Recurring Problems with Nursing Homes # 9

Dan Frith

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Lauren and I have reviewed over 500 potential nursing home cases over the years and we see some problems over and over and over again. I decided we would share with our readers some of the more frequent problems...and the answers.

Problem #9: A resident, and her family, are told that "Medicaid doesn't pay for the service or care that you want." Can they do that?

The answer is no. A nursing home must establish and maintain identical policies and practices regarding the provision of services, discharges, etc., for all individuals regardless of the source of payment. Medicaid is a thorny issue for nursing homes. Medicaid accounts for approximately one-half of nursing homes' total revenue. However, Medicaid often pays much less for a care than Medicare or a private insurance company.

A Medicaid-eligible resident should fight any attempt by the nursing home to provide second-class treatment. The federal law (Section 483.12(c)(1) of Title 42 of the Code of Federal Regulations) requires nothing less.