Question

Due to the change, nursing facilities have become highly regulated at both federal and state levels. Additionally, to be reimbursed by Medicare and Medicaid, a nursing facility must be certified. What is the difference?

Answer 1

Medicare	Medicaid
Medicare is considered an “entitlement” program. All people who have reached the age of 65 (or who are permanently disabled, or are victims of end-stage renal disease) are entitled to begin receiving their social security entitlements. These benefits, which were paid in over their lifetime as part of employment taxes, also qualifies them to receive Medicare.	Medicaid is a “public assistance” program. Its availability is limited to people who meet strict income and asset guidelines (or those who are pregnant, or people with specific additional circumstances). Medicaid pays for health care services for those individuals with low income and assets who may incur very high medical bills.Medicaid is a joint state-federal program. Each state is allowed to independently operate its own Medicaid system, providing roughly half the funding.
Medicare does not pay for most long-term care services except in particular circumstances, and typically doesn’t payout at all for personal or custodial care (i.e., when assistance is present to provide supervision or help with bathing, dressing, or eating). Most nursing home care is classified as custodial care, meaning skilled medical services are not being provided. Medicare will cover care provided during a short stay in a skilled nursing facility (SNF) provided the certain conditions are met.	For Long-term care services in nursing homes, it includes custodial care, for all eligible people age 21 and older Long-term care services provided at home, including visiting nurses and assistance with personal care, home and community-based services such as personal care services, laundry and cleaning support, and case management. Eligibility for long-term care services is typically determined by personal care and other service needs. If you require a level of assistance that would indicate you need to be in a nursing home, you may also qualify for help that could also allow you to receive in-home care and/or community-based services.
Total Medicare payments for long-term care delivered in an SNF(Skilled Nursing Facility) are limited. Medicare pays 100% of the cost through day 20 of your stay in an SNF You are responsible for any out of pocket co-pay ($164.50 as of November 2017). Medicare will cover the balance owed through day 100 of your stay in an SNF After day 100, Medicare does not cover any costs for stays in an SNF The above applies to Original Medicare. Medicare Advantage plans cover the same services in an SNF, but the way cost-sharing is determined can vary.	Also medical includes Skilled care/skilled nursing/related services Rehabilitation for injury/disability/illness. Long-term health-related services needed due to a mental/physical condition Medicaid coverage for Nursing Facility Services only applies to services provided in a nursing home licensed and certified as a Medicaid Nursing Facility (NF). Availability is additionally limited to Medicaid-eligible persons who have no other payment options.