Nursing homes make more money from residents with private insurance than they do from residents with Medicaid. Unfortunately, this leads some nursing homes to discriminate against Medicaid beneficiaries. Eldercare Resource Planning is well aware of this problem and works to combat it by making sure your loved ones get the care they need from Medicaid and from nursing homes.

Understanding Discrimination Against Medicaid Beneficiaries in Nursing Homes
Because nursing homes make more money from residents who pay the monthly cost with private funds or with long-term care insurance than they do from residents whose care is paid for by Medicaid, nursing homes have an incentive to admit more private-pay residents than Medicaid-funded residents.

The 1987 Nursing Home Reform Act prohibits nursing homes from asking residents to waive their Medicaid and Medicare rights. It is widely accepted that the intent was to reduce Medicaid-based discrimination. To be clear, Medicare does not cover long-term stays in nursing homes. It only covers short-term (100 days or less) stays in skilled nursing facilities with the intention of rehabilitating from a serious health issue, like major surgery or a stroke. However, nursing homes have found an easy loophole in that 1987 Reform Act that allows them to discriminate against Medicaid beneficiaries in order to increase their profits. They simply ask to review the applicant’s financial situation, and if they discover the applicant is on Medicaid, their application is denied. But this isn’t the only way nursing homes discriminate against Medicaid beneficiaries.

Some nursing homes may ask applicants to sign a contract agreeing not to apply for Medicaid for a pre-determined amount of time, which is very close to waiving the right to apply, but not quite. Some nursing homes may ask applicants who have Medicaid to pay the full price for a certain amount of time before allowing them to use their Medicaid coverage, which is another form of discrimination. Other nursing homes might ask for the family to pay the private fee and make them sign a contract agreeing to the terms.

A senior could also be discriminated against if they apply for Medicaid after they are admitted to the nursing home. The home could stop providing the same quality of care once the resident has been approved for Medicaid. The home might even try to evict the resident. Both of these actions are illegal and reprehensible, but they do happen.

There are a few ways nursing homes are allowed to treat Medicaid residents differently than other residents. Medicaid does not cover private rooms unless they are considered medically necessary, so almost all Medicaid residents will be assigned to a shared room. That means someone who started as a private pay resident could be moved from their single room to a shared room if they switch to Medicaid, and that would not be considered discrimination. Medicaid also does not cover comfort items, such as television or phone, or any care that isn’t deemed medically necessary. Some states allow the Medicaid beneficiary’s family to cover the cost of a private room or other nursing home services not covered by Medicaid, which is known as Family Supplementation, but not all states allow this.

What to Do When Facing Discrimination
It can be difficult to prove that you or your loved one has been the victim of Medicaid-based discrimination. If possible, document your experiences, keeping track of all communication with a nursing home, verbal and written. It’s also important to document any occasions that you notice other residents being treated differently. File complaints with the appropriate local agencies, most certainly with your state’s Long-Term Care Ombudsman program, but also notify your local Area Agency on Aging and/or Aging and Disability Resource Center.

Awareness is Half the Battle
Some of our clients are unaware that Medicaid discrimination even exists and they’re confused by what’s happening to them at the nursing home. By shedding light on the subject we can help these clients understand the challenges they’re facing and manage their expectations. And we can help all of our clients avoid discrimination from nursing home by acting as the intermediary between the facility and our client. Nursing homes are more likely to follow the rules if they are working with Certified Medicaid Planners because they know CMPs know all the rules.

If it’s necessary, our CMPs can also help you find alternate routes to long-term care. We can assist you in finding other nursing homes that accept Medicaid, and we can explore long-term care options at home. If you decide to apply to a new program, we’ll know the financial and medical eligibility requirements for that program and whether or not you meet them. If you do, we can help you complete and submit a mistake-free application in a timely manner.