A Clarification on Medicare and Medicaid From Our Last Inequality Report

BY Lee Koromvokis  September 22, 2011 at 6:40 PM EDT

Many viewers took us to task today for failing to acknowledge in our report on inequality Wednesday night that custodial nursing home care is usually paid for by Medicaid, rather than Medicare.

They are correct: Medicare generally does not pay for nursing home coverage. The average person’s nursing home costs are usually paid by Medicaid, assuming the individual can not afford to pay out of pocket for a long stay. Medicare might cover a very short-term stay, occasioned by an acute illness, if you were transferred from a hospital.

However, the two nursing home residents we selected randomly to interview for Paul’s piece (our reason was that they were sitting behind Robert Lerman, and visible in a wide shot) were in fact receiving both Medicare and Medicaid (known as “Mass Health” in Massachusetts).

According to Adam Goldman, campus administrator of EPOCH of Weston, Mass. — a skilled nursing facility, a.k.a. nursing home, NOT an assisted living facility, as some have commented — 50 percent of his residents are there for rehabilitation or skilled nursing care, and are expected to go home. For many of those people, Medicare or private insurance might well pick up the tab.

Moreover, though he could not discuss details of our two interviewees’ cases because of HIPAA privacy rules, Goldman did add that, in general, if a long-term resident otherwise covered by Medicaid has an illness or injury requiring daily rehabilitation from a licensed therapist, or daily skilled care from a licensed nurse, Medicare will pay. A minimum 3-day hospital stay is required to access this Medicare coverage, which is then available for a maximum of 100 days. Following a 60-day spell of “wellness,” the person is then eligible for another 100 days of Medicare coverage for daily rehab or skilled care.

The bottom line is that long-term, custodial care nursing home care is usually covered by Medicaid. But Medicare sometimes steps in. And Medicaid can require that some Social Security benefits be applied toward the nursing home bill. All three federal programs were cited by Lerman as examples of the hidden “wealth” that is not normally included in wealth distribution statistics.

Paul Solman: Boston Common? Boston Public Garden?

A note to viewers who pointed out I don’t seem to know the difference between the Boston Common and the Public Garden. I plead innocent by reason of congenital geographical handicap. Sadly, I can’t find my way out of a paper bag, and have always loosely referred to the Common, established in 1634 as a cow pasture for common grazing, as the park which includes the Public Garden, created several centuries later. My only excuse is that they’re right across the street from one another but since the Garden has flowers, the Common, a field, and I’ve spent 49 years in the area, proximity is less than exculpatory. My apologies.