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Medicaid Warnings: Changing Seasons

Nursing home owners have had enough – and you should take notice.

For decades, elder care attorneys and nursing home business offices maintained an uneasy peace. Both groups attempted to achieve a balance of acknowledging the reality that a family was trying not to lose hundreds of thousands of dollars, while competently securing a Medicaid solution for costs of care.

Today, that peace is starting to fray. With costs soaring, nursing home operators are wary of Medicaid planning that originated out of their control. Delays in pick-up dates, penalties, denials and miscommunications have caused nursing homes to take a financial hit. 

Nursing homes are increasingly demanding control over the entire process before a resident can transition smoothly into their new living arrangement. While that is a logical reaction, the increased pressure on families simultaneously dealing with an ill loved one and the complex legal landscape for long-term care is a recipe for disaster. Experienced professionals on both sides of the process have a shared language and shorthand that can dispense with most issues quickly and efficiently.

Each side having their own representation ensures consideration is given to all agendas. Removing these buffers, limiting proper advocacy and forcing families to deal directly with the nursing home will create more difficulties.    

What should be the primary focus – a loved one’s care during a period of decline – is often overshadowed by the overwhelming financial obligations associated with nursing home care. A hospital patient’s discharge to a rehabilitation facility begins a health insurance odyssey that can test even the most hardy souls.

Medicare will cover the first 20 days at 100 percent. For the next 80 days, Medicare covers 80 percent. The remaining 20 percent is either covered by supplemental insurance such as AARP or Blue Cross/Blue Shield, or Medicaid or private pay. If a patient shows measurable progress, they can reach their full 100 days under this Medicare system. If a patient does not show progress, Medicare coverage could end early, leaving both the family and the facility scrambling.

Medicare appeals may extend the care a few more days, but the next decision is the big one: Is your loved one able to come home?

If home care is not an option, then a ticking clock becomes the soundtrack of the Medicaid nursing home process. A Medicaid application will cover costs up to three months prior to the filing date if the applicant was otherwise financially eligible. If financial eligibility has not been attained during this health crisis, the services of an elder law attorney may be necessary. Without proper guidance, moving money and spending down assets could cause unexpected tax and estate issues, as well as Medicaid issues.

For the nursing home, each day that eligibility is delayed, the resident is potentially accruing a private pay bill that can reach five figures very quickly. Seasoned elder care practitioners understand the frustrations that are leading to the changes in Medicaid coordination. These same practitioners also know that cooperation breeds better results than divisiveness.

When a loved one suffers a health setback, it is time to seek professional elder care support. Families employing proper representation and planning can more easily traverse the changing Medicaid approach being pursued by nursing homes.

Alan D. Feller, Esq., is managing partner of The Feller Group, located at 625 Route 6, Mahopac. He can be reached at


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