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I am on Medicaid and my assisted living facility is talking about having us share an apartment. What resources are available to me that would prevent them from doing that?
Who is us? Is the room already shared by someone other than you?
If not, the standard for Medicaid is semi private. If there is family that will gift you, through the al if they allow it, the upgrade to a private room, that could be an option. A private room however is not so much a need as it is a privilege.
You will have to discuss their rules with them. I would imagine if you are on Medicaid they can. Most ALF do not accept medicaid at all. You need to know that rules that apply to nursing homes, et al, do not apply to ALF. They are seperate businesses, much like renting out apartments, and have their own rules. Ask your facility to show you the rules as printed in their printed materials.
So sorry, but an AL doesn't even have to except Medicaid. They only get a fraction of what is paid privately plus your SS and pension, if any. That room you have they can make money on. I know it won't be easy sharing a room, a big adjustment but that is what happens when the State pays for care.
Yes they can. My father is in AL in NJ which allows for Medicaid in AL. He surprisingly was in a private room for about a year and a half and then got one roommate who lasted two days due to not liking sharing. Tomorrow another person is supposed to be moving in. The state is paying so they can dictate how it all works. It all comes down to cost.
LouiseAM, are you in Assisted Living or in a Nursing Facility [both terms seem to get crossed-over]? Assisted Living, as others have mentioned, one has to pay from their own pocket. Or did you get in via a wavier?
You mentioned an apartment. How many rooms are in your apartment? Is there enough room for two people to share one bedroom or is there two bedrooms/one bath set-up?
When my Mom was in a nursing home, she had to share a room with a room-mate, and Mom was self-pay [paying $12k per month]. The facility had no private rooms.
Evidently, some states offer AL with Medicaid bed. Learned that info from reading the different comments on this site. In Texas, Medicaid bed usually means 2 beds per room in a NH facility - no AL. Recently, however, I became aware of a rehab center that lost too many patients during Covid. This facility was all private rooms and only had rehab patients. To generate income, they took on Medicaid beds and now operate some rooms as NH Medicaid beds. Fortunately, the private rooms for initial construction, as a rehab only center, are small enough that they shouldn't be able to put two beds in (per square ft allowed per patient), but just a tad larger for single bed use.
Perhaps there will be more facilities like this who lost patients and will take on Medicaid beds to improve their revenue.
If you're on Medicaid, it is common for medicaid to only approve payment for a double bed room. Some facilities have only private rooms, so the facility (just like a doctor's office) has to accept Medicaid payment and cannot bill patient for extra cost. So, it's possible your facility is trying to make the most of their Medicaid bed income by using the 2 beds per room.
Medicaid is for people who have little to no income. Medicaid pays very little and facilities/drs have to accept allowable amount. Most NH/facilities have some Medicaid beds and others are self pay. Those folks with money self pay for their privacy.
You might want to look around. There are more facilities around that only have private rooms and they also have Medicaid beds. You might find something where room was actually set up for a single bed, so little chance of turning it into a double room later on
The problem with moving...I don't think you can do that.
In my State of NJ when living in an AL you need to pay privately for at least two years to apply for Medicaid. And of course the AL has to except medicaid. My impression is that you would stay at that AL because that is who you paid privately to. You can't then go to another AL and expect them to take your medicaid since you have not paid a penny to them privately. Applying for medicaid helps you stay in that AL.
Medicaid gives you very little options. You are at their mercy for anything they cover. If you found a decent place for your father that takes Medicaid count your blessings. Maybe his new roommate will end up being his best friend. Plus I think most men are not as picky as women regarding privacy. Every man I’ve ever dated had no problem farting in front of me. 🙄😏
Yes, they can. If you are living on Medicaid, you have to take what they will give you. If you want to keep a private room, you will have to pay out of pocket. I do not know if you are allowed to pay just the difference between the Medicaid allotment and the fee for a private room. The facility would prefer to get their full price for that room from a Private Pay resident rather than accept a Medicaid subsidy. That is one of the drawbacks of relying on Medicaid.to pay your way.
I don't think you can. By the time your on Medicaid you have no assets other than the spend down you are allowed of maybe 2k. I think a family member may be able to though.
I'm pretty sure this part of Medicaid is the same in all states and I did search from the Medicaid umbrella documents once (that was painful) and find it "Medicaid will pay for shared accommodation where they are available". In many states AL's do not have to accept Medicaid at all. In NJ the number of AL's who will accept Medicaid is extremely limited and those that do only have to accept a very small percentage of beds.
So to answer your question ... yes, they can require you to accept a roommate, provided the facility meets the min. required square footage requirements for each person. I think in AZ the minimum requirement for shared accommodations is 60 sq ft per resident but you should check on this.
Medicaid pays such a low rate, that every facility I know of is losing money on Medicaid residents (which is why ALs often require that you are private pay for a certain length of time before they will accept you on Medicaid). To give you an example.... even though it was a different type of facility in a different state, NJ - long term care... my facility was the most reasonable in the county because it was government owned. We charged $220 per day per resident (and trust me that didn't cover operational costs). Medicaid gave us $178.43 per person.
Not sure how ALs operate in AZ but you could look at see if there are others that might accept Medicaid that have only private rooms. I hear your discomfort though. It is hard to have a roomie even if they are wonderful when you are not used to it.
What does your contract with the AL facility say? Were you accepted as a single person for your AL accommodations? If there is a contract like this, then no they cannot force you to share your living space. If you don't have this kind of contract, unfortunately they can make you share.
I would check your contract but... If you are living in an apartment that is suited for 1 person like a 1 bedroom or Studio I doubt they can move another person in. (There may actually be Fire or Building Codes that specify the occupancy of the rooms.) If you are in a Double then I am sure they can.
In my home state (MN) being on Medicaid almost always means a shared room, unless they have a glut of Medicaid-designated rooms and not enough recipients. But I also agree that you should review your contract and make sure they aren't trying to cram 2 people into a room that was designed for 1. If you have problems and admin isn't responsive or trying to resolve the issue, contact an ombudsman.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
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I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
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APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
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APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
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If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
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This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
If not, the standard for Medicaid is semi private. If there is family that will gift you, through the al if they allow it, the upgrade to a private room, that could be an option. A private room however is not so much a need as it is a privilege.
You need to know that rules that apply to nursing homes, et al, do not apply to ALF. They are seperate businesses, much like renting out apartments, and have their own rules. Ask your facility to show you the rules as printed in their printed materials.
You mentioned an apartment. How many rooms are in your apartment? Is there enough room for two people to share one bedroom or is there two bedrooms/one bath set-up?
When my Mom was in a nursing home, she had to share a room with a room-mate, and Mom was self-pay [paying $12k per month]. The facility had no private rooms.
Perhaps there will be more facilities like this who lost patients and will take on Medicaid beds to improve their revenue.
Medicaid is for people who have little to no income. Medicaid pays very little and facilities/drs have to accept allowable amount. Most NH/facilities have some Medicaid beds and others are self pay. Those folks with money self pay for their privacy.
You might want to look around. There are more facilities around that only have private rooms and they also have Medicaid beds. You might find something where room was actually set up for a single bed, so little chance of turning it into a double room later on
In my State of NJ when living in an AL you need to pay privately for at least two years to apply for Medicaid. And of course the AL has to except medicaid. My impression is that you would stay at that AL because that is who you paid privately to. You can't then go to another AL and expect them to take your medicaid since you have not paid a penny to them privately. Applying for medicaid helps you stay in that AL.
So to answer your question ... yes, they can require you to accept a roommate, provided the facility meets the min. required square footage requirements for each person. I think in AZ the minimum requirement for shared accommodations is 60 sq ft per resident but you should check on this.
Medicaid pays such a low rate, that every facility I know of is losing money on Medicaid residents (which is why ALs often require that you are private pay for a certain length of time before they will accept you on Medicaid). To give you an example.... even though it was a different type of facility in a different state, NJ - long term care... my facility was the most reasonable in the county because it was government owned. We charged $220 per day per resident (and trust me that didn't cover operational costs). Medicaid gave us $178.43 per person.
Not sure how ALs operate in AZ but you could look at see if there are others that might accept Medicaid that have only private rooms. I hear your discomfort though. It is hard to have a roomie even if they are wonderful when you are not used to it.
Wishing you good luck on this journey
If you don't have this kind of contract, unfortunately they can make you share.
If you are living in an apartment that is suited for 1 person like a 1 bedroom or Studio I doubt they can move another person in. (There may actually be Fire or Building Codes that specify the occupancy of the rooms.)
If you are in a Double then I am sure they can.
Has anything happened concerning your room?