First Month in a Nursing Facility Not Covered by Medicaid?

Some County DSS offices are incorrectly denying Medicaid coverage for the first month in a nursing facility for some beneficiaries. Some counties explain that this is the “deductible month” or some other similar term. Although there are some rare circumstances where the first month would not be covered at all, it is not Medicaid policy to automatically deny Medicaid coverage for the first month. 

Up until now, NCHCFA had a contact at the state who could assist with these issues. Now, Medicaid is requesting that providers, who feel that the first month of coverage was incorrectly denied (which may be most cases), should reach out to the Provider Ombudsman at Medicaid.ProviderOmbudsman@dhhs.nc.gov. In the text of your email, make sure you include: 

1. Facility Name 
2. Contact information for the appropriate person at the facility 
3. Medicaid number for the involved resident 
4. Brief description of the situation