While it is illegal for a nursing home to discriminate against a Medicaid recipient, it still happens. To prevent such discrimination, nursing home residents and their families need to know their rights.
The potential for discrimination arises because Medicaid pays nursing homes less than the facilities receive from residents who pay privately with their own funds and less than Medicare pays. Nursing homes are not required to accept any Medicaid patients, but Medicaid payments are a steady guaranteed payment, so many nursing homes agree to accept Medicaid recipients.
When a nursing home agrees to take Medicaid payments, it also agrees not to discriminate against residents based on how they are paying. Medicaid recipients are entitled to the same quality of care as other residents. A nursing home that accepts Medicaid cannot evict residents solely because they qualified for Medicaid (although it can refuse to accept more Medicaid patients once the number of Medicaid patients reaches whatever the facility has set as its maximum).
Unfortunately, discrimination against Medicaid patients does occur, and the discrimination can take different forms. The nursing home may refuse to accept a Medicaid recipient or may require that a resident pay privately for a certain period of time before applying for Medicaid. When a resident switches from Medicare or private-pay to Medicaid payments, the nursing home may transfer the resident to a less desirable room or claim that it doesn’t have any Medicaid beds.
There is at least one way that nursing homes can treat Medicaid recipients differently, however. Nursing homes are allowed to switch residents who were privately paying for a single room to a shared room once they qualify for Medicaid, although the resident must be given notice and a chance to appeal. In addition, the nursing home is not required to cover personal and comfort care items, such as a telephone or television. In some states families are allowed to pay the difference to get a private room or the care item. Other states do not allow any supplementation.
Keep in mind that these are general rules and that the rules in your state may be somewhat different regarding what is discriminatory. Your elder law attorney can tell you the precise rules for your state.
If you feel you have been discriminated against by a nursing home, contact your state’s long-term care ombudsman or your attorney.
For a guide to the 20 common nursing home problems, including discrimination against Medicaid recipients, click here.