“Won’t the nursing home treat my mother differently when she goes on Medicaid?” I hear this question quite frequently. A different variant of the question that I also often hear is, “I don’t want my mom to have to go to a Medicaid nursing home.”
People have this notion that there are two different types of long-term care facilities, those for privately-paying patients and those for Medicaid beneficiaries. If it weren’t for federal and state laws, I’m sure there would be two types of facilities, but thankfully for nursing home residents, there are laws against nursing facilities discriminating against Medicaid beneficiaries.
Most nursing homes in New Jersey are privately-owned facilities. In Monmouth County, for instance, there are only two county-run facilities, and quite frankly, if you visited these facilities, you wouldn’t know that they are owned by a governmental entity.
Because nursing homes are most often private facilities, the people who own those facilities want to turn a profit. Even non-profit facilities like to make money to pay the salaries of those who work at the facility, often paying those in upper management very generous salaries. In my opinion, companies are “non-profit” because upper management makes sure that they suck all the money out of the company in the form of salaries.
About two-thirds of all patients in nursing homes are also Medicaid beneficiaries. Nursing homes derive approximately 50% of their revenues from the Medicaid program.
In New Jersey, nursing homes charge private-pay residents anywhere from $8,000 a month to $12,000 a month. The average cost of a nursing home in our state is $9,000 a month. The Medicaid program will pay these nursing homes somewhere in the range of $6,500 a month for a Medicaid beneficiary.
Given the above, it is easy to see why the owners of nursing homes prefer private-paying residents; they make about 33% more from a private-paying resident than they do from a Medicaid beneficiary. But, given the above, it is also easy to see that nursing homes could not survive without the Medicaid program.
With two-thirds of their residents receiving Medicaid and with 50% of their revenues being derived from the Medicaid program, nursing homes need the Medicaid program. Moreover, although they receive less from Medicaid than they do from private-paying residents, another benefit of Medicaid is that the Medicaid program pays every month, on time. If you own a nursing home, you don’t have to worry about the state of New Jersey running out of Medicaid money and not being able to pay you. You can count on receiving payment for each of your Medicaid residents.
I have never seen or heard of an incident in which a nursing home discriminated against a nursing home resident because the resident was a Medicaid beneficiary. No client has ever raised this as an actual and factual issue to me. As I tell my clients, “Since most people who live in nursing homes receive Medicaid benefits, if the nursing home treated Medicaid residents differently, they’d be treating everyone one who lived in the facility the same.”
If, however, you have a concern about a family member being discriminated against because he is a Medicaid beneficiary, rest assured that there are laws against that discrimination. Since 1987 when the Nursing Home Reform Act was signed into law, nursing homes are prohibited from discriminating against residents because of the method with which they pay the facility. In short, a nursing home cannot discriminate against Medicaid beneficiaries.
A nursing home that does discriminate against Medicaid beneficiaries runs the risk of losing its Medicaid certification. The nursing home would not be eligible to receive payment from the Medicaid program. The nursing home would not receive monthly payment for two-thirds of its residents and would lose 50% of its revenue. In short, the nursing home would go out of business, in a hurry.
Nursing home residents have the right to receive appropriate care regardless of how that care is paid for. Knowing your rights can help you advocate with confidence when a loved one enters a long-term care facility.