Can’t Get into a Medicaid Nursing Home with Private Paying First

Last updated: April 28, 2022
Medicaid Long Term Care | Questions and AnswersCategory: ApplyingCan’t Get into a Medicaid Nursing Home with Private Paying First
medicaidplanner Staff asked 7 months ago

We are actively trying to find a nursing home for my mom. We are also actively applying for Medicaid. Each nursing home we go to asks us how much money we have and when we say we have enough for 3-4 months of private-pay, the nursing home seems to become uninterested in having my mom move in. Is there something going on here?

1 Answers
medicaidplanner Staff answered 7 months ago

Yes, something is going on, and it is called Medicaid discrimination. In this specific case, “Medicaid discrimination” is taking place because the nursing home is prioritizing the admission of nursing home candidates based on the likelihood of monthly fees being paid privately (out-of-pocket) for a longer period.

While nursing homes do not have to accept Medicaid, if they are Medicaid-certified, meaning they accept Medicaid residents, it is illegal to discriminate based on how one will pay. This means a nursing home cannot discriminate against a potential resident because they are on Medicaid, have applied for Medicaid, or have plans to apply for Medicaid.

Unfortunately, this type of discrimination is a rather common issue that comes down to how much money a nursing home makes based on form of payment. According to Genworth’s Cost of Care 2021Cost of Care 2021, the national average daily cost of nursing home care in a shared room is $260 / day. The amount Medicaid pays is approximately 25% less. Therefore, the amount of money a nursing home makes is significantly more when a nursing home resident pays out-of-pocket.

If one feels they have been discriminated against, they can contact the Long-Term Care Ombudsman (LTCOPLTCOP) Program in the state in which the discrimination took place. Alternatively, persons can call 800-677-1116. Ombudsmen are advocates for potential and current nursing home residents.

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