It is important for Hospital Discharge Planners, Healthcare Providers, Social Workers, Nurses, etc. to have a working knowledge of the basics of the Medicaid qualification process and of the basic planning tools available to families in order to direct patients in their care plan to the proper professionals to maximize options.
In the process of discharge planning a patient from an acute care hospital level of care to post acute care in a rehabilitation facility, in the home or perhaps in a skilled nursing facility, the social worker or discharge planner must work through the various financial options available to the patient as part of their long-term care plan. Medicare does pay for rehabilitation, but it rarely pays for ongoing care provided by home health agencies, or for respite care, or care in a skilled nursing facility. Case management often incorporates investigation into private pay and Medicaid pay options, no matter the level of care.
Discharge planning for post-acute care often includes Medicare or Medicare Advantage covered rehabilitation services, in which case the transition and planning for the longer-term falls to the discharge planner or social worker at the rehab facility, planning for home health services or transition to assisted living or a skilled nursing facility. The level of care needed and assessed during the case management process will depend upon the activities of daily living that the patient can independently perform according to the medical records. Discharge planning requires the coordination of all of these factors.
If the patient has limited funds to pay for post-acute and post-rehab care, Medicaid and other CMS options must be considered as part of the care plan. Medical records are part of discharge planning, and qualification for means-tested programs is as well. Medicare and Medicare Advantage doesn’t pay for everything. (Although it is important to note that Medicare and Medicare Advantage DO pay for hospice care in the event of a terminal illness.)
The process typically follows a common pattern, providing a full continuity of care for the treated individual. A patient enters the hospital for an acute care issue. If the issue is treatable and addressed, the possibility of rehabilitation is assessed, and, if supported by the medical records, will be prescribed. Rehabilitation sometimes takes place within the acute care hospital, but more often will take place at a separate stand-alone rehabilitation facility. Rehabilitation is typically covered by Medicare or Medicare Advantage or by most health insurance policies. After rehabilitation has been completed, the individual is then left to pay for any additional care needs in their transition of care from health care providers either through private pay or through CMS (Centers for Medicare & Medicaid Services) means tested assistance like Medicaid. This can include home health services from home health aides from home health agencies or home care agencies, assisted living, purchase of durable medical equipment, or care in a skilled nursing facility. Discharge planning requirements would dictate investigation of all of these avenues.
Quality Medicaid Care’s Medicaid University covers all of these topics and many many more. Please use the Medicaid University articles to help you assist those you serve, guiding them through the financial side of the care journey
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