Medicaid: Transitioning from skilled nursing to assisted living

Medicaid: Transitioning from skilled nursing to assisted living

If you have a loved one who is being cared for in a skilled nursing facility and is receiving Medicaid benefits, and that person no longer needs to be in skilled nursing (but cannot live on their own or is unable to come home), they may be able to transfer to an assisted living facility and qualify for Medicaid without having to be on a waiting list.  Unfortunately, the Medicaid program that pays for care in assisted living  typically has a long waiting list and it is hard to get benefits under this program (while the program that pays for skilled nursing care does not have a waiting list).

There is a little known rule under the Medicaid rules known as the “60-day Transition Rule” which allows a nursing home resident to move from skilled nursing to the community (whether that be back home or into assisted living) and qualify for Medicaid without having to be on the waiting list.  Unfortunately, most nursing home and assisted living facility administrators do not know about this program or how it works because the Department of Elder Affairs and the Agency for Health Care Administration have done nothing to get the word out about this program.  And, if you do not follow the exact rules for this program (which is also not well-known), you could lose Medicaid services and be placed on the wait-list for the Medicaid Diversion programs.

It is important to note that, in order for this program to work, the applicant must have been in skilled nursing for 60 consecutive days.  Next, the applicant (or his/her representative) must contact the CARES unit (CARES stands for “Comprehensive Assessment and Review for Long-Term Care Services” and is Florida’s federally mandated pre-admission screening program for nursing home applicants) in their area to open a transition case.  It is up to the CARES caseworker to determine whether the person can be safely discharged into the community.  Once the application is approved, the applicant can transition into an ALF and does not have to go on a waiting list to receive Medicaid Diversion services.

Although this sounds complicated, with the help of a qualified Elder law attorney, your loved one may be able to make the transition from skilled nursing back into the community either to their home or assisted living and still be able to receive some Medicaid benefits.  Contact Laurie Ohall, Board Certified Elder law attorney, for further questions.