If a nursing home resident changes to Medi-Cal payment status, the nursing home is prohibited from transferring the resident to another room as a result of that payment change, with the exception of transferring the resident from a private room to a semi-private room. Although nursing homes have been prohibited from seeking to evict residents simply because of a change from private pay or Medicare to Medi-Cal, this provision also applies to those residents who have made a timely and good faith application for Medi-Cal benefits, but for whom an eligibility determination has not yet been made. ( W&I Code §14124.7, 42 CFR §483.15(c)(1)(i)(E)). If a resident’s initial MediCal application is denied but appealed, the resident is not considered to be in nonpayment status. Thus, an appeal suspends a finding of nonpayment. CMS State Operations Manual, Appendix PP – Guidance to Surveyors for Long Term Care Facilities, at F622.
For more information, please read CANHR’s Transfer & Discharge Rights fact sheet or call the CANHR office directly at (800) 474-1116 to speak to an advocate.