Lifetime Medicaid Limit on Inpatient Mental Health Days

Family
1

Hi,

Has anyone else run up against this?

I just found out yesterday that Medicaid has a lifetime limit for the number of inpatient days of 160 days.

And my 60 year old brother just hit that limit.

Has anyone else dealt with this? What did you do?

It’s not like my brother suddenly became well.

2

Update: It appears this limit does exist.

Although at 65, if we can get him on Medicare, he will get some Medicare coverage

For now, while he can no longer get psychiatric care in inpatient mental health facilities, Medicaid apparently will cover mental healthcare in the psych ward of a regular hospital.

The trouble is that most hospitals don’t have psych wards.

I’m not sure how this works in other states.

3

I am lucky that my daughter had Obamacare when she had inpatient stays. There is also a nearby hospital with a psych ward that she went to. All were very short term stays though, less than 30 days. I think her insurance only paid for 30 days max each stay. She is doing well now at 39, and has a very part time job that enables her to buy insurance. But she hasn’t needed a hold for some time now as her meds have kept her stable since 2019.

I wish you luck sorting out the rules for your brother.

1 Like
4

Thanks. I’m not sure what will happen. He’s in impatient treatment right now despite being over the limit. We will see what happens.

5

I hope the best for you.