By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold, NJ Medicaid Application Attorney
It’s a question that I’ve been asked numerous times over the years. It’s also one that has caused a lot of confusion. I’ve spoken with some nursing homes who have told me their belief that it violates Medicaid rules. That is incorrect.
Here’s the scenario. Mom receives Medicaid, which pays for a semiprivate room, that is, one with a roommate. If the family wants a private room for Mom, they can pay the additional charge, provided of course that the home has a single room available.
And what is that charge? Usually, $20 to $30 per day which is the difference between the private room rate and the semiprivate room rate that the general public is charged. In other words, Medicaid is picking up the semiprivate room rate but based on the much lower Medicaid reimbursement rate. Medicaid is billed at a rate that is approximately 40-50% less than the rate that the general public pays. But, while you and I must pay a much higher rate than Medicaid does, the good news is that the difference between a semiprivate and a private room is relatively modest.
If your loved one is in an assisted living facility it works the same way. Medicaid will pay for a double but not a single room. Provided the facility makes a single room available, the family can pay the difference between a single and a double private non-Medicaid rate. Medicaid will cover the double room rate only.
Keep in mind that with both nursing home and assisted living Medicaid Mom must contribute some or possibly all of her income to the cost of the facility and Medicaid will pay the rest up to the reimbursement rate. It is, therefore, rare that Medicaid pays the entire cost, even at the reimbursement rate.
To discuss your NJ Medicaid matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at firstname.lastname@example.org. Please ask us about our video conferencing consultations if you are unable to come to our office.