Introduction: Will a Medicaid-Funded Resident’s Bed be Held During a Temporary Leave?

A nursing home resident who is a Medicaid recipient falls, breaks their hip, and requires hospitalization. Will the nursing home hold their bed for them? If so, for how long? Does the bed need to be paid for during this time? Will Medicaid pay to hold it? Can the nursing home refuse the resident readmission? What about if a Medicaid-funded resident wants to stay with their adult child in a neighboring state for the holidays? Is this permitted? Will their bed be held for them? Will Medicaid pay to hold a nursing home resident’s bed?

The simple answer is yes, in many states, a nursing home will hold a Medicaid-funded resident’s bed under these circumstances for a limited time. However, the length of time for which the bed is held is state-specific, as well as if Medicaid will pay to hold the bed. However, even if Medicaid will not pay, it may be possible for a resident (or their family) to pay to hold the bed for their return.

What is a Nursing Home Bed-Hold Policy?

A bed-hold (bed hold) is when a nursing home resident’s bed is held for them while they are temporarily away from the facility due to hospitalization or a therapeutic visit (a leave for a non-medical reason). During a bed hold, one’s bed remains vacant during their absence rather than being filled by a new resident.

All nursing home facilities are required to have a bed-hold policy, even if the facility does not hold beds. Also called bed hold rights, bed hold requirements, or reserved bed policy, these policies are set by Medicaid state law and indicate whether a facility is required to hold a resident’s bed during hospitalization and / or therapeutic visits (i.e., staying overnight with friends and / or family), the number of days a resident’s bed will be held, and if Medicaid will pay to hold the bed (and any circumstances associated with payment). Therefore, bed hold policies vary by state. Furthermore, nursing home facilities may have their own bed-hold polices, given they are in compliance with applicable laws. For instance, if state law requires a bed-hold up to 8 days per hospitalization, nursing home facilities in that state must hold a resident’s bed up to this length of time. However, if the state does not require bed-holds, a facility may still allow its residents to pay out-of-pocket to hold their bed.

Per federal law, nursing homes are required to provide their bed-hold policy in writing to the resident (or their representative) prior to hospitalization / therapeutic leave (i.e., at the time of admission), as well as when a resident is hospitalized or is going for a therapeutic visit. For instance, when a resident has an emergency hospitalization in Michigan, the nursing home facility must provide the written policy to the resident or their representative within 24 hours of hospitalization.

Medicaid & Reserve Bed Payments

In most states, Medicaid will pay to hold a nursing home resident’s bed for a limited time when they are hospitalized and / or go on a therapeutic visit. These Medicaid payments are often called bed hold payments or reserve bed payments. These payments are generally set at a lower per diem rate (fixed daily payment rate) than when a resident is present in the facility and is state-specific. States that provide bed hold payments set a maximum number of days for which they will pay. Furthermore, there may be state-specific requirements that must be met in order for Medicaid to provide payment. For instance, Michigan Medicaid will pay for up to 10 days to hold one’s bed per emergency hospitalization, but 98% or more of the facility’s beds must be occupied on the day of hospital admittance in order for Medicaid to pay. Furthermore, MI Medicaid will pay up to 18 days per 365 days for therapeutic visits, but these visits must be approved by a physician.

If Medicaid will not pay to hold a resident’s bed during temporary leaves of hospitalization and / or therapeutic visits, a nursing home facility may accept payment from the resident (or their family) to hold their bed. This daily fee can be as much as the private pay rate. Given Nursing Home Medicaid’s financial criteria, it is unlikely that the resident be able to afford this cost, and therefore, the resident’s family would have to pay it.

State-Specific Bed Hold Policies

Since states set their own Medicaid bed-hold policies, the specific rules associated with bed-holds during hospitalization and / or therapeutic visits are dependent on the specific state. This includes if a facility is required to hold one’s bed during these temporary leaves, the number of days for which a bed must be held, if Medicaid will pay to hold it, and the circumstances under which Medicaid will pay. To illustrate the differences between bed-hold policies, some example of state-specific policies follow.

– California Medicaid (Medi-Cal in CA) will pay up to 7 days for each acute hospitalization. For most Medi-Cal funded nursing home residents (non-developmentally disabled), Medi-Cal will pay up to 18 days / year of therapeutic leave.

– Connecticut Medicaid will pay for up to 15 days for hospitalization. For therapeutic leave, Medicaid will pay up to 21 days / year. After these days have been used, the resident or their family can pay the Medicaid rate per day to reserve the bed.

– Maryland Medicaid will only cover bed-hold for therapeutic visits (up to 18 days / year). The state eliminated Medicaid reimbursement for bed-holds due to hospitalization eff. 7/1/12.

– Mississippi Medicaid will pay up to 15 days per hospitalization and up to 42 days / state fiscal year for therapeutic leave.

– New York Medicaid eliminated bed holds due to hospitalization (eff. 5/29/19), with the exception of residents under 21 years old and residents on hospice. NY Medicaid will continue to pay for “therapeutic bed-hold” for up to 10 days / year.

– North Carolina Medicaid will pay up to 60 days / year of therapeutic leave. NC Medicaid does not pay to hold a resident’s bed during hospitalization.

– Tennessee Medicaid (TennCare) eliminated Medicaid-funded bed-hold all together eff. 7/1/18.

– Virginia Medicaid will not pay to hold a resident’s bed during hospitalization. The Medicaid program will, however, pay up to 18 days / year of therapeutic leave.

What if One Exceeds Bed-Hold Days or there is no Bed-Hold?

If a resident’s temporary leave exceeds the number of days permitted by Medicaid for bed-hold, the resident (or their family) may be able to pay out-of-pocket (likely at the private pay rate) to further extend their bed-hold. If this is not the case, the resident cannot afford the cost, or there is no bed-hold, federal law offers protection to Medicaid-funded residents. Specifically, it establishes their right to return to the facility (if they still require nursing home services) if their leave exceeded the maximum bed-hold days or if the facility does not hold beds. If the resident’s prior room is still available, they can return to that room, and if not, they can return to the first available bed in a semi-private room. This “right to return” also applies to Medicare recipients, but unfortunately, not private pay clients.
Although illegal, a nursing home may try to deny a resident’s right to return after hospitalization. They may claim there is no bed available or that they can no longer meet the needs of the resident. Learn more.

How to Find a State’s Bed-Hold Policy

Knowing the bed-hold policy in one’s state, as well as the specific nursing home facility in which one resides (or is considering), is imperative. Current nursing home residents should have been notified of the policy at the time of their admission, but if not, or if one is not currently a resident, the policy can be requested. Persons can also check their state regulations to ensure a facility is in compliance with state rules. One’s state Medicaid agency should be able to provide current state policy.