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  • Medicare covered rehab to Medicaid planning: coordinating quality care after an injury

When there is a severe injury resulting in the need for significant care over a period of time it is important to balance the care provided from Medicare and Medicaid.
Medicare Part A provides limited coverage for nursing home care intending to provide rehabilitation services. Medicare provides 100 days of rehabilitative care for 100 days after a qualifying hospital stay. For a hospital stay to be a qualifying hospital stay, the patient needs to be in the hospital for at least two days and have been admitted into the hospital, merely only observation is not sufficient. During the first twenty days of the rehab stay, Medicare covers the entire amount of the stay, and from day 21-100 there is a copayment of $140 a day. For the stay to be qualifying for Medicare, the patient must be receiving physical therapy that maintained the patient’s ability. It is often said incorrectly, that the patient is required to show improvement to receive benefits. Under Federal law, it is not necessary for the patient to be improving to receive benefits, but only be maintaining their abilities.
While a senior is receiving rehabilitation services covered by Medicare, it is a good time to begin the discussion of Medicaid planning. If the patient has an immediate need for long term nursing home care past the 100 days provided by Medicare, Medicaid planning can assist the patient in qualifying for Medicaid to cover nursing home costs after that point. This planning ensures that the entirety of the patient’s assets will not be exhausted by a nursing home stay. If the patient does not currently have a need for an extended stay in a nursing home and is returning to home or to assisted living, Medicaid planning can protect the patient’s assets from a future stay, and by planning ahead, a larger amount of assets can be protected.
An experienced elder law attorney can provide assistance bridging the gap from Medicare coverage to Medicaid while conserving the resources of the applicant