Does Medicaid Pay for a Skilled Nursing Facility?

What Skilled Nursing Services Does Medicaid Cover?

Medicaid provides comprehensive coverage for skilled nursing facility services, including:

• 24-hour skilled nursing care and supervision 
• Physical, occupational, and speech therapy 
• Medical equipment and supplies 
• Prescription medications 
• Physician and specialist visits 
• Diagnostic tests and laboratory services 
• Social services and discharge planning
  
  

Additional benefits like dental care, vision and hearing services, and specialized treatment for Dementia or wound care may vary by state. 

Medicaid’s Medical Necessity Requirements

In order to meet Medicaid’s skilled nursing eligibility, patients must show a level of medical necessity. This includes: 

• Needing skilled nursing services or rehabilitation 
• A physician’s certification that facility-level care is required 
• Regular reassessment to confirm ongoing medical need 
• Requiring care that cannot be safely provided at home or in a less intensive setting
  
  

Not only does Medicaid pay for a skilled nursing facility, but it also covers long-term custodial care for activities of daily living (ADLs) like bathing, dressing, and medication management. This means that Medicaid is particularly helpful if you need extended care.

Medicaid’s Financial Eligibility Requirements

Medicaid is designed to support those on a low income, and as a result, eligibility involves strict income and asset limits that differ by state. In general, to qualify for Medicaid, you must: 

1. Have a monthly income under your state’s threshold 
2. Have under $2,000 in assets, or $3,000 for married couples in some states 
   
   

The rules vary depending on where you live, your marital status, and whether you and your spouse both require care. There are also specific criteria around assets, with some assets being exempt from the calculation, including a primary residence (under a certain equity limit), a vehicle, personal belongings, and more. 

Medicaid Application Process and Timeline

Because of Medicaid’s strict eligibility requirements, the application process involves a lot of paperwork. It can take several weeks to gather all the necessary documentation, so it’s best to start the process early to make sure you have coverage when you need it most. 

For the application, you’ll typically need: 

• Social Security card and birth certificate 
• Bank statements for the past 5 years 
• Copies of insurance policies and retirement account statements 
• Property deeds and vehicle titles 
• Medical records demonstrating your need for care
  
  

The completed application takes 2-4 weeks to submit and an additional 45-90 days for states to process it, which means the whole process can take four months or more until your eligibility is confirmed. 

The good news is that Medicaid retroactively covers long-term care costs for up to three months prior to the date of your initial application, as long as you were eligible for Medicaid during that time. 

Medicaid Skilled Nursing FAQs

What Happens if I Have Too Much Income for Medicaid?

Medicaid will pay for care in a skilled nursing facility, but not if your income is over the threshold. If you are in this position, the next step depends on which state you’re in. Some states offer “medically needy” programs where you can “spend down” excess income on medical expenses, while others use qualified income trusts to help manage excess income.

How Long Does Medicaid Coverage Last in a Skilled Nursing Facility?

Medicaid coverage continues as long as you meet medical necessity requirements and remain financially eligible. There’s no time limit like Medicare’s 100-day maximum.

Can I Choose Any Skilled Nursing Facility With Medicaid? 

You can choose any facility that accepts Medicaid and has availability. However, not all facilities accept Medicaid, and some may have waiting lists for Medicaid beds.

What if My Medicaid Application Is Denied? 

You have the right to appeal any denial decision. The appeals process varies by state but typically allows 30-60 days to request a hearing and present additional evidence.

Nightingale Welcomes Medicaid Patients 

Not only does Medicaid pay for a skilled nursing facility, but it also significantly reduces the financial burden of care for millions of Americans every year. Understanding your state’s Medicaid rules and eligibility criteria can be complicated, but at Nightingale, we’re here to help.