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Nursing Home Tries to Move Patient Due to Payment Type
Jan L. Warner & Jan Collins

Question: After more than three years of paying privately at more than $4,000 monthly, Dad ran out of money, and I was forced to apply for Medicaid for him. The administrator told me that Dad would be moved from the private room he has called "home" for three years to a "Medicaid bed" in another part of the nursing home. Because I believe a move will be detrimental to his condition (he is 85), I tried to reason with the nursing home, with no success. What are our rights in this area?

Answer: As part of the budgeting process, nursing homes designate which beds will be used for Medicare and Medicaid residents. Some facilities "dually certify" all beds. Thatís why most nursing facilities separate residents based on their level of care and source of pay by placing them on different floors or in different areas of the facility. Thus, if a Medicaid-eligible resident occupies a bed that could otherwise be offered to a person who can pay privately, the nursing home will lose revenue because the rates paid by Medicaid are generally less than those the facility receives from private-pay patients. By law, there can be no difference in the care provided to the resident.

Before the facility can transfer your father, the facility must give notice of the pending transfer and the reason for it Ė here, a conversion to Medicaid. This notice must include information about the resident's right to appeal and other important information, and generally must be given at least 30 days before the resident is transferred or discharged. In addition, the facility must provide sufficient preparation and orientation to allow for a safe and orderly transfer.

Taking the Next Step: Find out if the bed your father has been using is certified for Medicaid. If it is, you may be able to stop the move; otherwise, we think youíll be fighting a losing battle to contest the transfer. Before you make a final decision, get an opinion from a qualified elder law attorney (www.naela.org).

Question: During the year and a half that my mother has lived at a nursing home, she has been in and out of the hospital several times. During some of this time, she was paying privately; during the rest, she was on Medicaid. The nursing home is now telling us they canít hold her bed while she is in the hospital. What are we supposed to do?

Answer: Before a nursing home can transfer a resident to a hospital, the home must, by law, provide the resident, a family member, or a responsible party with information that clearly specifies (1) the bed-hold policy, if any, under the plan of that state during which the resident is allowed to return and resume residence, and (2) the facilityís policies regarding bed-hold periods which allow a resident to return.

Each nursing facility is required by law to establish and follow written policies dealing with bed-hold and with what happens if the residentís absence from the facility exceeds the bed-hold period under the state Medicaid plan. Generally, that person must be readmitted to the facility immediately (if a bed exists) or when the first bed in a semi-private room is available. Because of the complexities involved, if you did not receive these notices, we suggest that you contact your local ombudsman and licensing agency of your state government. If you donít receive appropriate responses, contact an elder law attorney in your area.



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