Basics Of Medicaid And Skilled Nursing Care

What services does Medicaid cover/pay for?

Medicaid will cover most charges associated with skilled nursing facility services.

How do I get approved for Medicaid?

Upon admission to the skilled nursing facility, you will complete a Medicaid application. This application will be sent to the local Department of Family and Children Services (DFACS). An appointment will be scheduled for the responsible party to meet with an assigned DFACS case worker. The appointment may be in person or by phone. Based on the information provided by the patient/responsible party to the caseworker, a determination of eligibility will be made.

How will I know if my family member has been approved for Medicaid?

DFACS will send a Summary Notification Letter to the patient/responsible party as well as the skilled nursing facility informing them if the patient has been approved or denied for Medicaid.

What happens if I fail to provide DFACS with the requested information or fail to keep the appointment?

The payor type for the patient will change from Medicaid Pending to Private pay. Additionally, the patient/responsible party will be billed for all services rendered that would have been covered by Medicaid.  If payment is not received, the facility will initiate the discharge process. If the account is not settled after discharge it will be turned over to a collection agency and/or attorney.

Are there any charges if the patient is approved for Medicaid?

Each patient will owe a liability portion to the facility. This amount is determined by DFACS, not the facility. This amount is usually the total income that a patient receives for the month less a $50.00 personal allowance. The monthly liability amount will be clearly stated on the Summary Notification Letter.

When will I have to start paying my liability portion to the skilled nursing facility?

The liability portion will be due to the skilled nursing facility starting the month of admission.

What if I am using the patient’s resources to pay for other obligations of the patient?

If DFACS determines that the patient has a liability portion, that amount is due to the skilled nursing facility regardless of other obligations.  If the liability portion is not paid, the skilled nursing facility will initiate the discharge process for failure to pay. If the account is not settled after discharge it will be turned over to a collection agency and/or attorney.

How often do I have to go thru the application process?

The patient will only go through the Medicaid application process one time if they meet the following criteria:

  • The patient remains in the same skilled nursing facility.
  • The patient has not been discharged.
  • The patient’s financial position has not changed.

Each year, DFACS will send an annual review for you to complete and return. This survey is used to ensure that the patient continues to qualify for Medicaid assistance.

What happens if DFACS states the patient must “spend down” prior to approval for Medicaid?

If during the initial meeting with DFACS, it is determined that the patient must “spend down” their assets before they can be approved for Medicaid, the patient’s payor type will be changed to Private Pay and will be billed according, starting on date of admission. It will be the patient’s responsibility to track the “spend down” and contact DFACS to arrange another meeting when the “spend down” is complete.