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Spotlight Team probe: Potential Medicaid discrimination at Massachusetts nursing homes

The replies etched a clear pattern. Nursing homes were more than twice as likely to say they had no room when responding to inquiries from families saying they planned to pay for care with Medicaid — the government health program relied on by low-income residents — rather than paying privately.

Often the difference wasn’t subtle. In some cases, employees from the same facility would tell the daughter of a purported Medicaid applicant that there was a waiting list, while telling the daughter of a private payer, who could be expected to pay the nursing home nearly twice as much, she would be happy to discuss the options.

Discrimination against applicants covered by Medicaid has existed for years in the nursing home industry, say advocates for the elderly, and it can be illegal.

Massachusetts adopted explicit protections in 1994, barring nursing homes from discriminating against “any Medicaid recipient or person eligible or soon-to-be-eligible to receive Medicaid benefits.” The regulations also prohibit facilities from offering help “in the preparation of applications or in any facet of the admission process to private pay applicants in a manner greater than that rendered or offered to Medicaid recipients.”

And yet many nursing homes do appear biased against Medicaid patients.

“You have more choices if you have money. That’s the world we live in,” said attorney Steven Cohen, a partner at Pabian & Russell in Boston who specializes in long-term-care and estate planning.

Medicaid pays nursing homes an average $209 per day, far less than the $389 typically paid out-of-pocket by well-off senior citizens — a sizable difference for an industry plagued by ongoing financial struggles and closures — according to 2018 state data. The most exclusive nursing homes charge private-pay residents even more.

Bed availability at nursing homes legitimately varies daily as patients die or

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