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Medicaid and Medicare Skilled Nursing Coverage

When you or your loved one need care provided by a skilled nursing facility, you likely want to know if Medicare or Medicaid provides coverage for your care and services while you are at the facility.

Learn details about skilled nursing care and whether Medicaid or Medicare provides any coverage for your care at a skilled nursing facility.

Does Medicare Cover Skilled Nursing?

Although the terms are sometimes used interchangeably, skilled nursing care differs from when an individual receives nursing home coverage from Medicare. This is important to know because Medicare coverage for skilled nursing facility services varies from coverage for a nursing home stay even if the facility provides both skilled nursing care services and nursing home care at one location. One primary difference is the fact that nursing home residents live there permanently.

When you are ready to leave the hospital, but are not yet well enough to return home, your doctor may determine that you need to go to a skilled nursing facility for a time, if you meet the Medicare requirement of a three-day inpatient hospital stay. The hospital staff works with you and your loved ones to find a skilled nursing facility of your choice that accepts Medicare and provides the services you need.

Skilled nursing facilities provide care and services from the skilled staff that has specific expertise to treat patients and help them recover to their best possible level of well-being.
Medicare indicates that it covers skilled nursing care at a skilled nursing facility for a limited time period. You have to first meet all eligibility requirements to receive coverage for care provided at a skilled nursing facility.

Eligibility requirements include that you have Medicare Part A with days left in your benefit period and have a qualifying hospital stay. Your doctor has to have made the decision that you need skilled care provided by or directed by skilled nursing staff or therapy professionals at the skilled nursing facility. You receive your skilled nursing care at a Medicare-certified facility.

Skilled nursing care and services covered by your Original Medicare include a semi-private room, meals, medications, medical supplies and equipment, medical social services, dietary counseling, skilled nursing care and specific therapies to meet your goals.

Examples of covered therapies include physical therapy, occupational therapy, speech-language pathology services. This is not a complete list of Medicare-covered care and services.

Medicare points out some crucial factors for you to remember. First, if you refuse your daily skilled care or your therapy, you could potentially lose your Medicare-eligible skilled nursing coverage.
Another factor to take note of is that sometimes doctors or other healthcare providers recommend or order services that either Medicare does not cover or does not cover as often as the doctor wants you to have the specific care or services. If this happens you will possibly have to pay for some or all of the recommended care or services.

The Centers for Medicare & Medicaid Services booklet, “Medicare Coverage of Skilled Nursing Facility Care” explains that you have up to 100 days skilled nursing facility care per benefit period. There are no limitations on the number of benefit periods. Before you receive Medicare-covered skilled nursing care, you have to have a new three-day qualifying hospital stay each benefit period.

Does Medicaid Cover Skilled Nursing?

Although Medicaid is a U.S. Federal Government Program, Medicaid gives a great deal of opportunity for individual states to make decisions on coverage and benefits for Medicaid recipients. This is true of all groups, including seniors, receiving Medicaid or who are dually eligible for both Medicare and Medicaid.

Medicaid covers skilled nursing care at Medicaid-certified skilled nursing facilities. Eligible Medicaid recipients have to meet criteria for nursing facility care in their own state, yet the individual states must also abide by federal law and regulations when setting their skilled nursing care requirements and guidelines.

Medicaid covers skilled nursing facility care and services such as nursing services, rehabilitative services, pharmaceutical services, medical social services, meals and other care.
Medicaid reveals that it provides coverage for skilled nursing care that allows each eligible recipient the opportunity to “Attain or maintain the highest practicable physical, mental, and psychosocial well-being.”

Where Can I Find Medicare And Medicaid Skilled Nursing Care Near Me?

When you or your loved one is in the hospital and needs the services of a skilled nursing facility, your hospital care team discusses skilled nursing care options with you. Most hospitals try to accommodate any preferences you have, but that is contingent upon the availability of a room, as well as whether the facility is a Medicare-certified facility if you have Medicare or a Medicaid certified skilled nursing facility if you have Medicaid.

Senior care and senior living options provide excellent resources for finding a skilled nursing facility near you that accepts your Medicare or Medicaid benefits while you are receiving care and services provided by skilled nursing staff and therapy specialists.

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