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MPLP Seeks to Advocate on Issue of Lack of Dual Certification of Nursing Home Beds for Medicare and Medicaid

MPLP Spring 2007 Elder Law Section Newsletter Article

                Issue 33, Spring 2007

 MPLP Seeks to Advocate on Issue of Lack of Dual Certification of Nursing Home Beds for Medicare and Medicaid


Pursuant to MCL 333.21718, all nursing home beds certified for either the Medicare or Medicaid program are required to be certified for both programs (“dually certified.”).   However, the Michigan Department of Community Health has for decades failed to enforce this important mandate.

The failure to enforce the dual certification requirement causes clients great harm when, for example, their Medicare coverage runs out but they continue to need nursing home care.  If they happen to be in a Medicare only bed and if there are no other available Medicaid beds in the facility, they will face involuntary discharge.  If their bed had been duly certified as required by law, however, they would have been able to stay in the same bed and continue receiving care, thus vastly reducing their trauma and dislocation.  Moreover, although residents have the right to refuse an intrafacility room transfer when their payment status changes from or to Medicare pursuant to 42 C.F.R. §483.10(o), this federal requirement is also widely ignored.  Residents are therefore often forced to move to different rooms, with different roommates, staff, and amenities when their payment status changes. 

The Department of Community Health has long allowed facilities to have limited bed certification which means that only some of the facility’s beds are certified for Medicaid, Medicare, or both.  While the Department has said it is moving toward requiring dual certification of all beds, it has expressed concern about a number of Medicaid only facilities in the state that may not be able to meet the Medicare certification requirements.  Recently, some nursing home chains have determined it is more profitable to have Medicare only bed and have been seeking and obtaining approval from the state to  reduce the number of dually certified beds  in favor of Medicare only beds.  These reductions are contrary to the state’s goal of dual certification of all beds and have necessitated more involuntary transfers of Medicaid recipients.

At the request of MPLP, DCH staff recently agreed to halt approval of nursing home applications to change dually certified beds to Medicare only beds.  MPLP will be seeking to meet with the Department to press for implementation of the law and will be considering litigation if this issue cannot be successfully resolved.   Advocates are encouraged to share stories about the harmful effects of the failure of the state to enforce the dual certification requirement and to advise us if you are aware of homes that are seeking to or changing their beds’ certification status.  Please contact Alison Hirschel at hirschel@umich.edu or (517) 324-5754.


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