Nursing Home Patient With Their Nurse Going for a WalkFamilies often find themselves in an impossible situation when a loved one needs long-term care. On the one hand, they want to find a suitable facility with a Medicaid bed available. On the other, they may still be waiting for their loved one’s Medicaid benefits to be approved.

Fortunately, there are several ways spouses and family members can secure and pay for a place in a nursing facility. The right path for you will depend on the specifics of your relative’s situation. A Medicaid planning attorney explains the different approaches to getting someone into nursing home care and the pros and cons of each one.

Four Different Paths to Getting a Loved One Into a Nursing Home

It’s worth noting that not all approaches will work for all Medicaid applicants. Your chosen path will depend on whether your relative has already been approved for Medicaid, the amount they need to spend down before they’re eligible for benefits, their family’s resources, and how soon they need nursing home care.

Path #1: Medicaid Pending

If your loved one needs care immediately, you may need to take the Medicaid pending approach. Since it can take up to three months to get a response from the New York State Medicaid office, your loved one may be admitted to a long-term care facility before their benefits come through. Nursing homes that accept Medicaid-pending residents typically defer payment until the resident is approved.

The pros: Families can move their loved one into care immediately without paying for care out of pocket (assuming benefits are eventually approved). Nursing homes cannot evict applicants while their Medicaid applications are pending.

The cons: Few nursing homes will accept Medicaid-pending residents, and even fewer do so without requiring a backup form of payment if benefits fall through. Also, ratings for nursing homes that take Medicaid-pending residents typically have lower ratings than others. Worst of all, a patient denied benefits would likely be evicted immediately from the nursing home.

Path #2: 100 Days of Medicare

Your relative could move into a nursing home and have Medicare pay for their first three months. Medicare benefits cover 100% of long-term facility costs for the first 20 days of residence and 80% of costs afterward, up to 100 days. This reduced-cost plan is available to any Medicaid applicant with Medicare who:

  • Entered the nursing home within 30 days of an inpatient stay at a hospital
  • Has not previously used their 100-day long-term care benefit

The pros: No out-of-pocket costs for family members and the potential to go into care straight from a hospital.

The cons: Families will need to find a nursing home that accepts both Medicare and Medicaid and get their relative admitted as soon as possible. While 100 days may seem like a long time, there’s no guarantee that your relative’s benefits will be approved before Medicare benefits run out.

Path #3: Private Pay During Spend Down

If your loved one needs care now but has too many assets to qualify for Medicaid, you may need to take the private pay approach until their benefits kick in. In the meantime, your loved one will need to spend down their countable assets—without incurring a penalty—until they are under Medicaid’s asset limit. Once eligible, a resident will switch to Medicaid as the payer.

The pros: Nursing homes are more likely to accept private pay residents than those whose stays are paid for by Medicaid. If the facility accepts Medicaid and private pay, your relative will not have to move when their benefits begin.

The cons: The biggest drawback of this method is spending thousands of dollars of the applicant’s own money on their care.

Path #4: Family Private Pay Before Approval

Family members may secure immediate long-term care for a relative by paying up front and applying for reimbursement once Medicaid is approved. Medicaid benefits may be retroactive for up to three months before the date of application. Once Medicaid pays the nursing home for these months of care, the nursing home refunds the cost to the family.

The pros: Immediate care and the eventual return of at least some of what you paid for nursing home costs.

The cons: If you don’t get a refund agreement in writing from the nursing home, you may never get reimbursed for your out-of-pocket costs.

Is There Any Way to Get Good Nursing Home Care Without Spending Tons of Money?

The more time you have to plan, the better your chances of avoiding paying for nursing home costs out of your own funds. The Medicaid planning attorneys at Landskind and Ricaforte Law Group, P.C. can determine if your loved one would benefit from home health care services, can spend down by benefiting children who have been caring for an ailing parent, and find ways to secure care while preserving your estate. Contact us today through our online form to get started or read our free book, Estate and Medicaid Planning in New York: What Everyone Needs to Know.


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