Does having Medicaid pay for private room in nursing home be medically necessary? - AgingCare.com

Does having Medicaid pay for private room in nursing home be medically necessary?

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I am looking at nursing homes for my mom and she is basically refusing to move into a semi-private and I really hate to force the issue. I really do understand her reasoning not to want one. But Medicaid will only pay for a semi-private and I don't think we can afford a private room for her long term. One place I just talked to said it is $25 a day. Since they take all of her money to be at the nursing home, outside family members must come up with this payment.

I read Medicaid will pay for it, if medically necessary. Does anyone know what qualifies as medically necessary? As well as know the process for this?

My mom is 67, has MS, and needs complete assistant to transfer from bed to scooter, to toilet, etc. She sleeps horribly and gets muscle spasms and lots of pain at night, and is bedbound unless someone comes to help her out. She does not want to deal with a roommate on top of her own issues, knowing she is keeping them awake, as well as them waking her up.

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I don't know where you are located, but there is one poster here (jeannegibbs) whose mom is in a private Medicaid room because all the rooms at that particular nh are private. Having read your other posts, I wonder how much of this "condition setting" by mom is simply her making things hard for you so that you'll agree to have her live with you. Sometimes, life is not fair, some people get MS, lose their independence and some of their privacy. My mom and her roommate at nh simply politely ignore each other and pretend the other doesn't exist.
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Okay, thanks, I see more how that works. I can see why it would be necessary for others!

Now to get relatives to chip in to help pay for a private room. I figure I should just be upfront about it with them and ask them for their help. She has four brothers and I know at least two would be able to help out.
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Medically necessary private room? Well if she had TB or something else that was contagious, it would be medically necessary. If she was assaultive and raving, perhaps. Not for MS.
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