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NJ medicaid; need assisted living; list given by state; facilities say non-participating.

Oakhurst, NJ |

Global Options (medicaid); state list indicates places accept medicaid, yet am told they only "accept private payers who spend down, then medicaid eligible, and i'm not welcome; musn't they comply if accepting fed/state funds; case mgr. is in another galaxy...get "what me worry" responses. what r my options? lawsuit? state agency intervention?

Attorney Answers 3

  1. Consult with an experienced local elder law attorney for specific legal advice. However, it is not uncommon for providers like assisted living facilities and nursing homes to have a priority list and place Medicaid patients at the bottom of the priority list. You would most likely get admitted if you were transferring into such a facility directly from a hospital admission. I doubt you are actually being told they won't put you on the list, I think they are more likely telling you that you will be far down the list and may not ever get to the top of the list. A lawsuit isn't likely to be a solution for you. Instead I think you need to consult with an elder law attorney to explore other options, which may very well include needing to look at other facilities for placement. I hope this helps you.

    It is impossible to give specific answers to questions without meeting and fully discussing all of the potential issues that may not be addressed by your question. The answer(s) provided should be considered general information and are not legal advice. Viewing this information is not intended to create, and does not constitute, an attorney-client relationship. The answer provided is intended to educate you and point to issues for you to raise in a consultation with a lawyer. You should not take any action that might affect your claim(s) without first seeking the professional opinion of a licensed attorney.

  2. These facilities are under no obligation to admit any given individual who wants to stay there. They look first to ones with private-pay money. They are required to take Medicaid reimbursement for people on Medicaid but they don't need more than about 10% in the facility as per state law, so most assisted living facilities will go to great lengths to avoid having more than that amount in the facility. The Medicaid rate is MUCH less lucrative than the private rate.

    What you'll need to do is try and find another community, consider other care options including home care and possibly SNF care, and yes, talk to a qualified elder law attorney in your area who will have those connections and have avenues to pursue so they can see whether they can arrange a placement.

    This answer does not create an attorney-client relationship. In order for you to establish such a relationship, you will need to pay an attorney who is licensed in the state you're currently living in. Feel free to give one a call and ask them, in order to get a more detailed answer.

  3. Unfortunately the previous answers are correct. In a perfect world, legislation would keep this from happening and facilities that receive Medicade patients would be required to not discriminate against them. That is not the law at this time. You must continue to search until you find a facility that has an opening. The existing facility will charge much higher prices until they accumulate all of the assets of their residents and then start taking the lower rate from Medicade. Find a facility that does not work in this fashion.

    Disclaimer Information on this site is provided by attorney Clint Curtis as general information and not specific legal advice. Specific advice can only be provided after a complete analysis of all information related to the asker. No attorney-client relationship is established by the use of the information provided. If you have additional questions please contact the law office.

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