When Does Medi-Cal Pay for a Nursing Home?

Outside of long term care insurance, you can’t count on anyone but you to pay your nursing home bill unless you’ve done some advanced planning with the help of a Pasadena lawyer. Some people are under the impression that Medicare will automatically pick up the full tab, but this is not the case. Medicare only covers extremely limited nursing home bills, so every California resident should be prepared with their own Medicaid qualification plan.

Creating such a plan should be done with the guidance of a lawyer. Today, Medi Cal covers around 65% the residents inside California nursing homes. It’s supported by both state and federal funds and requires that certain application criteria are met before someone can get funded this way.

Medi Cal only covers these expenses when a nursing home stay is “medically necessary.” This is defined as:

  • When it’s necessary and reasonable to protect the person’s life
  • When it would prevent significant disability or serious illness
  • When it would help alleviate serious pain

Your treating physician should recommend and prescribe this for you as a first step to show that it’s medically necessary. Things like inserting or replacing catheters, giving injections, feeding through a tube, and treating bedsores are all examples of skilled nursing care.

Your doctor will look at your ability to handle the six activities of daily living to determine if you need support from outside parties to manage these. These are toileting, bathing, dressing, moving from one place to another, feeding, and continence.

Set aside time to speak to a Pasadena area Medicaid planning lawyer if you are concerned about the high expense of nursing homes and want support in planning out how you could qualify for Medicaid quickly and legally if needed in the future.

Request A Consultation

"*" indicates required fields

This field is for validation purposes and should be left unchanged.