FREE Ebook: Next Stop: Nursing Home Get My Copy Now!

Schedule Your Consultation Today!

(407) 574-8125

How to Get Into a Nursing Home as a Medicaid Recipient

Get The Legal Help You Need

How to Get Into a Nursing Home as a Medicaid Recipient

June 8, 2022
Geoff Hoatson

While Medicaid helps pay for nursing home care, getting into a nursing home as a Medicaid recipient is not always easy. There are several ways to navigate the process, depending on your situation.

With the median cost of a nursing home room being more than $250 a day, most families need help paying for long-term care. Medicaid is the primary method of covering the costs of nursing home care in the United States, but in order to qualify for Medicaid, an applicant must have limited income and assets.

Generally, nursing homes will only accept patients who can pay for their care, while Medicaid will not pay for nursing home care unless an applicant is already living in a nursing home. This creates a predicament: How to get a loved one into a nursing home in order to receive Medicaid? The following are some of the methods you can use to find a nursing home that will accept your loved one:

  • Private Pay. The easiest way to get into a nursing home is to be able to pay for care while the resident’s assets are spent down in order to qualify for Medicaid. Residents who can pay privately for a few months can file a Medicaid application once they are in the nursing home and start receiving benefits when the resident’s funds are below their state’s threshold for “countable assets.” Make sure the nursing home accepts Medicaid patients — and get the timing right so that the resident doesn’t run out of funds before the Medicaid application is approved.

If the resident lacks the funds to pay for his or her own care, the resident’s family could pay. However, this is risky. The family will not be reimbursed if the resident eventually qualifies for Medicaid. It may be possible for the family to lend the money to the nursing home under a written agreement stating that the funds will be returned when the resident qualifies for Medicaid.

  • Medicare. Medicare provides nursing home coverage for up to 100 days of “skilled nursing care” per illness. The patient must enter the nursing home no more than 30 days after a hospital stay that had lasted for at least three days (not counting the day of discharge). The care provided in the nursing home also must be for the same condition that caused the hospitalization (or a condition medically related to it). In addition, the patient must receive a "skilled" level of care in the nursing facility that cannot be provided at home or on an outpatient basis. And finally, Medicare covers care only for people who are likely to recover from their conditions. If a loved one meets these conditions, it is possible for them to enter a nursing home and immediately apply for Medicaid while Medicare pays in the meantime.
  • Medicaid Pending. There are some nursing homes that will accept a resident who has applied for Medicaid and is awaiting a response. Unfortunately, there are only a few nursing homes that accept Medicaid pending residents without some type of payment guarantee in the event the application is denied. The nursing homes that accept Medicaid pending residents tend to be those with lower ratings for nursing home quality.

When moving into a nursing home, be careful about signing a nursing home admission agreement. Nursing homes may try to get families to agree to pay their loved one’s bills if a Medicaid application is denied. Read any agreement thoroughly and have it reviewed by your attorney.

Navigating the Medicaid maze is complicated, but that's why the Family First Firm is dedicated to helping you and your loved one during this process. Give our office a call at (407) 574-8125 or click here to schedule your assessment today.

Copyright © 2024. Family First Firm - Medicaid & Elder Law Attorneys. All rights reserved.
The information in this blog post (“post”) is provided for general informational purposes only and may not reflect the current law in your jurisdiction. No information in this post should be construed as legal advice from the individual author or the law firm, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting based on any information included in or accessible through this post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country, or other appropriate licensing jurisdiction.
Family First Firm – Medicaid & Elder Law Attorneys
(407) 574-8125
Share This Blog

Our Locations

Winter Park Office

Family First Firm - Medicaid & Elder Law Attorneys

1030 W Canton Avenue, Suite 102,
Winter Park FL 32789

Get Directions

Altamonte Springs Office

Family First Firm - Medicaid & Elder Law Attorneys
By Appointment Only

715 Douglas Ave Suite# 40,
Altamonte Springs, FL 32714

Get Directions

Get free legal advice sent to your inbox


Download Our Free Guide on How to Save Your Assets

How to Save Your Assets Form