Long Term Care Guide
Nursing Facility Program
This program pays for the cost of care in nursing facilities in Delaware that have contracts with Medicaid. These nursing facilities provide room, board, and nursing services to persons who are elderly, infirm, or disabled. An individual applying for the Nursing Facility Program must be in need of skilled or intermediate level of care as defined by Delaware Medicaid criteria. In other words, the individual must require the level of care provided by a nursing facility.
If in a nursing facility, a Medicaid resident may keep $44.00 of his monthly income. The rest of his income must be paid to the facility unless an amount has been protected for
- health insurance premiums,
- medically necessary medical equipment and services not covered by Medicaid (e.g. eye glasses, dentures, hearing aids..) and/or
- the needs of a community spouse under the Spousal Impoverishment provision.
If a patient in a Medicaid enrolled nursing facility runs out of private funds and converts to Medicaid payment, the nursing facility cannot discharge him if there is an available Medicaid certified bed.
Federal law prohibits nursing facilities from charging Medicaid residents or their families for items and/or services that are covered by Medicaid.
Nursing facilities which accept Medicaid cannot ask Medicaid residents for contributions as a condition of admission or charge fees to supplement the Medicaid rate.
Nursing facilities must provide a list of what items and services are included in the basic Medicaid rate and what items or services would require an extra charge. At the time of the Medicaid application interview, each applicant is given a list of what Medicaid pays for and what the nursing facility is required to supply.
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