What does Medicaid pay for nursing homes?

[garyt]

Anybody know what Medicaid pays for nursing homes/memory care facilities? Is it a set dollar amount? Are there better places that accept Medicaid and then you can pay the rest? Total newbie to this and asking for my inlaws.

Thanks

 

[CowgirlUp]

Medicaid? Or do you mean Medicare?

 

[razztazz]

I give you the "medicaid rates" but I can speak to my personal experience.

My mother got into a nice one. In fact it was rated 5 stars by some place that rates these things. She had nothing except her rather meager social security a small pension and medicaid.

My own research, which includes reading of other people's experiences on this forum, indicates that most decent, perfectly reasonable nursing homes will accept medicaid but not right from the Day #1. Those would be the less desirable ones. But if you can fund the first year or two from private funds at retail rates, if you're still around and the money has run out, you will continue on as resident/patient with no changes and will not be thrown out. They will continue to collect your social security and any pensions or annuities you might have and just file to have medicaid pay the difference.

Sounds like a reasonable approach.

I cannot say for sure, but I suspect the nursing home my mother got into takes a certain number of "medicaid only" patients every year as a sort of pro-bono thing and she pulled the lucky number.

 

[jim584672]

Medicaid (elderly) will pay everything once the person has exhausted almost all assets, saving a small amount. Any income is also taken. Any assets after death are subject to estate recovery. Usually a person will self pay in the beginning until they run out of money.

I visited a memory care home with people with advanced dementia it is a nightmare. The people are literal zombies.

 

[garyt]

Not sure if it would be Medicaid or Medicare. They have limited money saved so would be broke quickly, but I guess SS and a small pension would keep them from Medicaid?
I understand there are facilities that will accept whatever Medicaid/Medicare pays but can't find out what this amount is. I'd like to know so we can decide if we can afford to pay the difference to get in a better facility.
Mt wife and sIL looked at two places today. One accepted Medicaid and one didn't. Surprisingly the one that did was more expensive. I believe it was $7000 a month. If we knew Medicaid paid ,say $3000 a month we'd know what needs to be added.

 

[garyt]

Medicaid? Or do you mean Medicare?

Not sure, either would help.

 

[Bamaman]

Medicaid (elderly) will pay everything once the person has exhausted almost all assets, saving a small amount. Any income is also taken. Any assets after death are subject to estate recovery. Usually a person will self pay in the beginning until they run out of money.

I visited a memory care home with people with advanced dementia it is a nightmare. The people are literal zombies.

I once came up on an old nursing home in the cotton fields of Eastern Arkansas. It was a concrete block building, and the residents were not exactly well taken care of. That's what the Medicaid nursing homes often look like.

Thankfully my mother left this world right on time--when she was down to her last $5,000 in cash. She lived in a really plush assisted living for the last 3 years, and was very happy. The full service nursing homes really turnover quick as most residents are not there very long.

 

[timo2]

I once came up on an old nursing home in the cotton fields of Eastern Arkansas. It was a concrete block building, and the residents were not exactly well taken care of. That's what the Medicaid nursing homes often look like.
.

So imagine if there was no Medicaid for those folks. That's what Medicaid is for IMHO.

 

[jim584672]

Not sure if it would be Medicaid or Medicare. They have limited money saved so would be broke quickly, but I guess SS and a small pension would keep them from Medicaid?
I understand there are facilities that will accept whatever Medicaid/Medicare pays but can't find out what this amount is. I'd like to know so we can decide if we can afford to pay the difference to get in a better facility.
Mt wife and sIL looked at two places today. One accepted Medicaid and one didn't. Surprisingly the one that did was more expensive. I believe it was $7000 a month. If we knew Medicaid paid ,say $3000 a month we'd know what needs to be added.

You can use expenses to lower your income. So a person with a pension and Social Security of say 5,000 a month can offset that income against the monthly cost of the home, and that is how they would qualify for the income requirement.

 

[badatmath]

I was looking for stats on that recently and the best guess I came up with is that would pay about 70% of the normal daily rate. And that to a nursing home, a even a few dollars over that was a big deal. I do not recall where I found the information as once I found enough to serve as a rough estimate I quit looking.

 

[Myssdragn]

For a single person to go on Medicaid you have to have less than $2K in assets. Everything must be spent down to that level. You are allowed a $1.5K burial fund. The persons SS will continue but is taken by Medicaid to pay for nursing care. The persons Medicare insurance premiums continue to be paid to cover medical expenses The person is allowed $60 for personal expenses such as cable TV and hair care. All nursing home expenses are then covered. To my eyes care to Medicare and private pay individuals was identical and I doubt the CNA’s that do the bulk of the work know who is Medicaid and who is not. It is a minimal existence. Difficult for all involved. This may vary state to state as the state is who administers the Medicaid program.

 

[Lakewood90712]

IIRC MEDICARE will pay for a very limited time, like less than 30 days.

Medicaid, for the long term indigent. As others have posted, very limited assets, usually a 2 year look back on assets, and claw of anything upon death , including home equity.

Chat with and estate atty in your area.

 

[Dtail]

I give you the "medicaid rates" but I can speak to my personal experience.

My mother got into a nice one. In fact it was rated 5 stars by some place that rates these things. She had nothing except her rather meager social security a small pension and medicaid.

My own research, which includes reading of other people's experiences on this forum, indicates that most decent, perfectly reasonable nursing homes will accept medicaid but not right from the Day #1. Those would be the less desirable ones. But if you can fund the first year or two from private funds at retail rates, if you're still around and the money has run out, you will continue on as resident/patient with no changes and will not be thrown out. They will continue to collect your social security and any pensions or annuities you might have and just file to have medicaid pay the difference.

Sounds like a reasonable approach.

I cannot say for sure, but I suspect the nursing home my mother got into takes a certain number of "medicaid only" patients every year as a sort of pro-bono thing and she pulled the lucky number.

Bolded - Agree although I don't believe this concept works 100% of the time. Nevertheless if my parents need LTC, the plan is to spend down some assets to zero while protecting other assets in an irrevocable trust.
They also have LTC policies which should provide for most of the costs.

 

[Col. Klink]

It appears OP that you asked what Medicaid pays a nursing home to care for your loved one. The answer is that each year the nursing home files a cost report prepared usually by a CPA firm that has people specifically trained to do these. The report can be very long and details every aspect of the homes costs, occupancy rates and much more. The homes are sometimes audited by the state and / or the feds to ensure the accuracy of the report. From that a "Medicaid rate" is assigned for the next 12 month period. The facility is paid this rate per day for each resident on Medicaid.

 

[KM]

Not sure if it would be Medicaid or Medicare. They have limited money saved so would be broke quickly, but I guess SS and a small pension would keep them from Medicaid?
I understand there are facilities that will accept whatever Medicaid/Medicare pays but can't find out what this amount is. I'd like to know so we can decide if we can afford to pay the difference to get in a better facility.
Mt wife and sIL looked at two places today. One accepted Medicaid and one didn't. Surprisingly the one that did was more expensive. I believe it was $7000 a month. If we knew Medicaid paid ,say $3000 a month we'd know what needs to be added.

I think you’ll find most nursing homes don’t work this way. They either take Medicaid or they don’t. I don’t think you can “subsidize” Medicaid to get a “better place”? Maybe....but I don’t think so.

1) if a nursing home accepts Medicaid, once your in-laws assets have been drawn down to Medicaid levels (check your state laws for that level), Medicaid picks up the tab. What that amount is, is an agreement between the nursing home and Medicaid. You don’t “chip in more” to get a better room or better care at that facility.

2) if they don’t accept Medicaid, they don’t. Period. They don’t and won’t bill Medicaid. You pay the full amount and if you run out of assets you must move to a facility that does accept Medicaid.

In our experience (and as you saw) Type 2 facilities often cost less out of the gate because they DONT accept Medicaid. Type 1 facilities cost more, as private pay are making up some of the lost revenue from the Medicaid patients. Type 1 homes get much less from Medicaid than from private pay patients. But as someone else said....the care within that home is all the same.

The real questions are how many years do you think your in-laws could private pay? If you think they’ll outlive their money, are they prepared to move once they do? If not, then start with a place that takes Medicaid so they can stay when they run out.

In my mother’s case we opted for the less expensive place that didn’t take Medicaid, knowing she might have to move. We did this because 1) she had 7 years she could afford, 2) we felt she had about 7 years left (based on family history) and 3) she was suffering from dementia and the private pay home specialized in giving dementia patients a more “in-home” experience. It worked out extremely well and she passed away after 5 years, so we didn’t have to move her.

 

[Golden sunsets]

I think it depends on the State. In the State that I live in the facility purchases Medicaid beds, and either has none, some or many beds certified by the State. The state will not allow unlimited medicaid beds or they would have no control over their annual commitment. I have not seen any facility that takes an unlimited number of medicaid patients and as someone above said, in most if not all circumstances the patient needs to have a certain number of private pay months, before going on state aid. Once below the threshhold of funds that a patient is allowed to keep, any SS or pension is taken by the State and they pay the rest of the room cost, which is limited by State Statute. If the facility has medicaid beds, it doesn't matter to the patient what the monthly cost is, the patient does not pay any more than their monthly SS and pension toward their support.

 

[Col. Klink]

I think it depends on the State. In the State that I live in the facility purchases Medicaid beds, and either has none, some or many beds certified by the State. The state will not allow unlimited medicaid beds or they would have no control over their annual commitment. I have not seen any facility that takes an unlimited number of medicaid patients and as someone above said, in most if not all circumstances the patient needs to have a certain number of private pay months, before going on state aid. Once below the threshhold of funds that a patient is allowed to keep, any SS or pension is taken by the State and they pay the rest of the room cost, which is limited by State Statute. If the facility has medicaid beds, it doesn't matter to the patient what the monthly cost is, the patient does not pay any more than their monthly SS and pension toward their support.

As an example, at the time I retired from being a Nursing Home Administrator, the Medicaid threshold in CT. was $1600 in assets. SS money, as noted by Golden Sunsets, goes to the State. The resident was able to keep $60 per month holdback for personal use. Usually this ends up being spent on gifts for the kids, grandkids, and at the hair salon.

 

[Spock]

MedicARE does not cover LTC costs. The only times Medicare pays for a SNF is for rehab stays after discharge from a 3day or longer hospital stay.


MedicAID is the program that pays for LTC once your assets are depleted. You can not kick-in extra out of your pocket on top of MedicAID to live in a more expensive facility.

 

[kgtest]

I give you the "medicaid rates" but I can speak to my personal experience.

My mother got into a nice one. In fact it was rated 5 stars by some place that rates these things. She had nothing except her rather meager social security a small pension and medicaid.

My own research, which includes reading of other people's experiences on this forum, indicates that most decent, perfectly reasonable nursing homes will accept medicaid but not right from the Day #1. Those would be the less desirable ones. But if you can fund the first year or two from private funds at retail rates, if you're still around and the money has run out, you will continue on as resident/patient with no changes and will not be thrown out. They will continue to collect your social security and any pensions or annuities you might have and just file to have medicaid pay the difference.

Sounds like a reasonable approach.

I cannot say for sure, but I suspect the nursing home my mother got into takes a certain number of "medicaid only" patients every year as a sort of pro-bono thing and she pulled the lucky number.

I agree my Grandma has been in a very nice place for a long time but the waiting list was like 4 or 5 years. Her only complaint is the ladies that live with her in the apartment complex hahaha. Stubborn German. Her rent is paid with most of her SS but she does have a small pension and money for groceries, bills and small gifts for grandkids. She even has a little extra to live on each month. I think she said rent was like $590/month for her 1br 3rd story end unit.

 

[ivinsfan]

I think you’ll find most nursing homes don’t work this way. They either take Medicaid or they don’t. I don’t think you can “subsidize” Medicaid to get a “better place”? Maybe....but I don’t think so.

1) if a nursing home accepts Medicaid, once your in-laws assets have been drawn down to Medicaid levels (check your state laws for that level), Medicaid picks up the tab. What that amount is, is an agreement between the nursing home and Medicaid. You don’t “chip in more” to get a better room or better care at that facility.

2) if they don’t accept Medicaid, they don’t. Period. They don’t and won’t bill Medicaid. You pay the full amount and if you run out of assets you must move to a facility that does accept Medicaid.

In our experience (and as you saw) Type 2 facilities often cost less out of the gate because they DONT accept Medicaid. Type 1 facilities cost more, as private pay are making up some of the lost revenue from the Medicaid patients. Type 1 homes get much less from Medicaid than from private pay patients. But as someone else said....the care within that home is all the same.

The real questions are how many years do you think your in-laws could private pay? If you think they’ll outlive their money, are they prepared to move once they do? If not, then start with a place that takes Medicaid so they can stay when they run out.

In my mother’s case we opted for the less expensive place that didn’t take Medicaid, knowing she might have to move. We did this because 1) she had 7 years she could afford, 2) we felt she had about 7 years left (based on family history) and 3) she was suffering from dementia and the private pay home specialized in giving dementia patients a more “in-home” experience. It worked out extremely well and she passed away after 5 years, so we didn’t have to move her.

This is true my MIL had dementia , she had money to pre pay for around 2-3 years but we had to select our second choice because our first choick told us very clearly that they didn't accept Medicaid. It was a difficult choice for the family because it was her third placement and everytime we switched her placement she declined significantly.

 

[Huston55]

OP-

As noted above, most states have a program structured around these characteristics:

- Nursing homes can choose to have or not have “MediCAID” (Not Medicare) certification, meaning they have a certain number of Medicaid beds
- Medicaid certification means that the facility must accept what Medicaid pays, after the resident has met the asset/income tests (IOW, cannot self pay) in that particular state (IOW, the resident cannot be evicted for nonpayment)
- Most states have some form of asset recovery (Including the primary home) if Medicaid pays for care
- Medicaid will typically not pay for “Assisted Living” but, some (most?) states have some sort of graduated program to help with ADL when necessary.

I see you’re in Warren, Michigan. You may want to check out the PACE program, which includes services in Warren, if your in-laws are there (or in another area served by PACE).

https://www.michigan.gov/mdhhs/0,5885,7-339-71551_2945_42542_42543_42549-87437--,00.html

ETA: I went through this process in another state and, I found the State Agency on Aging VERY helpful. Suggest you contact them if you’ve not already done so.

https://www.michigan.gov/osa/1,4635,7-234-64081-295815--,00.html

 

[razztazz]

Bolded - Agree although I don't believe this concept works 100% of the time. Nevertheless if my parents need LTC, the plan is to spend down some assets to zero while protecting other assets in an irrevocable trust.

Yes, I'll bet none of of this works 100% of the time anywhere.

The other big deal killer is, as someone else mentioned, the never-popular waiting list. Depending on your location and "Druthers" you can have all the money in the world but if there's no room at the inn.... you're out. And you have to hold on until you find something

 

[Col. Klink]

I give you the "medicaid rates" but I can speak to my personal experience.

My mother got into a nice one. In fact it was rated 5 stars by some place that rates these things. She had nothing except her rather meager social security a small pension and medicaid.

My own research, which includes reading of other people's experiences on this forum, indicates that most decent, perfectly reasonable nursing homes will accept medicaid but not right from the Day #1. Those would be the less desirable ones. But if you can fund the first year or two from private funds at retail rates, if you're still around and the money has run out, you will continue on as resident/patient with no changes and will not be thrown out. They will continue to collect your social security and any pensions or annuities you might have and just file to have medicaid pay the difference.

Sounds like a reasonable approach.

I cannot say for sure, but I suspect the nursing home my mother got into takes a certain number of "medicaid only" patients every year as a sort of pro-bono thing and she pulled the lucky number.

As a Nursing Home Administrator, if someone had over a year of private assets to spend down prior to transitioning to Medicaid, we would usually accept that person as a new resident so long as the our ability to care for them on the medical side checked out.

 

[Col. Klink]

Yes, I'll bet none of of this works 100% of the time anywhere.

The other big deal killer is, as someone else mentioned, the never-popular waiting list. Depending on your location and "Druthers" you can have all the money in the world but if there's no room at the inn.... you're out. And you have to hold on until you find something

There is a five year look back period on assets. Believe me that the feds and nursing homes have seen every trick in the book to shelter, transfer, or hide assets. My advice is to play it straight or you could find yourself in the Klink.

 

[garyt]

It appears OP that you asked what Medicaid pays a nursing home to care for your loved one. The answer is that each year the nursing home files a cost report prepared usually by a CPA firm that has people specifically trained to do these. The report can be very long and details every aspect of the homes costs, occupancy rates and much more. The homes are sometimes audited by the state and / or the feds to ensure the accuracy of the report. From that a "Medicaid rate" is assigned for the next 12 month period. The facility is paid this rate per day for each resident on Medicaid.

Awesome info, thanks