How can I find a facility that will accept Medicaid without private pay first?

1 answer | Last updated: Oct 02, 2016
A fellow caregiver asked...

Many facilities indicate they accept medicaid, however, I have found many of the facilities "reserve" their medicaid rooms for folks that are in their private pay facility that are moved to the "RESERVED" rooms once their private pay funds have been used. How can I find a "decent" facility that will accept Medicaid without private pay first?


Expert Answers

Kay Paggi, GCM, LPC, CGC, MA, is in private practice as a geriatric care manager and is on the advisory board for the Emeritus Program at Richland College. She has worked with seniors for nearly 20 years as a licensed professional counselor, certified gerontological counselor, and certified geriatric care manager.

Most communities make very little profit from their Medicaid residents. Many would have to close if they depended solely on Medicaid for payment. So they require residents to live there for several months as private pay before allowing them to have a Medicaid reimbursed room. The resident generally 'spends down' their assets while living in the community, and then qualifies for Medicaid. I believe it is illegal for residents to actually have to change rooms when they transfer from private pay to Medicaid; the care should be the same, no matter the payor source.

If your parent or family is unable to fund these private pay months, then you must do some homework to find one that accepts Medicaid Pending (meaning from day one). And, you must realize that these facilities that have no private pay residents have a tiny margin of profit and the care there will not be equal to that in other communities.

Start by getting a listing of all the facilities in your area. Medicare.gov has a complete list, and also compares facilities and posts a rating for each one. This list also shows which facilities accept only Medicare or private pay, and which accept Medicaid. You then call all those that accept Medicaid and ask if they accept Medicaid Pending. Some of these are 'decent'. All will have a higher proportion of residents who have no visitors, so plan to share your visits with other lonely residents. Also the staff will be overworked and underpaid. Be sure to show your appreciation of these people by saying thanks you often.