Annals of Long-Term Care: Brittany Cone & Jordan Johnson Discuss Common Nursing Facility Medicaid Issues, Possible Solutions
“In many ways, Medicaid reimbursement is the buoy that keeps skilled nursing facilities afloat,” the authors write. “Unfortunately for facilities, however, actually obtaining Medicaid reimbursement for the care and services provided is dependent upon the resident and/or the resident’s representatives providing the necessary financial verification and the state Medicaid agency reviewing and approving the eligibility application. Naturally, countless issues can, and often will, arise during this process.”
They explain that the most prevalent issue facing the skilled-nursing industry today is the inability to obtain the necessary financial verification to establish Medicaid eligibility. This can arise in various forms, including residents and their representatives not cooperating with the application process, or representatives abandoning or being unwilling to assist incompetent residents, among others.
The authors suggest creative solutions to these issues, including thorough communication regarding payer sources, eligibility requirements and the Medicaid application process, assessing and considering the state of the resident, and considering the use of a Petition for Guardianship/Conservatorship when necessary.
“These are just a few examples of the types of Medicaid issues faced by nursing facilities and possible approaches and solutions thereto,” Brittany and Jordan conclude. “Regardless of the type of Medicaid issue, there is always a best practice or outside-the-box approach to resolve, many of which involve getting back to the basics: clear and effective communication and expectation management.”
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