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What does Medicaid cover in a Skilled Nursing Facility?

The short answer is, almost every expense associated with room, board, and healthcare when associated with long term care in a nursing home.

A more thorough answer is:

The Florida Medicaid program provides medical coverage for Florida residents who meet the program’s eligibility requirements. Once an individual is approved for Medicaid in Florida medical bills will be paid, primarily by Medicaid although Medicaid is always the payer of last resort.  In other words, if there is other potential payers (i.e. Medicare, private insurance, V. A. benefits, etc.) then those sources pay first and Medicaid covers the balance.

The bills covered include not just nursing home care, but also hospital stays, home health care, home and community based services, hospice, transportation, dental and vision care, community behavioral health, and prescription medications. (Although in some cases, Medicare coverage may overlap this coverage).

The following services are required to be offered by all states, including Florida, under Medicaid:

  • Nursing facility services for individuals age 65
  • Nursing facility services for individuals 21 or older if determined disabled
  • Home health care for individuals that are eligible for nursing facility services
  • Inpatient hospital services
  • Outpatient hospital services
  • Physician services
  • Medical and surgical dental services
  • Lab and x-ray services
  • Family nurse practitioner services

The following services are optional; however, most states, including Florida will offer them through Medicaid:

  • Ambulatory services to individuals who are entitled to institutional care
  • Home health services to individuals who are entitled to nursing facility services
  • In-home assistance
  • Prescription drug coverage
  • Dental services
  • Prosthetic services
  • Optometrist services and eyeglasses