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⭒ New Developments

DPH Warns Nursing Homes that Medi-Cal Discrimination Is Illegal

On December 22, 2023, the Department of Public Health (DPH) issued All-Facilities Letter 23-37 reminding nursing homes in California of the admission, transfer, and discharge laws that are often disregarded in the pursuit of higher profit margins.  Unfortunately, nursing homes needed a stern reminder they are required to provide “continuous skilled nursing care . . . on an extended basis.”  In other words, they are all required to provide long term care and staff are barred from telling residents they only provide short term care or that residents have to leave when their short term Medicare coverage is ending.  The AFL states:

“[Nursing homes] may not seek to transfer or discharge residents solely due to a change in their source of payment, e.g., Medicare to Medi-Cal, or to open a bed for residents with insurance coverage that provides a higher rate of reimbursement.”

After a resident’s Medicare coverage has ended, they might switch to lower-paying private pay or Medi-Cal, reducing a facility’s potential profits.  As a result, nursing homes commonly refuse admission to prospective residents who are likely to stay for months or more because Medicare benefits usually cover only a few weeks.  Similarly, residents whose Medicare coverage ends are usually pressured to leave, even when they qualify for Medi-Cal coverage and the discharge is premature and unsafe.  Facilities will tell residents, illegally, that they don’t provide long term care or custodial care or only offer “short term” or “rehab” stays.

Medi-Cal discrimination has long been illegal, as the AFL points out, but has been a staple of the nursing home playbook for decades due to a lack of consumer awareness and state enforcement.  Hopefully, the AFL will give residents, their advocates, and enforcement agencies the hook they need to fight back against Medi-Cal discrimination.