by Debbie Robus

Created on: May 20, 2010

When my paternal grandmother fell and had to be hospitalized and then discharged to a nursing home for rehab, I learned quickly what is and is not covered by Medicare and Medicaid.  For starters, Medicare requires that a patient spend three midnights in the hospital before being admitted to a skilled nursing facility.  My grandmother fell one morning before 6:30.  Her injuries from the fall were significant enough to merit keeping her long enough for the "qualifying hospital stay."  The information at

www.medicare.gov states "This is at least three days."  Ask any nurse or physician... they will tell you that technically it is "three midnights."  There is a difference, so be sure you discuss this with your physician and medical staff.  With the push to get people in and out of hospitals, some doctors may be reluctant to keep the patient this long, so be prepared to play hardball.

Once the patient is admitted to a skilled nursing facility following a qualifying hospital stay, Medicare will pay for up to 100 days of rehab if deemed necessary by a physician and nursing home therapists and case workers. Once this time period is exhausted, the patient may either be discharged or remain in the nursing home at his/her expense - or covered by Medicaid if certain qualifications are met.

Medicare.gov states that "Medicaid is a State and Federal program that will pay most nursing home costs for people with limited income and assets. Eligibility varies by State. Check your State's requirements to learn if you are eligible. Medicaid will pay only for nursing home care provided in a facility certified by the government to provide service to Medicaid recipients."

In my grandmother's case, should she have needed to stay beyond 100 days, Medicaid would have paid for her care by garnishing her monthly Social Security check, less a set amount for personal extras (somewhere around $25) such as clothing, hair care, vending machines, and specialty items.  There are rules and regulations, and many of these are explained at www.elderlawanswers.com (see Medicaid Rules under ElderLaw101).  One of these rules states that "In order to be eligible for Medicaid benefits a nursing home resident may have no more than $2,000 in "countable" assets." This includes checking and savings accounts and cash.  We got into trouble on this one, because my grandmother misunderstood and believed she could have $2300 in assets.  When

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