"Medicaid decertification": Can a smart person explain this to me??

[Nurse!Nurse!Hello?]

I work in a for-profit 100-bed SNF/ICF. The DON announced that a large number of our beds are going to be "medicaid decertified." She seemed very happy about this, so naturally, I am suspicious!

She wants to fill these beds with Medicare/private pay people since the rate is higher. I understand this.

My question is this: if a facility can just voluntarily have the beds medicaid decertified, what will happen to the long-term residents? Do facilities usually try and "transfer" people in order to free up the bed for the higher rate? Doesn't there need to be a certain percentage of beds that are available for medicaid people? Any info on this whole concept of decertifying medicaid beds will be appreciated.

I am soliciting the opinions of the nurses here rather than asking for an explanation from the administration of the facility. They tend to "sugar-coat" things (to say the least!) to reflect their biases. I am looking for the real scoop!! Thanks.

[Katie82, RN]

Medicaid rules vary from State to State. In most states, when applying for Medicaid provider status, facilities sign a contract with the state that stipulated the number of beds that would be available to Medicaid patients. "Decertification" can only be accomplished by an alteration to this contract. The state can refuse if there is a shortage of MA beds in your area. Long term residents are totally different from SNF patients. Sounds like your director is shifting designation of these beds from LTC to SNF also. LTC patients cannot be put out on the street in most States. If there are no other beds available, they have to remain. Of course, LTC facilities get around this by shipping patients off to hospital (pyrexia, etiol. unknown) and then failing to have an available bed on discharge. Medicare does not pay for LTC (first 30 days only), so your long-term care patients are either Private pay or MA. Private pay is becoming rare as the costs increase, so that leaves MA. Your facility had better find a way to profit from SNF patients before they anger the state Medicaid office.