Can A Family Agree to Pay A Nursing Home or Assisted Living Residence for A Private Room When Their Loved One is Receiving Medicaid?

By Fredrick P. Niemann, Esq. of Hanlon Niemann Wright, a Freehold, NJ Medicaid Attorney

It’s a question I’m asked often.  It’s also one that causes a lot of confusion within the nursing home community.  Some nursing homes think that any form of private payment violates Medicaid laws.  That is incorrect, it’s perfectly legal.

Here’s the general fact pattern – Mom qualifies for Medicaid, which pays for a semiprivate room, that is, a room with a roommate.  If the family wants a private room for Mom, they can pay the additional charge, provided of course that the home has a single room available.

What is the going rate for a private room? Generally it ranges from $25 to $30 per day. While Medicaid is picking up the semiprivate room rate its reimbursement rate is much lower than the private pay rate. You see, Medicaid pays long term care facilities at a rate approximately 40-50% less than the rate that you and I must pay.  But, while you and I must pay the much higher rate, the good news is that the difference between a semiprivate and a private room is small, once Medicaid eligibility is established.

If your loved one is in an assisted living facility it works the same way.  Medicaid will pay for a shared room but not a single, private room.  Provided the facility has a single room available, the family can pay the difference between the single vs double room rate at the private non-Medicaid rate.  Medicaid will cover the double rate.

Keep in mind that with both nursing home and assisted living Medicaid Mom will continue to contribute almost all of her income to the cost of the facility and Medicaid will pay the rest up to its reimbursement rate.

To discuss your NJ Medicaid matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at  Please ask us about our video conferencing consultations if you are unable to come to our office.