If my husband goes into a nursing home and enrolls in Medicaid, will I lose all of his Social Security check?Read more
Will You Lose Medicare or Medicaid If You Leave the Nursing Home to Visit Family?
- October 30th, 2017
Reunions, graduations, birthdays, and holidays: Whatever the occasion, nursing home residents don't want to miss out on family gatherings, but may be afraid that they will lose Medicare or Medicaid coverage if they leave the nursing home. In most cases, Medicare recipients can leave for a day or two, although the nursing home may bill them in order to hold their beds. Medicaid recipients will need to check with their state.
Medicare's coverage of nursing home care is quite limited and it only covers "skilled care" – i.e., treatment provided by a doctor or nurse. Coverage can stop if a patient is no longer benefitting from this skilled care. However, the Medicare policy manual states that a short leave of absence to attend a family occasion is not, by itself, evidence that the resident no longer needs to be in the nursing home. The manual also states that staff should not tell a resident that leaving the facility will cause coverage to lapse.
Local Elder Law Attorneys in Ashburn, VA
Law Offices of John L. Laster
John Laster is a lawyer licensed to practice in Virginia, Maryland and the District of Columbia. He limits his practice to wealth transfer planning, trusts, wills, powers of attorney, health care decision-making issues, estate administration and related tax, elder law and disability concerns. Listed in The Best Lawyers...
Felinton Elder Law & Estate Planning Centers
Mindy Felinton concentrates in the areas of Medicaid planning, Veterans' Benefits, asset protection, nursing home planning, elder law, wills, estate planning, trusts, living wills, powers of attorney, probate administration and trust administration and began her legal career 30 years ago as an Assistant State Attorney...
Hale Ball Carlson Baumgartner Murphy PLC
Jean Galloway Ball is certified in Elder Law by the National Elder Law Foundation. She is a 1977 honors graduate of the National Law Center, George Washington University, and she did her undergraduate work at the University of California at Berkeley, graduating Phi Beta Kappa in 1971. She is admitted to practice in Vir...
If a resident leaves and returns by midnight the same day, the nursing home can bill Medicare for the day. However, if the resident is gone overnight, Medicare will not compensate the nursing home for the time missed. If the resident wants to leave for a few days, he or she should check with the nursing home to make sure the bed can be held. The nursing home may charge the resident a bed-hold fee in order to keep the space available.
If a Medicaid recipient leaves a nursing home to visit family, it is called "therapeutic leave." State laws regarding therapeutic leave vary widely. Some states will pay to hold a bed for as long as 30 days a year, while others pay nothing at all for such leave. Each nursing home is required to provide residents with information about their bed-hold policy before the resident leaves the facility. In addition, if a Medicaid recipient is absent longer than the nursing home's policy allows, federal law requires the nursing home to readmit the recipient to the first available room. For a list of state bed-hold policies, click here.
If a nursing home gives a resident a hard time about leaving for a few days, the resident should contact his or her attorney.
For more information about Medicare's nursing home coverage, click here.
For more information about Medicaid’s long-term care coverage, click here.
Last Modified: 10/30/2017