Does Medicaid Cover Rehabilitation in a Nursing Home?

Medicaid Nursing Home Care
Infographic: Medicaid Nursing Home Care

 

If you or someone close to you needs rehab after health issues, injury, or an operation, a big question arises: can Medicaid help pay for nursing home care?

The reality is complicated. Coverage varies depending on state guidelines and personal situations.

This article explores the common ins and outs of tapping into Medicaid for nursing home stays.

We’ll look at basics like eligibility factors, what expenses may be covered, where there are limits, and other options beyond Medicaid to weigh as well.

The goal is to equip you with the knowledge to make the best decision in your rehabilitation journey. Rules differ across the board based on location and need.

However, understanding core Medicaid provisions around nursing home use can provide a starting point of clarity.

What is Medicaid, and How Does It Work?

Medicaid is a joint initiative between the federal and state governments, providing health insurance for low-income and disabled individuals.

It covers a range of services, including hospital care, doctor visits, prescription drugs, home health care, and long-term care.

Unlike Medicare, which caters to individuals over 65 and some younger individuals with disabilities, Medicaid does not include coverage for long-term nursing home care.

However, it may offer up to 100 days of skilled nursing facility or short-term rehabilitation care per benefit period.

Who qualifies for Medicaid nursing home care?

To qualify for nursing home care through Medicaid, meeting two key criteria is necessary: financial eligibility and level of care eligibility.

  • Financial eligibility demands that your income and assets are below a specified limit, which varies based on state and marital status.
  • Level of care eligibility necessitates a specific need for medical care achievable only in a nursing home.
  • Moreover, being a U.S. citizen or legal resident and residing in the state of the Medicaid application are essential prerequisites.

How much does Medicaid contribute to nursing home care?

Medicaid fully covers qualified nursing home costs, such as:

  1. room and board
  2. nursing care
  3. therapy
  4. medication
  5. social services
  6. meals

However, participants still kick in most of their income, known informally as “patient liability” or “share of cost.”

They keep back a small “personal needs allowance” each month for personal items like clothing or entertainment.

This PNA amount varies from state to state, and those in Florida keep $160.

So while Medicaid does pick up the healthcare tabs, residents aren’t off the hook fully.

Income levels and state rules determine out-of-pocket costs after setting aside that modest PNA for personal expenses.

READ ALSO:

Benefits and Limitations of Medicaid Nursing Home Care

Benefits and Limitations of Medicaid Nursing Home Care
Infographic: Benefits and Limitations of Medicaid for elderly home care

 

Alternatives to Medicaid Nursing Home Care

If you’re not eligible for Medicaid elderly homecare, consider these options:

Alternatives to Medicaid Nursing Home Care
Alternatives to Medicaid Nursing Home Care

 

Conclusion

Medicaid can provide real assistance when an elderly home or ongoing rehab care is needed. But it shouldn’t be viewed as the only choice out there or as a fit for every situation.

Whether it works for you comes down to personal needs, what coverage you qualify for, finances available, and other preferences in play.

Talking to experts like social workers, case managers, Medicaid specialists, or elder law attorneys could bring clarity. They help map out options to judge if turning to Medicaid suits your health and budget realities.

With something as vital as an elderly home treatment on the line, getting professional guidance makes sense before locking in a coverage decision.

The key is determining all angles based on the full picture, from medical necessities to the resources at hand.

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