If Dad moves back home, will Medicaid still pay for his nursing home stay?

1 answer | Last updated: Oct 05, 2016
A fellow caregiver asked...

After several falls, a brief hospital stay and a stay in a rehab facility, we made the decision to move my Dad to a nursing home here in NJ. Dad has SS and pension income but no assets (my parents are deeply in debt, house in foreclosure, etc). We applied for Medicaid and are awaiting the approval.

He has now been in the nursing home for about 6 weeks and Mom has decided he needs to come home. While I believe this is a huge mistake, there is no fighting her on this.

My question is this. If she moves him back home, his income exceeds the Medicaid limit so he will no longer qualify (he only qualifies if he is in a nursing home). So what happens to the bill for the couple of months he was in the nursing home? Will Medicaid still pay that, and then "shut off" after he goes home? Or will my parents be held responsible for that bill, which will be upwards of $10,000?

Thanks for any insight!


Expert Answers

You're right that there are two different sets of eligibility for Medicaid nursing home coverage and Medicaid medical care coverage. If your father applied for Medicaid nursing home coverage when he entered the nursing home, and Medicaid ultimately approves his application, Medicaid will pay his nursing home costs from the date of his completed application until he leaves the nursing home, regardless of the fact that he leaves voluntarily.

Even if your father does not qualify for "regular" Medicaid medical coverage (because his income is too high) when he gets home, you should explore with Medicaid the possibility that he can qualify for its home and community-based program, which can provide some in-home care for people who would otherwise qualify for nursing home care. Every state makes its own eligibility and coverage rules for these in-home care programs, so you'll have to check directly with New Jersey Medicaid. But it may be possible for him to qualify for some in-home care from Medicaid under such a separate community-based care program, which could provide some much-needed relief to your mother and the rest of the family when your father comes home.

Also, New Jersey may have a program that would permit your mother or other family member to get paid to provide care for your father. If so, it would only be a small amount, but it still could be helpful. The special program that might provide these payments is usually run by the Medicaid program, but if not, it would be run by a state agency that Medicaid would connect you with.