Medi-Cal Discrimination in Nursing Homes – Getting in is Half the Battle

Over the past five years, one of the most disturbing violations of state and federal laws has been the increase in discrimination against Medi-Cal beneficiaries who need nursing home care.

Call a nursing home and tell them that your mother, a Medi-Cal beneficiary, has dementia along with other medical issues and that her doctor has recommended a nursing home– good luck in finding a placement within 200 miles - or at all! Tell them that your mother is in the hospital on Medicare, and your chance of finding a nursing home placement increases 100 percent. Because Medicare reimbursements are higher than the Medi-Cal daily rates, discrimination against accepting Medi-Cal eligible residents has become the preferred way for nursing homes to increase their profits.

Illegal? Yes, such discrimination is illegal under both state and federal laws. In fact, certification for Medi- Cal is totally voluntary and nursing homes who wish to participate in the Medi-Cal program must sign a provider agreement certifying under penalty of perjury that they will adhere to all state and federal laws, which include a prohibition against Medi-Cal (Medicaid) discrimination. Despite these laws, nursing homes have found numerous ways of discriminating to reduce their Medi-Cal population and free beds up for private pay or Medicare residents.

If a resident does happen to find placement as a Medicare patient, when Medicare days are terminated, the facility will often tell the resident or the resident’s family that the resident must leave; that they only retain “short-term” residents; that they don’t have any Medi- Cal beds; or that the resident – despite all evidence to the contrary - no longer needs the nursing home level of care. These are falsehoods, of course, aimed at scaring residents out of the facility. The truth is that, in California, if a nursing home is certified for Medi-Cal – all the beds are Medi-Cal certified. There is no such animal as a “short-term” nursing home. If they have a bed at all, it’s a Medi-Cal bed.

Because Medi-Cal does not pay for a private room, a common practice is to transfer the resident to the Medi-Cal “wing”, i.e., a section of the facility with 2-4 bed rooms all on Medi-Cal with limited staffing and no rehab services or to transfer the resident to the acute care hospital and refuse to readmit them, regardless of their right to a bed hold, the right to return to the facility and their right, even if the bed hold time has passed, to the first available bed.

Nursing home discrimination against Medi-Cal beneficiaries and residents has become epidemic in California, and the state regulatory agencies do nothing to contain it.

(This article was reprinted with the permission of California Advocates of Nursing Home Reform.)