Nursing Home Room Upgrade to Private Room on Medicaid

Last updated: November 26, 2019
Medicaid Long Term Care | Questions and AnswersCategory: BenefitsNursing Home Room Upgrade to Private Room on Medicaid
medicaidplanner Staff asked 11 months ago

Can we upgrade mom to a private room in a nursing home when she is on Medicaid?

1 Answers
medicaidplanner Staff answered 11 months ago

The ability to upgrade your mom to a private room in a Medicaid-funded nursing home depends on the state in which your mom resides. Let’s back up. Family supplementation, also called income supplementation, allows relatives to provide financial support to supplement Medicaid-funded care that their loved ones are already receiving. Most commonly, family supplementation is utilized in residential care settings, such as assisted living residences. This is because Medicaid will cover care services, but not room and board costs. Therefore, if a Medicaid recipient cannot afford these costs, relatives may help to cover them.

In the case of a nursing home Medicaid recipient, Medicaid covers the cost of room, board, and care services. That said, Medicaid pays for a semi-private (shared) room, not a private room. In some states, via family supplementation, relatives can pay to upgrade their loved ones from a Medicaid-funded semi-private room to a private one. In this case, the family would pay the difference in cost between the semi-private room and the private room.

However, it is important to mention that not all states allow for family supplementation; approximately half of the states allow for it. Furthermore, of the states that do allow for family supplementation, not all of them allow it to upgrade from a shared Medicaid-funded nursing home room to a private room.

To find out if your state allows for family supplementation, and specifically income supplementation to upgrade your mom from a shared room to a private room, contact your state’s Medicaid agency or your local Area Agency on Aging office.

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