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- already in a NH in order to file
or
- if a new admission into the NH it’s they are coming in a post hospitalization stay. So they are in the facility as a rehab patient / post hospitalization care, with stay paid as a Medicare benefit and then once MediCARE coverage ends then can file for LTC Medi-Cal to remain there as a LTC resident.
That they can’t just enter a NH directly on their own and apply for LTC Medi-Cal on Day 1. They need the records from hospital to NH and for rehab so there’s fat health chart from the hospital and rehab to clearly establish “at need” medically. Or have been at the NH for a while and again there’s a fat health chart from the NH to show their “at need”.
Couple of posts in the past read that they couldn’t just move mom out of her house and into a NH directly for CA medi-cal anymore. That the needs assessment required hospital chart or facility chart to be used to establish need along with the on site assessment. And the on site assessment could be waived if hospital records were there - so less time & costs for the state. Done so totally cuts down on having elders kinda grey area for needing skilled not to be able to be pass eligibility and then facility has to deal with getting them moved out.
NH would like this as they are getting 20/21 rehab days paid at Medicare higher rate too, instead of starting out with Medicaid pending period and that uncertainty.
Insight?
We have a very knowledgeable California member who may be able to answer this.
each person she talks to.