Frequently Asked Admissions Questions

A long-term care ombudsman helps residents of a nursing facility resolve complaints. Help provided by an ombudsman is confidential and free of charge. To speak with an ombudsman, a person may call the toll-free number 1-800-252-2412.

Admitting a loved one into a nursing home is an emotionally difficult process to go through. The admissions staff here at West Rest Haven is committed to doing anything in our power to make the transition smooth and easy. This includes giving you all the information you need for a seamless move-in. Our admissions staff will compassionately and competently guide you and your loved one through the admissions process when it’s time. We can also help you apply for Medicaid.

The following items are not allowed to be brought into our facility by residents or their families:

● Prescription or over-the-counter medication. Medicine will be given as noted in the chart.

● Any Substance with a Warning Statement

● Portable Heaters

● Heated Blankets

● Cookware

● Ironing Equipment

● Coffee or Cup Heaters

● Rugs

● Sharp Items, including but not limited to razor blades and straight razors

● Chemicals, including but not limited to laundry and house cleaning products

● Extension Cords

● Power Strips

● Smoking/Tobacco products or smoking paraphernalia, including but not limited to lighters

● Illegal Substances

This list of prohibited items is not exhaustive. A comprehensive list of items will be provided when your loved one is admitted. Upon assessing the resident, West Rest Haven reserves the right to deem other items not included on this list as unsafe to be kept in the resident’s room.

Medicare and Medicaid eligibility requirements are changing along with the long-term healthcare industry as a whole. For your reference, here is a summary of Medicare, Medicare Advantage, and Medicaid eligibility for long-term care coverage in the State of Texas. It’s always best to consult with a member of our trained admissions staff to go over exceptions and explain your circumstances.

Medicare

Medicare Part A guarantees access to health insurance for Americans who are 65 or older and who have paid into the federal health insurance program when they were working. People younger than 65 with certain disabilities may also be able to receive Medicare regardless of their income.

You can qualify for skilled nursing facility (SNF) care in a long-term care facility on the following conditions:

● You spend three consecutive nights at an inpatient hospital

● You require daily skilled nursing or therapy

● You must meet with the facility’s business office to verify SNF benefits are available

Medicare can pay up to 100 days of care in a skilled nursing facility if you or your loved one qualifies for SNF benefits. Medicare will cover 100% of the first 20 days if you haven’t used any Medicare days within the last 60 days. After 20 days, a co-pay of $185.50 per day, which is determined by Medicare, will be required. Please be aware that Medicare increases this amount every January and you should confirm the right rate with our admissions office.

It’s important to note that Medicare Part A only applies to short-term rehabilitation care, as opposed to room and board for rehabilitative long-term care. Medicare Part B is the program that covers those services in a long-term facility as long as room and board is covered by private pay, Medicaid or a long-term care policy. It is extremely important to consult with the admissions office of the facility that you or your loved one will be staying at in order to get an accurate idea of your coverage.

Medicare Advantage

Medicare Advantage plans are offered by private insurance companies and are approved by Medicare. They are also occasionally referred to as “Part C” or “MA Plans.” Medicare Advantage plans take the place of traditional Medicare and provide all of hospital and medical insurance coverage that would have been provided by Medicare Part A and Medicare Part B.

You may be eligible for a Medicare Advantage plan to cover skilled nursing facility (SNF) Care in a long-term care facility if you require daily skilled nursing or therapy services. You don’t necessarily have to spend three consecutive nights in the hospital, but be sure to meet with our admissions office so we can confirm SNF benefits are available. Before admission to an SNF, you must get prior approval from a Medicare Advantage Plan.

Your Medicare Advantage Plan determines the length of the SNF stay, and the facility will provide weekly updates to your plan. You may incur a co-pay, but the amount will depend on your Medicare Advantage Plan. Note that a three-night inpatient hospital stay is not a requirement to be eligible for these plans.

Medicaid

If you’re wondering what Medicaid is and how it works, the admissions staff at West Rest Haven would be happy to walk you through it. Generally speaking, Medicaid gives low-income Americans access to more affordable long-term care. Medicaid is a joint federal and state program, and the eligibility standards are determined by the State of Texas, not by the facility.

If you or your loved one only need assistance with custodial care, which includes bathing, toileting, eating, and getting around, that will not meet the medical necessity requirement.

The two financial requirements for Medicaid involve income and resources; all of the following is based on the available information, which is from 2021.

All of the following can be excluded from the list of resources: a home the individual intends to return to, life insurance with no cash value, irrevocable burial funds, one vehicle of any value, and a burial space.

In terms of protected resources for a spouse in the community, there is a $26,076 minimum and $130,380 maximum that excludes value of a homestead, household goods, personal goods, one car, and irrevocable preneed burial funds. After one year, the assets can be transferred only to the spouse with no penalties. 

When you come to your appointment at the admissions office of West Rest Haven, we suggest you bring the following items in order to complete your Medicaid application:

● Bank Records ● Life Insurance Policies, including cash values and spouse’s policies

● Proof of Income ● Property Information ● Wage Garnishments ● Any Deductions ● Preneed Funeral Policy

Community Medicaid has different eligibility requirements than Medicaid for a long-term skilled facility, which means you have to reapply for long-term Medicaid if you have Medicaid in the community.

After qualifying for Medicaid for a long-term care facility, your income will be applied towards the care at the long-term facility. That’s with the exception of a Personal Needs Allowance. The facility doesn’t determine the amount; the Texas Medicaid Program does. You can expect a few different things depending on whether you’re an individual, you’re a couple, or you have a spouse in the community.

For individuals: Total gross income, less any deductions (supplement premium, Part D premium, Medicare Advantage Premium), less $60 for personal needs.

For an individual with a spouse in the community: Total gross couple income, less any deductions (supplement premium, Part D premium, Medicare Advantage Premium), less $60 for personal needs, less $3,259.50 for community spouse, less certain amount for dependents living with community spouse.

For a couple: Total gross income, less any deductions (supplement premium, Part D premium, Medicare Advantage Premium), less $120 for personal needs.