Can a nursing home refuse to admit me until I have paid for my care privately for a period of time before I start receiving Medicaid?

Probably not. Medicaid regulates nursing homes that participate in the Medicaid program. Medicaid will only pay a certain amount to nursing homes for the long-term care of Medicaid recipients. Nursing homes cannot charge the resident more than this Medicaid amount. However, nursing homes may charge more for persons who privately pay for their care. 

To avoid the reduced Medicaid price, an unscrupulous nursing home may try to make you pay privately for a period of time before you apply for Medicaid. This is called a duration of stay contract. The duration of stay contract allows nursing homes to charge you an inflated rate above the Medicaid amount. 

Federal law prohibits this practice. Nursing homes cannot require you to privately pay before you receive Medicaid coverage. Nursing homes are allowed to give admission preference to private-pay applicants over Medicaid-eligible applicants, but only after the home has reached nearly maximum capacity. In these situations, a nursing home may try to pressure family members into “voluntarily” accepting a duration of stay contract. The implication is that the nursing home will give preference to other patients if you do not accept the duration of stay contract. Since the availability of nursing home care is limited, families feel pressure to accept these terms “voluntarily.” 

However, federal law states that a nursing home cannot force you to waive your right to Medicaid. While the nursing home is not technically “forcing” you to waive the right, this practice may still be illegal. 

If you believe that a nursing home is pressuring you into a duration of stay contract, you can report this to: 

Office of Health Facility Licensure & Certification Phone: (304) 558-0050  

408 Leon Sullivan Way Fax: (304) 558-2515 

Charleston, WV 25301    

For more information, see: 42 U.S.C. §§ 1320a-7(b), 1396r(c)(5)(A)(i)-(iii) (2015); Joan M. Krauskopf et al., Elderlaw: Advocacy for the Aging § 12.12 (2nd ed. 1993); West Virginia Department of Health and Human Resources, Office of Health Facility and Licensure, (last visited May 26, 2015).