LTC Medicaid Coverage in SNF. Any insight?

This is why I don't like Medicare Advantages. They are suppose to do exactly what Medicare does. I would get the doctor involved and call them and tell them that the patient needs more rehab. That they are to honor exactly what Medicare would. Which is 50% of the cost after 20 days. There must be a way of appealing this decision.

This is something that I kept. Never tried it but you want to talk to someone other than the person who picks up the phone.

Medical Hack
So, your doctor ordered a test or treatment and your insurance co. denied it. That is a typical cost saving method. Here is what you do.

1. Call the insurance company and tell them you want to speak with the "HIPAA Compliance/Privacy Officer". (by Fed. law they have to have one)

2. Ask them for the NAMES as well as CREDENTIALS of every person accessing your record to make that decision of denial. By law you have a right to that information.

3. They will almost always reverse the decision very shortly rather than admit the committee is made of low paid HS graduates looking at "criteria words" making the medical decision to deny your care. Even in the rare case it is made by medical personnnel, it is unlikely that it is made by a board certified doctor in that specialty and the DO NOT WANT YOU TO KNOW THIS!

4. Any refusal should be reported to the US Office of Civil Rights (OCR.gov) as a HIPAA violation.

What this means is only Medical people should be making decisions concerning your care and able to access your records. Not people that have no experience.

Have you all noticed the ads for Medicare Advantages lately. Before the word Medicare Advantage was not mentioned in the Ads. It was "what you are not getting from Medicare that you are entitled to" I saw this as false advertising and wondered why Medicare did not put their foot down. Now they are upfront that it's a Medicare Advantage policy and that they do honor Mecicare Part A and B. Which means they must abide by Medicare criteria. According to my daughter they don't and she was always fighting with them. So much so, she called me in the middle of her work day to confirm I didn't have a MA.

Thanks @newbiewife, this is good information. I actually just spoke with the LTC Medicaid case manager and he explained that they would cover LTC but rehab would not be provided. I didn't think about the option of having her advantage plan cover the therapy part. That's a very interesting solution that I will follow up on. I really appreciate yours, and everyone else's, help.

Although, as noted by others, each state's Medicaid program is different, rehab services (PT, OT, etc.) would still be paid by Medicare even if the person is on LTC Medicaid in a nursing home., so long as there is a doctor's order for it. So, even if Medicare is no longer paying for the daily "bed" your mom can still get the needed rehab services. We ran into this when we were fighting with my husband's Medicare Advantage plan to get them to cover his rehab stay after breaking his hip. (They wanted him to go right home from the hospital and not to the rehab place). They told us that if we chose to private pay at the rehab place, they would cover the therapies on an "outpatient" basis, as though he were at home and going for outpatient services. We did finally manage to get them to cover inpatient rehab for 21 days, and then they covered in-home PT and OT for several more weeks. I'd definitely try to fight for more days from the Medicare Advantage coverage, even though your mom would be able to switch over to Medicaid LTC; it sounds as though there's more than adequate medical justification, just so long as the facility and Dr. provide good documentation to the advantage plan company.

Since Medicaid is run independently by each state, the rules can vary so it's best that you contact your Medicaid office where you live. This is a global forum so you may get advice that doesn't apply to your situation.

I don't know about Medicaid, but I would think her Medicare would be covering her PT (I could be wrong - government programs always confuse me).
You could appeal the insurance pushing her to get discharged by filing an appeal with Livanta/Kepro. I had to do it when my mom's insurance was due to quit paying. (They quit paying when it seems that the patient is not making progress.) I can't remember which, but they did want her Medicare number or her Supplemental insurance number.

For Florida, it's https://www.keproqio.com