Is there any way to extend the number of skill-nursing care days offered by Medicare?

A fellow caregiver asked...

My mom owns a home in Florida. She is now living with me in NY. She will be entering a rehab facility in NY. She was in rehab in Florida for 60 days for a broken hip. She was released and three weeks later suffered a stroke. I was told she has only 40 days of skilled care left on Medicare. Can I extend her Medicare since she was entitled to 100 days originally, and this is a new condition? Is there a period of time she needs to be off Medicare? Can I re-apply for Medicare? If she needs to eventually go on Medicaid, can the NY facility go after her home assets in Florida?

Expert Answer

You're facing some complicated Medicare rules regarding coverage for skilled nursing facilities (SNFs) and rehabilitation facilities. In your mother's situation, there are two ways in which she might get added coverage in a rehabilitation facility, depending on what has happened already and on her condition.

  1. Your mother might have an entirely new 100-day period of Medicare coverage for care in an SNF or rehabilitation facility if she was out of a facility for 60 consecutive days following her first stay (broken hip) in the rehab facility before she again entered a rehab facility (stroke). Also, she would be required to have had another 3-day hospital stay treating her for the stroke in order for a new 100-day period to begin. These two time sequences (another 3-day hospital stay and 60 days between facility stays), which would start a new "benefit period" in Medicare lingo, is what determines whether she gets a new 100 days of coverage. The fact that there was a new medical condition does not create a new benefit period. If your mother did not have a new 3-day hospital stay and 60 days between rehab facility stays, she would only have the 40 days remaining of Medicare coverage.

  2. Another type of Medicare coverage is for a different kind of care in what's called an independent rehabilitation facility (IRF). The same facility often operates as both an SNF and an IRF. Under these Medicare IRF rules, your mother would not need a new hospital stay in order to get coverage, nor would it matter how long she had been out of the first facility before she entered the IRF for treatment of her stroke. However, the rules to qualify for IRF coverage are strict themselves. Your mother must need at least three hours per day of acute rehabilitation consisting of at least two different types of therapy (such as physical and speech therapy, or physical and occupational therapy), as prescribed by a physician. If she qualifies under these rules, however, she can get full Medicare coverage -- no patient copayments -- for as long as she needs this level of therapy.