Does Medicaid pay for skilled nursing/rehab?

  1. Molly Dworken 10/16/2012 05:33PM

    There are Medicaid-certified nursing homes offering Nursing Facility Services that primarily fall into three categories: skilled nursing, which includes medical care and related services; rehabilitation, which is needed in the event of injury, disability, or illness; and long-term care, which consists of health-related care and services that are not available elsewhere in the community and are needed regularly due to a mental or physical condition.

    Medicaid coverage of Nursing Facility Services is available only for services provided in a nursing home licensed and certified by the state survey agency as a Medicaid Nursing Facility (NF). Such services are available to individuals eligible for the Medicaid program only when other payment options are unavailable.

    Nursing facility services are required by law to be provided by state Medicaid programs for anyone over the age of 21 who needs them. Therefore, Medicaid SNF services are typically more readily available than other long-term care options. Federal requirements specify that each NF must provide (and residents may not be charged for) at minimum: nursing and related services; specialized rehabilitative services; medically related social services; pharmaceutical services; dietary services; professionally directed activity program; emergency dental and possibly routine dental services; room and bed maintenance services; and routine personal hygiene items and services. They may be charged or pay for personal items (clothing, cosmetics, reading materials) as well as telephone, television, and special amenities such as private room.

    Many nursing homes are certified as both Medicare Skilled Nursing Facilities and Medicaid Nursing Facilities. It has become increasingly common for individuals to use the benefits at a Medicare SNF following an eligible hospitalization for the limited period allotted, continue paying until private funds and any long-term care insurance are exhausted, then become eligible for Medicaid and continue to reside there under the Medicaid NF benefit. If the nursing home is not Medicaid-certified, he or she would have to transfer to a different facility in order to receive the Medicaid benefit.

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