Medicaid in skilled nursing facilities is useful to delve into. A Nursing Facility is one of the settings for care and services provided by Medicaid. The program provides Nursing Facility Services from Medicaid-certified nursing homes. These facilities primarily provide three types of services:
- Skilled nursing or medical care and related services;
- Injury, disability, or illness rehabilitation; and
- Long term care.
The Medicaid-provided long-term care is health-related care and services that are beyond the level of room and board and aren’t available in the community, but needed regularly due to a mental or physical condition.
Medicaid in Skilled Nursing Facilities – Getting Deeper
Medicaid coverage of nursing facility services is available only for services provided in a nursing home that’s licensed and certified by the state of Florida as a Medicaid Nursing Facility (NF). Medicaid Nursing Facility Services are available only when other payment options are not available, and the patient is eligible for the Medicaid program.
It’s typically unnecessary for a senior to transfer to another nursing home when the payment source changes to Medicaid NF. Many nursing homes in Florida are also certified as Medicare skilled nursing facilities (SNFs), accepting long term care insurance and private payment.
It’s commonly for a person to enter a Medicare Skilled Nursing Facility (SNF) after a hospitalization that qualifies him or her for a limited period of SNF services. If nursing home services are still needed after that period of SNF coverage, the person may pay privately and use their long-term care insurance. If the individual exhausts their assets and is eligible for Medicaid—and the nursing home is also a Medicaid-certified nursing facility—he or she can continue to reside in the nursing home under the Medicaid NF benefit. If the nursing home isn’t Medicaid-certified, the patient would need to transfer to a NF to be covered by the Medicaid Nursing Facility benefit.
Medicaid Nursing Facility (NF) Requirements
Federal law states that each Medicaid Nursing Facility must provide and not charge its residents for the following:
- Nursing and related services;
- Specialized rehabilitative services (required by those with mental illness or intellectual disability and not provided or arranged for by the state);
- Medically-related social services;
- Pharmaceutical services;
- Individualized resident dietary services;
- A professionally-directed program of activities that meet the interests and needs of each resident;
- Emergency dental services;
- Room and bed maintenance services; and
- Routine personal hygiene items and services.
On the other hand, Medicaid Nursing Facility residents may be charged for items such as the following:
- A private room, unless medically needed;
- Specially prepared food;
- Telephones, televisions, and radios;
- Personal comfort items, such as tobacco products and candy;
- Cosmetic and grooming items and services beyond those of the basic service;
- Personal clothing;
- Personal reading materials;
- Social events and activities beyond the activity program; and
- Special care services not included in the facility’s Medicaid payment.
If you have questions about Florida Medicaid Planning and Medicaid in Skilled Nursing Facilities, Attorney Frazier is a skilled Medicaid planning (with over 2,000 cases completed that helped preserve their family’s savings), estate planning and elder law practitioner. Please contact Attorney Frazier for a free telephone consultation at 727-586-3306 extension 104. If you prefer click here now to send in a contact form and we will call you.