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Medicaid Policies in Assisted Living Communities and Nursing Homes

Policies and Procedures. Successful business, law and profit background.

Policies and Procedures. Successful business, law and profit background.

Long term care communities – whether assisted living communities or nursing homes – usually have written Medicaid policies.  These are their rules and regulations that apply to someone who moves into their community and may need Medicaid at some point in the future.

Medicaid Policies

The admission agreement or a Medicaid addendum usually contains the Medicaid policies.  These are not Medicaid rules.  These are rules established by the long term care community that govern people in their community who need Medicaid.  They often cover things like private pay requirements, Medicaid beds, waiting lists and private vs. semi-private rooms.

Discuss Medicaid policies with the representatives at the long term care community before your loved one moves in.  That way you will be aware of any issues that could prevent your loved one from staying in that community when they ultimately run out of money and need to go on Medicaid.

The Importance of the Admission Agreement

Medicaid policies are usually part of the admission agreement.  Someone will have to sign the admission agreement.  That person is usually your loved one or you as their agent pursuant to their power of attorney.

The agreement should be reviewed carefully before anyone signs it.  An elder law attorney can assist with this process.  Make sure you clearly understand the agreement.  Medicaid policies that are part of the admission agreement catch many people off guard so make sure you understand the agreement.

A Common Example

Consider a long term care community that has a two year private pay requirement.  That is the amount of time your loved one has to pay from their private funds before they can stay there as a Medicaid beneficiary.  If your loved one only has one year of private pay funds available then they probably won’t be able to stay there as a Medicaid beneficiary.  In that situation they would have to leave the community and move somewhere else.

In this case you might not want your loved one to move into a community that has a two year private pay requirement.  Doing that might require another move in the future. They would have to find a community that would admit them as a Medicaid beneficiary.  And being admitted to a community as a Medicaid beneficiary – especially an assisted living community – isn’t always easy.

In Conclusion

When your loved one moves into a long term care community be sure to identify their Medicaid policies and procedures.  A clear understanding of these issues may go a long way towards preventing a stressful situation in the future.

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