The Nursing Home Will Tell the Family Dad Has to Private-Pay for 12 Months Before It Will Consider Medicaid. They Will Pay $118,000, and That Requirement Has Been Illegal Since ...

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Nursing homes have been quietly telling families that Dad must pay privately for a full year before Medicaid is even on the table, and most families hand over the money without ever asking whether that rule is real.

Picture a family sitting across a desk from the admissions director of a Medicaid-certified nursing home. Dad can't go home after his hospital stay. The director explains that the facility's policy requires 12 months of private pay before it will "consider" Medicaid. The family agrees on the spot because they're terrified of losing the bed.

That 12-month private-pay rule doesn't survive contact with federal law. Nursing-home reforms passed in 1987 bar Medicaid-participating facilities from making residents give up their Medicaid rights or promise not to apply. Today's federal rules say the same thing plainly: a facility can't require that assurance as a condition of admission or continued stay.

Assume an example rate of $9,833 a month. Twelve months of that comes to $117,996, and the family pays it before anyone asks whether the rule is real.

That rate falls squarely between current…

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