I reside in a nursing home but I have to go to the hospital for surgery. The nursing home told me I must prepay in order to return after my hospital stay. Do I have to pay?

Yes, you must pay to reserve your bed while you are in the hospital. This reservation is called bedhold and the charge is legal. The nursing home is allowed to charge you if you temporarily leave for medical treatment or for other reasons with the intent of returning. This charge is different from the illegal practice of requiring prepayment. Prepayment refers to duration of stay contracts where a nursing home may ask you to pay privately for a room before you apply for Medicaid. Medicaid will pay the bedhold rate for a maximum of twelve days in a calendar year if you must leave for medical reasons. Medicaid will also fund six bedhold days per year if you leave for other reasons, such as visiting family.

Nursing homes are required by law to give you a copy of the Medicaid bed reservation policy prior to medical leave. They must also notify you if your hospital stay exceeds the number of days Medicaid will pay the bedhold charge. If you must stay in the hospital for longer than twelve days, the nursing home can charge you to reserve your bed only if there are no vacancies in the facility and there is a waiting list for admission.

For more information, see: Medicaid Program Instruction, MA-92-30, Memorandum from Ann Stottlemyer, Director, Office of Medical Services, WV Department of Human Resources to Nursing Home Facilities (September 17, 1992); Medicaid Bedhold Policy, The West Virginia Long Term Care Ombudsman (Legal Aid Society of Charleston), Vol. 2 No. 2, Summer 1999.