Skilled Nursing or Nursing Homes

The key difference between skilled nursing facilities and nursing homes is the required medical attention and the length of stay.

Skilled Nursing or Nursing Homes
Skilled Nursing or Nursing Homes

Skilled Nursing

A skilled nursing facility is usually utilized following a short hospital stay (3 night stay or greater) when the patient requires specific medical services to fully recover. Skilled nursing facilities have specialized staff such as speech-language pathologists, rehabilitation specialists, and audiologists who are not typically staffed in a nursing home. Following a short skilled nursing rehabilitation stay, a patient assessment will be done to decide if the patient is able to return home.

Nursing Homes

A nursing home, on the other hand, provides permanent custodial care. These locations offer certified health professionals, meal preparation, and assistance with non-medical, everyday living tasks such as bathing, grooming, bathroom use, medication monitoring, and more. Nursing homes offer 24-hour care nursing care as well as room and board. Some nursing homes have special wings for Alzheimer’s and dementia patients.

How Much Do Nursing Homes Cost?

There are important differences in medical coverage between these two care options. Outside of private pay and insurance programs there are two main sources of government funding from Medicaid and Medicare. The biggest difference is that skilled nursing care is covered by Medicare Part A under most circumstances, whereas long-term care services in nursing homes are not.

Under Medicare, the following services are covered at skilled nursing facilities:

  • Semi-private room (a room you share with other patients)
  • Meals
  • Skilled nursing care
  • Physical and occupational therapy
  • Speech-language pathology services
  • Medical social services
  • Medications
  • Medical supplies and equipment used in the facility
  • Ambulance transportation to the nearest supplier of needed services
  • Dietary counseling

Up to 100 days in a skilled nursing facility is covered for the most part by Medicare. Your skilled nursing facility stay of 20 days or less is fully covered by Medicare.  Here is a breakdown of exactly what you should expect to pay for a skilled nursing facility stay:

You pay: 

  • Days 1–20: $0 for each benefit period .  
  • Days 21–100: $185.50 coinsurance per day of each benefit period.
  • Days 101 and beyond: All costs

Long-term nursing home care is not covered by Medicare. Most people pay for nursing home care through their own funds or through the Florida Medicaid Program.

Are nursing home stays covered by Medicaid?

Florida Medicaid’s Institutional Care Program (ICP) Income and Asset Limits

If you do not already qualify for Medicaid, you might be eligible if you have little income. The asset limit for Medicaid currently  in Florida is $2,000 for an individual and $3,000 for a couple. If the individual or a couple has income at or below 88% of the Federal Poverty Level (FPL), the asset limit is $5,000 for an individual and $6,000 for a couple.

If you are elderly or disabled, you will still need to have few assets to qualify for Medicaid ICP.  Some assets are not counted,such as a home if your spouse is living there or if you intend to return there, one vehicle, personal belongings, and small burial or life insurance policies.

In some instances, you are permitted to“spend down” your assets to qualify for Medicaid ICP by paying for certain kinds of debts or expenses. Be very careful about transferring any of your assets. Medicaid will look back 60 months from the date that you apply for Medicaid-paid long-term care and examine any asset transfers to see if they were legitimate.

How Much Does the Patient Pay Under Medicaid ICP?

After you are determined to be eligible, a special budget is used to determine the monthly amount the patient is responsible to pay. In general, all of the patient’s monthly income, except for $35 for personal needs, must be paid to the nursing home for the patient’s care.. This includes and funds deposited into a Qualified Income Trust (QIT). The payment to the facility is called the “patient responsibility”.

How Much Does Medicaid Pay Under Medicaid ICP?

Medicaid pays the difference between how much the patient pays (patient responsibility) and what the nursing home charges under Medicaid.

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