretty sure this part of Medicaid is the same in all states and I did search from the Medicaid umbrella documents once (that was painful) and find it "Medicaid will pay for shared accommodation where they are available". In many states AL's do not have to accept Medicaid at all. In NJ the number of AL's who will accept Medicaid is extremely limited and those that do only have to accept a very small percentage of beds.
So to answer your question ... yes, they can require you to accept a roommate, provided the facility meets the min. required square footage requirements for each person. I think in AZ the minimum requirement for shared accommodations is 60 sq ft per resident but you should check on this.
Medicaid pays such a low rate, that every facility I know of is losing money on Medicaid residents (which is why ALs often require that you are private pay for a certain length of time before they will accept you on Medicaid). To give you an example.... even though it was a different type of facility in a different state, NJ - long term care... my facility was the most reasonable in the county because it was government owned. We charged $220 per day per resident (and trust me that didn't cover operational costs). Medicaid gave us $178.43 per person.
Not sure how ALs operate in AZ but you could look at see if there are others that might accept Medicaid that have only private rooms. I hear your discomfort though. It is hard to have a roomie even if they are wonderful when you are not used to it.
Yes, they can. If you are living on Medicaid, you have to take what they will give you. If you want to keep a private room, you will have to pay out of pocket. I do not know if you are allowed to pay just the difference between the Medicaid allotment and the fee for a private room. The facility would prefer to get their full price for that room from a Private Pay resident rather than accept a Medicaid subsidy. That is one of the drawbacks of relying on Medicaid.to pay your way.
I don't think you can. By the time your on Medicaid you have no assets other than the spend down you are allowed of maybe 2k. I think a family member may be able to though.
Medicaid gives you very little options. You are at their mercy for anything they cover. If you found a decent place for your father that takes Medicaid count your blessings. Maybe his new roommate will end up being his best friend. Plus I think most men are not as picky as women regarding privacy. Every man I’ve ever dated had no problem farting in front of me. 🙄😏
The problem with moving...I don't think you can do that.
In my State of NJ when living in an AL you need to pay privately for at least two years to apply for Medicaid. And of course the AL has to except medicaid. My impression is that you would stay at that AL because that is who you paid privately to. You can't then go to another AL and expect them to take your medicaid since you have not paid a penny to them privately. Applying for medicaid helps you stay in that AL.
If you're on Medicaid, it is common for medicaid to only approve payment for a double bed room. Some facilities have only private rooms, so the facility (just like a doctor's office) has to accept Medicaid payment and cannot bill patient for extra cost. So, it's possible your facility is trying to make the most of their Medicaid bed income by using the 2 beds per room.
Medicaid is for people who have little to no income. Medicaid pays very little and facilities/drs have to accept allowable amount. Most NH/facilities have some Medicaid beds and others are self pay. Those folks with money self pay for their privacy.
You might want to look around. There are more facilities around that only have private rooms and they also have Medicaid beds. You might find something where room was actually set up for a single bed, so little chance of turning it into a double room later on
LouiseAM, are you in Assisted Living or in a Nursing Facility [both terms seem to get crossed-over]? Assisted Living, as others have mentioned, one has to pay from their own pocket. Or did you get in via a wavier?
You mentioned an apartment. How many rooms are in your apartment? Is there enough room for two people to share one bedroom or is there two bedrooms/one bath set-up?
When my Mom was in a nursing home, she had to share a room with a room-mate, and Mom was self-pay [paying $12k per month]. The facility had no private rooms.
Evidently, some states offer AL with Medicaid bed. Learned that info from reading the different comments on this site. In Texas, Medicaid bed usually means 2 beds per room in a NH facility - no AL. Recently, however, I became aware of a rehab center that lost too many patients during Covid. This facility was all private rooms and only had rehab patients. To generate income, they took on Medicaid beds and now operate some rooms as NH Medicaid beds. Fortunately, the private rooms for initial construction, as a rehab only center, are small enough that they shouldn't be able to put two beds in (per square ft allowed per patient), but just a tad larger for single bed use.
Perhaps there will be more facilities like this who lost patients and will take on Medicaid beds to improve their revenue.
Yes they can. My father is in AL in NJ which allows for Medicaid in AL. He surprisingly was in a private room for about a year and a half and then got one roommate who lasted two days due to not liking sharing. Tomorrow another person is supposed to be moving in. The state is paying so they can dictate how it all works. It all comes down to cost.
So sorry, but an AL doesn't even have to except Medicaid. They only get a fraction of what is paid privately plus your SS and pension, if any. That room you have they can make money on. I know it won't be easy sharing a room, a big adjustment but that is what happens when the State pays for care.
You will have to discuss their rules with them. I would imagine if you are on Medicaid they can. Most ALF do not accept medicaid at all. You need to know that rules that apply to nursing homes, et al, do not apply to ALF. They are seperate businesses, much like renting out apartments, and have their own rules. Ask your facility to show you the rules as printed in their printed materials.
Who is us? Is the room already shared by someone other than you?
If not, the standard for Medicaid is semi private. If there is family that will gift you, through the al if they allow it, the upgrade to a private room, that could be an option. A private room however is not so much a need as it is a privilege.
Has anything happened concerning your room?
If you are living in an apartment that is suited for 1 person like a 1 bedroom or Studio I doubt they can move another person in. (There may actually be Fire or Building Codes that specify the occupancy of the rooms.)
If you are in a Double then I am sure they can.
If you don't have this kind of contract, unfortunately they can make you share.
So to answer your question ... yes, they can require you to accept a roommate, provided the facility meets the min. required square footage requirements for each person. I think in AZ the minimum requirement for shared accommodations is 60 sq ft per resident but you should check on this.
Medicaid pays such a low rate, that every facility I know of is losing money on Medicaid residents (which is why ALs often require that you are private pay for a certain length of time before they will accept you on Medicaid). To give you an example.... even though it was a different type of facility in a different state, NJ - long term care... my facility was the most reasonable in the county because it was government owned. We charged $220 per day per resident (and trust me that didn't cover operational costs). Medicaid gave us $178.43 per person.
Not sure how ALs operate in AZ but you could look at see if there are others that might accept Medicaid that have only private rooms. I hear your discomfort though. It is hard to have a roomie even if they are wonderful when you are not used to it.
Wishing you good luck on this journey
In my State of NJ when living in an AL you need to pay privately for at least two years to apply for Medicaid. And of course the AL has to except medicaid. My impression is that you would stay at that AL because that is who you paid privately to. You can't then go to another AL and expect them to take your medicaid since you have not paid a penny to them privately. Applying for medicaid helps you stay in that AL.
Medicaid is for people who have little to no income. Medicaid pays very little and facilities/drs have to accept allowable amount. Most NH/facilities have some Medicaid beds and others are self pay. Those folks with money self pay for their privacy.
You might want to look around. There are more facilities around that only have private rooms and they also have Medicaid beds. You might find something where room was actually set up for a single bed, so little chance of turning it into a double room later on
You mentioned an apartment. How many rooms are in your apartment? Is there enough room for two people to share one bedroom or is there two bedrooms/one bath set-up?
When my Mom was in a nursing home, she had to share a room with a room-mate, and Mom was self-pay [paying $12k per month]. The facility had no private rooms.
Perhaps there will be more facilities like this who lost patients and will take on Medicaid beds to improve their revenue.
You need to know that rules that apply to nursing homes, et al, do not apply to ALF. They are seperate businesses, much like renting out apartments, and have their own rules. Ask your facility to show you the rules as printed in their printed materials.
If not, the standard for Medicaid is semi private. If there is family that will gift you, through the al if they allow it, the upgrade to a private room, that could be an option. A private room however is not so much a need as it is a privilege.