By Laurie E. Ohall, Florida Board-certified Elder Law Attorney
The call usually comes on a weekday afternoon. Mom broke her hip, the hospital sent her to rehab, and Medicare has been paying for everything — Medicare coverage is ending, and if Mom stays, the bill is yours.
The family’s first reaction is almost always the same. Wait. Medicare paid for the rehab. Mom clearly still needs care. Why won’t it pay for the nursing home?
Medicare Buys Recovery. It Does Not Buy Care.
Here is the distinction the entire system turns on. Medicare is health insurance. It pays for skilled care, meaning treatment that requires nurses or therapists working to address a medical condition, like physical therapy after that hip surgery.
What Medicare does not pay for is custodial care, which is help with the tasks of daily living: bathing, dressing, eating, using the bathroom, supervision for dementia. That is precisely the care most nursing home residents need, month after month, and it is precisely the care Medicare excludes no matter how medically fragile your mother is.
So Medicare covered rehab because Mom was receiving skilled therapy. Once her care becomes primarily custodial, Medicare’s role ends. The care did not stop being necessary. It stopped being the kind of care Medicare covers.
The ‘100 Days’ Everyone Mentions and Almost Nobody Gets
You may have heard that Medicare covers 100 days in a skilled nursing facility. Treat that number as a ceiling, not a promise. Coverage generally requires a qualifying inpatient hospital stay first, and here is a trap worth knowing: Time spent in the hospital under observation status may not count, even if Mom slept there for three nights. After the first 20 covered days, a substantial daily copayment kicks in. And coverage continues only as long as skilled care is actually needed, which is why so many families see it end well before day 100.
One more myth worth correcting, because I hear it constantly: families are often told coverage must end because Mom has “plateaued” or is “no longer improving.” Improvement is not actually the legal standard. Skilled care to maintain her condition or slow decline can still qualify, and families have the right to appeal a cutoff they believe is premature. Facilities do not always volunteer that.
So Who Does Pay for the Nursing Home?
For long-term custodial care in a nursing home, there are essentially three payers: your own savings, long-term care insurance if it was purchased years earlier, and Medicaid.
Medicaid is the program families confuse with Medicare, and the one-letter difference costs people dearly. Medicaid is needs-based. It pays for exactly the custodial nursing home care Medicare refuses to cover, but only for people who qualify financially under strict income and asset rules. And Florida’s Medicaid program reviews financial transfers made during the look-back period, so decisions made years earlier, including well-meaning gifts to children and grandchildren, can affect eligibility at the worst possible moment.
This is where planning matters. As a Florida Board Certified Elder Law attorney, I can tell you that the gap between “Medicare is cutting off” and “Medicaid is approved” is where families lose homes and savings they could have protected.
What to Do If You Just Got the Cutoff Notice
Do not panic, and do not assume the facility’s word is final. Ask whether the decision can be appealed, and note the deadlines, which are short. Ask exactly what care Mom needs going forward and what it will cost privately.
At the Law Offices of Laurie E. Ohall, we help Fishhawk area families bridge the gap between Medicare’s limits and Medicaid’s rules, protecting what can be protected while making sure a loved one gets the care they need. Call us at 813-438-8503 to schedule a consultation, ideally before the care meeting, but we can help even if the notice is already in your hand.
Frequently Asked Questions
What is the difference between Medicare and Medicaid for nursing home care?
Medicare is health insurance that covers short-term skilled care, such as rehab after a hospital stay, and it does not cover long-term custodial care. Medicaid is a needs-based program that does pay for long-term nursing home care, but only for those who meet strict financial eligibility rules.
Does Medicare ever pay for any nursing home stay?
Yes, but only in limited circumstances: generally after a qualifying inpatient hospital stay, only while skilled nursing or therapy is needed, and only up to 100 days per benefit period, with a significant daily copayment after day 20. It is short-term recovery coverage, not long-term care coverage.
Is it too late to protect assets if my parent is already in a nursing home?
Often, no. While the best results come from planning years ahead of a care crisis, Florida law still permits certain planning strategies even after a nursing home admission. Speak with an elder law attorney before spending down assets, because options may exist that families rarely find on their own.
