Medicaid pending status means a nursing home resident has applied for Medicaid benefits but hasn’t yet received an approval or denial from the state. This period — which can last anywhere from 30 days to several months, depending on the state — creates a billing gap in which the facility is providing care but may not have a confirmed payer. Without the right policies and procedures in place, Medicaid pending admissions can quietly erode your facility’s revenue.
Here’s the scenario we see all the time: A resident is admitted. Their application for Medicaid has been submitted, but hasn’t been processed. The facility provides care daily — room, board, nursing, everything. Meanwhile, there’s no confirmed payer. The resident can’t pay privately. And the clock is ticking.
If the Medicaid application is eventually approved, the state typically backdates coverage to the application date (or the date of eligibility). The facility can then bill retroactively. But if the application is denied? You’ve been providing care for weeks or months with no payer source at all. That balance sits on your aging report, growing older every day.
This is how facilities end up with massive Medicaid pending balances on their A/R — and why having iron-clad policies around pending admissions is non-negotiable.
1. Pre-Admission Financial Screening
Before admitting any resident, your admissions team should complete a financial screen. Does the resident qualify for Medicaid? Has an application been filed? Who is managing the application — the family, a caseworker, or your facility? If there’s no application filed and no clear path to one, your facility needs to decide whether to accept that risk before the resident is in a bed.
2. Application Tracking System
Every Medicaid pending resident should be tracked on a log that includes: the application filing date, the caseworker or responsible party, required documents (submitted and outstanding), estimated processing time, and regular follow-up dates. Your BOM should review this log weekly — not monthly. It might feel like too much, but applications stall when nobody follows up.
3. Document Collection Protocol
Medicaid applications get denied or delayed most often due to missing documentation — bank statements, asset verifications, insurance policies, and property deeds. Establish at admission exactly what documents are needed, who is responsible for obtaining them, and what the deadline is. Don’t leave this to the family to figure out on their own.
4. Communication with the State Medicaid Office
Don’t wait for the state to contact you. Your BOM or designated staff member should be calling the Medicaid office regularly to check application status, confirm receipt of documents, and ask what else is needed. In some states, applications sit in a queue until someone follows up.
5. Backup Payer Policy
What happens if Medicaid is denied? Your admission agreement should clearly state the financial responsibility in that scenario. Does the responsible party agree to pay privately if Medicaid is not approved? Is there a secondary insurance option? Having this documented at admission protects your facility legally and financially.
A denial isn’t always the end of the road. Most states have an appeal process, and many denials are overturned if the missing documentation can be provided. Your facility should have a protocol for:
Medicaid pending residents are a reality in every SNF. You can’t avoid them — but you can manage them. The difference between facilities that handle pending admissions well and those that don’t comes down to process: who is tracking applications, who is following up, and what happens when things go wrong.
If your Medicaid pending balances are growing and your team doesn’t have a clear system for managing applications from admission through approval, SNF Solutions can help you build one.
Contact us for a free consultation or call 407-977-8878.
— Nicole
Chances are that you’re leaving revenue on the table. This quick resource guide will help ensure that your office is getting the most from your existing business so you can maximize your revenue without adding a single resident.
