When someone who needs nursing home care in Texas has no assets (money in the bank or in investments), there is a provision that they can enter a nursing home "Medicaid pending."

This means that the patient will apply for Medicaid help to pay for care after entering the nursing home. While the patient will contribute what income is available, the nursing home will wait to be paid the balance until the patient's Medicaid funding has been approved.

The State will not process the patient's application for Medicaid assistance until the patient has actually been in the nursing home for 30 days. After those initial 30 days it can take an additional 60 days or more to approve a Medicaid application once it is received. When the patient is ultimately finally approved, Medicaid will then reimburse the nursing home for their costs from the day the patient moved in.

This means that any nursing home that accepts a patient with "Medicaid pending" is taking a risk and accepting a financial burden that many nursing homes are no longer willing to accept. They will have to provide room and board, nursing care and other professional services, medications and supplies for at least three months, and possibly longer with only a minimum payment from their patient. The nursing home accepts the patient with no guarantee that the family will properly follow through with the application process, and no absolute guarantee that she will ultimately be approved by Medicaid.

Once a patient is a nursing home resident, the nursing home cannot easily discharge the patient, as she will have nowhere safe to go. Therefore, they are extremely cautious about accepting a resident "Medicaid pending" when they have no guarantee that they will be paid for providing care.

What most families discover is that the few nursing homes willing to accept a patient "Medicaid Pending" are the second and third tier nursing homes that consistently have trouble filling their available beds. They are willing to take the Medicaid Pending risk because that risk is ultimately less costly than having empty beds that produce no revenue at all.

A senior who needs nursing home care can easily find several highly rated nursing homes if she is able to pay privately for care while her Medicaid application is being processed. However, those with no resources find that they usually must go to one of the less exemplary nursing homes and wait to move to a higher rated facility until Medicaid has been approved. This is far from a good situation, but it is often their only option.

The best solution to the lack of nursing home Medicaid Pending openings is to look for a good nursing home when there are still enough funds left to pay privately for at least six months. Most nursing homes that participate in the Medicaid program will accept a patient with enough to pay for six months' care. Some nursing homes that are having no difficulty filling their beds require patients to be able to pay privately for a year or more.

Privately paying residents pay more for their care than Medicaid pays for the same care. The nursing home can make enough from a privately paying resident to cover any potential loss during the time when the patient has finally exhausted their money and is in the process of applying for Medicaid. By the time the patient has "spent down" in the nursing home, the staff have gotten to know the family, and they have some level of confidence that the family will complete the application process. Many nursing homes have assisted the family with the paperwork so that it is ready to go the moment the patient is eligible. They have reduced their risk by getting to know the patient and the family.

Unfortunately, this kind of planning means that our seniors may not be able to "age in place" at home or in an assisted living residence as long as we had hoped. If it appears that funds will run out within the year, we now recommend that families immediately begin investigating nursing care options. While this means moving into a nursing home several months earlier than planned, moving earlier often means that the patient will have a higher quality of care in a better nursing home for the remainder of his or her life. It's a trade-off that an increasing number of caregiving families are choosing to make, so that they don't fall into the Medicaid Pending trap of no decent openings available and no option but to take any opening available, no matter how poor.