Federal Nursing Home Administrator Practice Exam

What can a nursing home charge to a resident who qualifies for Medicaid and Medicare?

1. Full service fees

2. Co-pays

3. None

4. Additional service fees

The correct answer is: Co-pays

The correct choice regarding what a nursing home can charge to a resident who qualifies for both Medicaid and Medicare is co-pays. This is because both Medicare and Medicaid have established guidelines that allow for certain cost-sharing mechanisms, even for residents who are covered under these programs. For residents who are eligible for Medicare, the program generally covers a significant portion of medical and rehabilitative services provided in a nursing home. However, there are specific circumstances under which co-payments for particular services may still apply. For instance, Medicare might require a co-pay for certain stays after the initial coverage period. Additionally, Medicaid, which is designed to assist low-income individuals with medical costs, may also involve co-pays, though these are often minimal or negligible depending on the state regulations and the resident's financial situation. In contrast, the other options present charges that are typically not allowed under Medicaid and Medicare policies. For example, charging full service fees or additional service fees would not be compliant with the regulations governing pricing for those covered by these programs, since they dictate what allowable costs can be charged. Furthermore, in most scenarios, residents under these programs would not be charged anything beyond standard co-pays, aligning with the principle of reducing financial barriers to essential healthcare services.