Leaving the Nursing Home to Visit Family Could Jeopardize Medicaid Coverage

There is a lot of confusion about Medicare, Medicaid and nursing home coverage. Much of that confusion comes down to the differences between the Medicare and Medicaid programs. Nonetheless, any questions about Medicaid patients leaving a skilled nursing facility in order to visit family should be answered before any arrangements are made. Under some circumstances, a patient could lose coverage by leaving a facility.

Under the federal Medicare program, patients at skilled nursing facilities can usually leave and return on the same day without incurring any loss of coverage. This is partly due to the fact that Medicare only pays for up to 100 days of skilled nursing care at an approved facility. Medicaid coverage is different.

Medicaid is designed for people who do not have the financial resources to pay the bulk of their own medical care. It is generally assumed that a Medicaid patient entering a skilled nursing facility is doing so because the care being provided is absolutely necessary. Any absence from that facility could be construed as evidence that the care is no longer required. However, if a leave of absence is considered to be therapeutic in nature, Medicaid Coverage is not likely to be jeopardized immediately. The program will more than likely pay to hold a bed for a certain amount of time. Leaves that are not considered therapeutic are treated differently.

Unfortunately, there are no hard and fast rules regarding whether or not Medicaid patients can leave skilled nursing facilities. It all comes down to individual state rules. One state may hold a bed and continue Medicaid coverage for up to 30 days when a leave of absence is therapeutic. Another state may pay nothing at all. It’s up to each individual patient and his family to know the laws in their state of residence as well as the policies of the nursing home in question.

Because the laws surrounding Medicaid and patient leave can be somewhat complicated, we recommend you seek the advice of a competent attorney before making arrangements to leave a skilled nursing facility, whether to visit family or for another purpose. The attorneys at Felinton Elder Care & Estate Planning Centers are available to give you the sound advice you need to make a wise decision. Our number one goal is to make sure you and your family are protected to the fullest extent of the law.