we checked with some of the nicer nursing homes in our area . while they have a limited number of medicaid beds once you are in privately and paying for 2 years ,done deal , they will take medicaid assignment and nothing changes .
In Illinois, many NH's that accept medicaid have only the minimum number of Medicaid beds necessary to qualify them for Medicare rehab patients. Many are private-pay exclusively. In the NH where my MIL is living, there are 18 Medicaid beds (out of about 120) in 9 rooms. The Medicaid rooms are a bit smaller than private pay double rooms and two rooms share a single bath (instead of one bath per double room.) Amenities, food, staff, etc., seem to be the same for Medicaid and private-pay.
When we extensively shopped for a place for MIL, we found all the "decent" NH's only accepted folks who started as private pay and that would be able to pay for a couple of years (among other financial circumstances such as SS, pensions, insurance, military benefits, their evaluation of your health and longevity, etc., etc.).
MIL's situation was that she had only SS and the value of her condo (which would cover almost two years). She was accepted with a guarantee that if she outlived her money, she would be allowed to stay on Medicaid. But, she was required to move into a Medicaid bed from the beginning. That is, for almost two years, she private-paid for Medicaid accommodations. The rule is that you must be in a Medicaid bed at the time you run out of funds in order to be allowed to stay on Medicaid.
There were no Medicaid beds available for folks with no/little money or resources at the beginning. All 18 Medicaid beds are always full with previously private-pay folks who outlived their funds. They don't even keep a waiting list for Medicaid new resident applicants. But there is a waiting list for private-pay applicants willing to start directly in a Medicaid bed since they know their finances are limited and they are likely to run out of money.
They made it clear that if we initially moved MIL into a regular private-pay double room and she ran out of money before passing, she'd have to move out. The Medicaid beds are always full and their policy is to not keep Medicaid folks in private-pay beds.
It seems that in Illinois, where state payments are low and slow (especially slow), NH's are working hard to be able to attract private-pay customers and keep Medicaid beds at either zero or the minimum required to qualify for Medicare rehab business (fed requirement).
I can't say this is how it works at all (or even most) Illinois NH's, but this is how it worked at the ones we checked out except for one that had a high percentage of Medicaid beds and that one was unsatisfactory and we never considered it.
