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.
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.
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.
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.
I will add, if patient need is greater, the hospital can and does fudge rules. It comes down to having the right paperwork and at worst, having your brother sign paperwork with a social worker at his side. It’s not for things like his MH treatment, although it can be.
In my brother’s case we had to prove he needed more time in hospital than Medicare would give us when his first amputation was healing. He couldn’t come home and still needed very heavy duty antibiotics (not to mention his ability to provide self care or bathing was limited.) At worst what the hospital will need is proof of financial hardship via a bank account and other proof of identity documentation. From the hospital billing department and the other services, they will do their best to try and get treatment needs balanced considering his Dx and present need for care.
The only funny thing that happened during that time is that he looked at me and I looked at him when the nurses were describing how to bathe him without getting his wound site wet, and he said “I don’t want to see my sister naked and I don’t think she wants to see me naked. I’m not going home.”
It’s great that he could have a sense of humor despite everything.
I’m thinking this will likely go the financial needs route as my brother is on SSI with very low income.