Medicaid Pending is a common word in the long-term care industry, and it will you to know what a nursing home social worker, admissions, or other employee is talking about when they refer to Medicaid Pending status.
When a person enters a nursing home without the necessary funds to pay for care, Medicaid qualification MUST be addressed and Medicaid eligibility obtained. The situation is exactly the same if a nursing home resident enters a nursing facility with private pay, but after a period of spend down, exhausts his or her funds and must engage in enrollment to a Medicaid program for long-term care cost payment. When the resident has exhausted all funds, or enters the facility with no funds, a Medicaid application must be filed. After resident has entered nursing home care, has exhausted their private pay, but before the Medicaid application process has been completed and Medicaid eligibility has been obtained is called the period of Medicaid Pending status. The person cannot pay for their care, therefore a Medicaid application has been filed but has not yet been approved: this is called Medicaid Pending, and the resident is referred to as a Medicaid Pending Resident.
Being aware of Medicaid Pending status and knowing how it works is very important for loved ones and family members, for a variety of reasons. Some nursing home care providers require private pay through the Medicaid application process; if the prospective Medicaid recipient is unable to private pay until Medicaid approval is obtained (and he or she probably is not able to make those payments), then payment for that time period may have to be made by loved ones and family members. Other nursing homes, by the way, do not require payment until qualifying for the Medicaid long-term care coverage begins. And here is an area in which loved ones will greatly benefit from being fully educated on the ins and outs of Medicaid Pending status. Sometimes it takes more than just knowing the Medicaid eligibility criteria to know how to navigate the full path to Medicaid benefits and Medicaid coverage. Having a full care plan prior to entering the world of care services is greatly beneficial to navigate the cost of care path.
Can early Medicaid planning help getting through the Medicaid eligibility process? Absolutely. Beginning the process as soon as health care becomes an issue, or addressing the issue when the care recipient is at a lower level of care, or beginning immediately when a loved one enters Medicare rehabilitation and long term care may be necessary after the rehab.
When care benefits from the state become a possibility, it is best to contact the Medicaid planners at QMC to determine the best path forward. Social Security and pensions alone rarely pay for the full nursing home bill. Nursing home Medicaid can always be obtained if the financial criteria can be met and the family begins the preparation process early.
Contact QMC today!