Medicaid will pay for a nursing home only when having access to skilled care is medically necessary. In New York, when you are admitted to a nursing home, an evaluator will meet with you to review all of your medical conditions and your ability to do some activities of daily living like eating, moving between a bed and chair or wheelchair, using the bathroom, and getting around. The evaluator will use a form called a Hospital and Community Patient Review Instrument (HC-PRI) to assign a particular score to your need for nursing home care. Medicaid uses that information to decide whether you need a nursing home, what kind of nursing home is appropriate for you, and what services Medicaid will pay in the nursing home. In general, for a nursing home to be considered medically necessary, you must have a medical condition that is so serious that you need the level of nursing care that is only available in an institution.
Elder Care Advisors of Long Island, LLC has been assisting families and their loved ones with eligibility, through Estate Planning and Medicaid Qualifying Trusts for almost a decade to ensure that they are qualified to become eligible, within a five-year look-back, to be able to obtain long term and palliative care from a skilled nursing home facility.