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Specifically referring to Medicaid and the issue of receiving temporary housing (recovery).

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Mom is in rehab not her AL at this point. She has to have private pay , at the AL, for two years before I can apply for Medicaid.
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JoAnn29

You did not apply for Medicaid did you? Some NH and ALs, will try to convince family to apply in the hopes the resident will stay longer.
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Not sure about Medicaid. I have found with my preemie GS and disabled nephew, they pay for everything. Mom is in rehab right now Medicare fully pays up to 20days after that 50% of the cost. With Medicare and her supplemental her cost will be $157 a day up to 100 days I think. After that, you pay. Told admitting that Mom can't afford to pay after 20days. Medicaid is not an option because she does have money but that has been set aside for her care at the AL. She still owns her home so bills, taxes and personal needs use up her SS and sm pension.
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It is at the particular NH's discretion. My late mother was in the rehab unit of her NH for 10-12 days, only to be told she was deemed to well to stay at the NH AT ALL. They got it wrong, in fact dead wrong because less than 48 hours later she suffered a stroke there!
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pamstegma,
Thanks for adding this dimension to the discussion.Yes, Jimmo has relevance but has limited application. It does not give carte blanche to continued therapy without a bona fide clinical justification. In my experience, we would rely on Jimmo very rarely, but believe me, we used Jimmo to argue for further therapy as much as we could since it is certainly to the advantage of both the resident and the facility to continue therapy whenever justified. There is no downside to appealing the facility's (or increasingly is the case, the ins. co.'s decision on continued therapy, but an appeal will not automatically result in a reversal, as the rules still are the rules .
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plzdnr, Please read Jimmo v HHS (2014). I just had a case where the NH stopped PT and I advised the patient to appeal. The facility immediately reinstated PT and the patient is making progress. I am an Ombudsman.
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I'm a retired long term care administrator. I'm assuming that this person is not covered by Medicare, which only covers up to 100 days depending on the person's medical/therapy needs. Medicaid varies from state to state and many who have Medicaid as their insurance are on a HMO plan that specifies more clearly what is covered for short term. If this person does have Medicare coverage along with Medicaid, Medicaid will dovetail with Medicare, as Medicare is always the first to be billed for services (to spare the state budget, not to enlarge the facility's budget, but it does have a positive effect on the facility.) The discharge planner at the hospital will be able to explain what is covered for this person and the facility admission person can explain more specifically what to expect once admitted to the facility. If the person is being admitted for therapy, there is a generally predictable trajectory for recovery based on the basic reason for the therapy, other diagnoses that may impact the person's ability, motivation, age, etc. Once the person has reached what the therapy staff believe are the person's maximum potential (aka "plateau"), the person will be discharged from therapy and if there are no other medical needs that require "skilled nursing services" (as defined by Medicare and Medicaid), Medicare coverage will end. Medicaid will only continue if there is a need for non-skilled nursing services (or skilled nursing past the 100 days), including assistance with activities of daily living (bathing, dressing, toileting, etc.). What care is covered by Medicaid varies from state to state. Hope this helps.
May God bless.
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Ask the Medicaid experts in your state what their definition is.
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Short term care can go up to 100 days, but only if the patient is making progress. If "failure to progress" is noted, the patient converts to long term care, since treatment has not helped.
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