Delay in Medicaid Status Change Following Resident Discharge
Penalty
Summary
The deficiency involves the facility’s failure to ensure a safe and timely discharge process for a resident whose Medicaid coverage needed to be transitioned from nursing home level to community level upon discharge. A complaint submitted to the State Agency alleged that the facility delayed notifying the Michigan Department of Health and Human Services that the resident had been discharged, which affected the resident’s ability to access community level Medicaid services. Record review showed the resident was admitted on an unspecified date and discharged back to the community on 8/1/25, with Medicaid-MI as the payor source at the time of discharge. During an interview, the Regional Business Office Manager explained that the facility business office is responsible for switching a resident’s Medicaid from nursing home level to community level, typically on the day of discharge, the next day, or by the end of that week. However, for this resident, the request to switch to community Medicaid was not submitted until 8/28/25, nearly four weeks after discharge. The Regional Business Office Manager attributed the delay to the prior business office manager leaving around that time. Review of the facility’s Social Services policy showed that the facility is responsible for providing medically related social services, including assisting residents with financial matters, to help them attain or maintain their highest practicable well-being.
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