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home | Medicaid | Why Medicaid Pending Can Mean Troubl . . .

Why "Medicaid Pending" Can Mean Trouble When You Need a Nursing Home

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BJ did everything right for her mother. She made sure her mother had long term care insurance, she consulted with an eldercare attorney about eventually qualifying for Medicaid legally and ethically, she managed Mom's money well and kept her "at home" in assisted living as long as possible. Now that the money is gone, the insurance is exhausted, and her mother needs nursing home care, why won't any "decent" nursing homes accept her?

BJ's mother needs to find a nursing home that will accept her as a "Medicaid Pending" patient. "Medicaid Pending" means that she does not have the money to pay for care privately. Both she and the nursing home are waiting for Medicaid approval to cover the cost of her care.

Medicare will not be picking up any of the costs, and BJ's mother cannot even apply for Medicaid until after she has been in a nursing home for 30 days. After those initial 30 days it can take an additional 60 days or more to approve a Medicaid application once it is received by Medicaid. When she is ultimately finally approved the Medicaid program in her state will reimburse the nursing home for the care they provided while the application was in process.

This means that any nursing home that accepts her as a patient is taking a risk and accepting a financial burden that many nursing homes are no longer willing to accept. They will have to provide BJ's mother with room and board, nursing care and other professional services, medications and supplies for at least three months, and possibly longer. Although on paper it appears that BJ's mother will easily qualify for Medicaid because of her health needs and her financial status, the nursing home has no guarantee that the family will properly follow through with the application process, and no guarantee that she will ultimately be approved.

Once a patient is a nursing home resident, the nursing home cannot easily discharge the patient. Therefore, they are extremely cautious about accepting a resident when they have no guarantee that they will be paid for providing care.

BJ can easily find several highly rated nursing homes that will accept her mother if her mother will pay privately for care while her Medicaid application is being processed. Unfortunately, at almost $200 per day, BJ's mother no longer has the ability to pay, and neither does BJ.

What BJ has found is that the few nursing homes in her area who are willing to accept her mother "Medicaid Pending" are the second and third tier nursing homes that consistently have trouble filling their available beds. They are willing to take the Medicaid Pending risk because that risk is ultimately less costly than having empty beds that produce no revenue at all.

Because her mother can no longer afford to pay the assisted living residence, and she now needs much more care than they could provide even if she had the funds, BJ must now admit her mother to one of those less exemplary nursing homes and put her mother on the waiting list at a "better" nursing home that will accept her after her Medicaid has been approved. This is far from a good situation, but it is their only option.

What could BJ have done differently that none of her advisors suggested?

The best solution to the lack of nursing home Medicaid Pending openings is to look for a good nursing home when there are still enough funds left to pay privately for at least six months. Most nursing homes that participate in the Medicaid program will accept a patient with enough to pay for six months' care. Some nursing homes that are having no difficulty filling their beds require patients to be able to pay privately for a year or more.

Privately paying residents pay more for their care than Medicaid pays for the same care. The nursing home can make enough from a privately paying resident to cover any potential loss during the time when the patient has finally exhausted their money and is in the process of applying for Medicaid. By the time the patient has "spent down" in the nursing home, the staff have gotten to know the family, and they have some level of confidence that the family will complete the application process. Many nursing homes have assisted the family with the paperwork so that it is ready to go the moment the patient is eligible. They have reduced their risk by getting to know the patient and the family.

Unfortunately, this kind of planning means that our elderly may not be able to "age in place" at home or in an assisted livng residence as long as we had hoped. If it appears that funds will run out within the year, we now recommend that families immediately begin investigating nursing care options. While this means moving into a nursing home several months earlier than planned, moving earlier often means that the patient will have a higher quality of care in a better nursing home for the remainder of his or her life. It's a trade-off that an increasing number of caregiving families are choosing to make, so that they don't fall into the Medicaid Pending trap of no decent openings available and no option but to take any opening available, no matter how poor.

·  What is "Spending Down" for Medicaid?
·  What Do You Need For a Medicaid Application?
·  Improved Nursing Home Quality Ratings
·  Nursing Home "Bad" Alert: The Nursing Homes & Rehab Centers You Probably Want to Avoid