Does Social Security Disability Cover Nursing Home Costs?

by | Published on Sep 1, 2021 | Social Security Disability

Medical records and accurate clinical documentation are vital considerations in disability claims. Attorneys assisting with such claims prefer to utilize medical records services to review the voluminous medical records. A comprehensive review of the relevant medical documentation provides details of the illness/injury of the claimant. A common question people have, who collect social security benefits, is whether nursing home stays are covered by their Social Security Disability Insurance, and also whether they will continue receiving their disability benefits. While one’s SSDI benefits are not impacted even if the person is entering a nursing home, his/her Supplemental Security Income (SSI) could be affected. That is, based on the nature of the nursing home facility and the duration of the stay.

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Type Of Nursing Home Facility

If a person stays in a nursing home that accepts Medicaid payments, he or she could lose all or part of their disability benefits depending on the type of care facility.

  • Nursing Homes or Facilities that Accept Medicaid: Beneficiaries may lose their eligibility for disability benefits if Medicaid pays for more than half the cost of living and care at such a facility.
  • Private Facilities that don’t Accept Medicaid: Beneficiaries may theoretically be able to keep their benefits. It is important to remember that those who can pay for private care independently may not be eligible for SSI based on their personal income.
  • Public Facilities: Here, even if Medicaid pays for less than half the cost of care, beneficiaries lose their SSI eligibility.

The SSA has allowed exceptions for children staying at facilities that accept Medicaid, and children with private insurance to cover half the cost of nursing home care. Children who are SSI beneficiaries may be able to collect a reduced benefit of $30 per month.

In the case of spouses who collect social security benefits, if one of them enters a nursing home, the other spouse’s eligibility for SSI or SSDI benefits is not affected. However, the spouse living outside the nursing home will be given individual payments instead of couple’s payments.

Temporary or Short-duration Stays

In the case of a disability beneficiary who is in a nursing home for less than 90 days (temporary institutionalization), he/she may be able to keep their full disability benefits. It is required to inform the SSA that they need ongoing benefits to maintain a permanent place of living during the stay. Also, a doctor must state in writing that the stay will not last longer. Temporary institutionalization benefits are available to adults staying in public facilities or institutions that accept Medicaid payments. Children staying in any type of nursing facility may also qualify for these benefits.

If the short-duration stay extends beyond 90 days unexpectedly, the beneficiary should immediately inform the SSA about it. The SSA will stop the benefits at this point; the beneficiary may be eligible for quick reinstatement of disability benefits when he or she leaves the nursing home if they use the SSA’s pre-release procedure. This procedure is available to beneficiaries who apply for reinstated benefits months before leaving the nursing home. They must prove that their medical conditions are likely to qualify for disability benefits. These beneficiaries who utilize the SSA’s pre-release procedure could receive their regular disability payments as early as 30 days after release from the nursing home.

Keeping The SSA Notified Is Important

As a provider of medical record review for social security disability firms, we understand that it is very important for benefit recipients to inform the SSA when they are planning to enter or leave a nursing home. It is especially important to give notice when entering the nursing home. This will give the benefit recipient the opportunity to provide information regarding the duration of stay and the type of facility. If they fail to communicate this information to the SSA, there is the risk of benefit termination. Typically, nursing home staff assist the SSI recipient to notify the SSA, especially if the nursing home is billing Medicaid for services provided. Nursing home residents can get reliable information about Medicaid and social security from the nursing home staff. When leaving a nursing home, the beneficiary must ask the nursing home staff about the pre-release procedure because it will ensure that he/she gets their full benefits reinstated as soon as they are back home. More information about social security disability benefits can also be obtained from individual state Medicaid agencies.

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