How Much Does Medicare and Medicaid Pay for Skilled Nursing Services?

Skilled nursing care isn’t just for the final chapters; it’s a lifeline for post-surgical recovery, rehabilitation, and long-term management. But the cost? That’s where things may get a little challenging.

If you’ve found yourself asking questions about Medicaid skilled nursing and what your loved one might actually pay out of pocket, you’re not alone. The good news? Help is out there, and Medicaid plays a crucial role in making skilled care more accessible. The key is understanding who pays for what and how it all works.

What Does Medicaid Skilled Nursing Cover?

Let’s start with the basics: Medicaid skilled nursing services are designed for those who qualify both medically and financially. Medicaid steps in to cover the cost of in-home skilled services that meet medical necessity.

Here’s what’s typically covered under Medicaid:

• 24-hour skilled nursing care at home.
• Personal care assistance (bathing, dressing, grooming).
• Physical, speech, or occupational therapy.
• Medications, medical supplies, and equipment.
• Social and activity services.
• Rehabilitative treatments.

Medicaid’s goal is to ensure that people who need constant or recurring medical attention can get it without draining their savings or burdening family caregivers.

Please note: BrightStar Care accepts Medicaid for skilled nursing services, but only for home care.

Medicaid Requirements for In-Home Skilled Nursing Care

Qualifying for Medicaid skilled nursing care at home isn’t automatic. There’s a list of boxes that need to be checked on both the health and financial sides:

1. Medical Need: A doctor must confirm that the patient needs daily skilled care, like wound management or rehab therapy.
2. Functional Limitations: Patients typically need help with daily living tasks, like walking, eating, or toileting.
3. Financial Eligibility: Medicaid is income-based. Your assets and monthly income must fall under a set threshold, which varies by state.
4. State Assessment: Some states require an in-person review to verify care level needs and Medicaid eligibility.

If your loved one meets all four, they could be eligible for Medicaid-covered skilled nursing at home. BrightStar Care specializes in Medicaid-covered in-home care.

Can You Get Skilled Nursing Care at Home?

Yes! 

Many people are surprised that skilled nursing care doesn’t have to happen in a facility. 

Thanks to Home and Community-Based Services (HCBS) waivers, Medicaid allows eligible patients to receive skilled medical care in their own homes or community-based settings. This approach supports independent living and helps families avoid institutional placement whenever possible.

Here’s what’s typically required to qualify:

• Medical justification from a doctor: A licensed physician must confirm that skilled care is medically necessary. This could include wound care, injections, IV therapy, or condition-specific nursing interventions.
• State-level approval: Each state runs its own version of HCBS waivers, so approval depends on local guidelines. There may be waiting lists or caps on the number of people served. You’ll usually need to go through an assessment to confirm eligibility for in-home care.
• A licensed agency or provider enrolled in Medicaid: Care must be delivered by an approved provider who is officially enrolled in Medicaid. These agencies must meet federal and state requirements and demonstrate the ability to deliver medically necessary care in a home setting.
• A documented care plan: The state will usually require a formal care plan outlining the type, frequency, and goals of the services provided. This ensures accountability and helps track health outcomes.

According to Medicaid, HCBS waivers are designed to offer flexibility and help people "receive services in their home or community rather than institutions or other isolated settings." For many families, this means the difference between uprooting a loved one and allowing them to age safely in place, with skilled support.

If you're trying to keep a loved one at home rather than moving them to a facility, these programs can be a genuine lifeline, offering clinical-level care without sacrificing comfort, dignity, or familiarity.

Frequently Asked Questions

Q: Can you receive Medicaid skilled nursing at home?
A: Yes, many states offer in-home skilled nursing through HCBS waivers. You’ll need to meet the same medical and financial criteria.

Q: How long will Medicaid pay for skilled nursing care at home?
A: As long as you remain eligible and meet care criteria, Medicaid can continue coverage indefinitely.

Q: Do I have to spend all my savings to qualify for Medicaid?
A: Not necessarily. There are “spend down” and asset protection options that vary by state. A Medicaid planner or elder law attorney can help.

Understanding how Medicaid skilled nursing works can make a world of difference when planning care. Medicaid steps in for the long haul, helping those who qualify get the support they need without breaking the bank.

Whether your loved one needs skilled care at home, knowing what’s covered (and what’s not) can save a lot of stress and dollars.

Contact BrightStar Care of Fairfax Today!

BrightStar Care of Fairfax is here to provide you with the resources and support you need to take care of your loved one. We understand the challenges faced by caregivers and are committed to providing compassionate care that meets the needs of those we serve. 

If you would like more information about our services, please visit our website or call us today at (703) 267-2380. It will be a pleasure to meet you and your family, and we look forward to providing you with the care and support you need. 

Come visit us at 10517 Braddock Rd, Suite C, Fairfax, VA 22032. Hopefully, we’ll hear from you soon!