Medicaid covers nursing costs and room and board for certain applicants, making it a lifesaver for families who cannot care for a loved one. However, getting a Medicaid-eligible parent or spouse into a nursing home is extremely difficult due to the interaction between government-sponsored benefits and each facility’s requirements. We strongly recommend that you involve a Medicaid planning attorney in the process to get Medicaid to cover the best possible care.
How Many Nursing Homes Accept Medicaid?
An estimated 80% of nursing homes nationwide accept Medicaid, with over 350 Medicaid-funded nursing facilities within 25 miles of New York City. Unfortunately, there’s a big difference between a facility that accepts Medicaid benefits and one that will admit your loved one.
Furthermore, the number of Medicaid-funded facilities doesn’t take into account the following:
- The number of Medicaid beds. Nursing homes often have a limited number of “Medicaid beds,” or rooms available to people whose care is covered by Medicaid.
- The number of private pay residents. Medicaid requires nursing homes to offer services to their beneficiaries at a lower rate than those paying out-of-pocket for their care. Since “private pay” residents pay nearly 25% more for nursing home care than Medicaid does, nursing facilities prefer to admit more private residents than those on government benefits.
- The level of care needed. Medicaid nursing home benefits are only available to applicants who require a nursing facility level of care. All applicants must undergo a pre-admission review process and a medical assessment to determine their needs before entrance is granted.
- The recipient’s marital status. The financial requirements for each facility change based on whether one or both spouses need care and how much a healthy spouse can contribute toward nursing home costs.
- The facilities offered. Your loved one’s specific condition and limitations will play a significant role in determining which nursing home is the best fit. Common considerations include the number of onsite doctors and nurses, the number of staff members per bed, and whether your loved one requires a shared or private room.
How Can I Start Narrowing Down Nursing Home Options?
The easiest way to select a nursing home that will accept Medicaid and provide good care to your loved one is to work with an elder law team that can assess your situation personally. Our lawyers have extensive experience working with facilities across the state, easing the financial burden of nursing home care for families across New York.
You can narrow down your potential choices by:
- Making a master list. Create a list of nursing homes in your area that accept Medicaid using the Nursing Home Profiles of the New York Department of Health. You can rank these depending on location, services, or other variables important to you.
- Contacting each facility. Starting with your first preference, contact the admissions department to confirm Medicaid acceptance, whether Medicaid beds are available, and whether a Medicaid-pending resident will be considered.
- Getting on wait lists. If your chosen facility accepts Medicaid-pending residents, request to be put on the waiting list. You can ask to be put on as many nursing home waitlists as possible, and it’s a good idea to be added even if you eventually take a bed at another facility.
- Applying for Medicaid. People who need benefits as soon as possible should seek legal representation for help with their applications. If an applicant moves into a nursing home and is denied Medicaid coverage, they could be immediately evicted unless they file an appeal.
Does Medicaid Pay for Alternatives to Nursing Home Care?
Medicaid pays for various services for ill or elderly New York residents, including at-home health and nursing care. The elder law attorneys at Landskind and Ricaforte Law Group, P.C. can help determine your Medicaid eligibility, perform necessary estate planning, and guide you through the application process. 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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