Next Steps After Medicaid Certification at Your Assisted Living

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Congratulations on becoming a Medicaid-certified provider! This is a huge milestone for your assisted living business, opening doors to serve more residents while securing a stable revenue stream. But now that you’re certified, what’s next? Let’s dive into the essential steps to maximize your Medicaid certification and set your business up for long-term success.

Check out the video, too:

What Does Medicaid Certification Mean?

Being Medicaid-certified means you can provide care to residents who qualify for Medicaid benefits. This allows you to bill Medicaid for their care, helping cover their expenses and ensuring consistent payments to your facility.

However, certification is just the beginning. To truly thrive, you’ll need strong systems, good relationships, and a plan to attract Medicaid-eligible residents.

Step 1: Set Up Your Documentation and Systems

Getting organized is the first step to smooth operations. Here’s what you need:

Certificate of Insurance (COI): Update your COI to include Medicaid as an insured party. Your insurance broker can help with this.
Banking Details: Ensure you’ve submitted accurate bank info to Medicaid for direct deposit payments. This ensures you get paid on time.
Billing System: Set up a reliable billing system. Learn your state’s Medicaid billing codes and establish a schedule for submitting claims—bi-weekly billing works well for many providers.

Step 2: Work with Third-Party Administrators (TPAs)

In many states, Medicaid payments are handled by TPAs. For example, in Idaho, Molina Healthcare and Blue Cross of Idaho are key players.

Research TPAs in Your State: Understand which ones operate locally.
Complete Contracts: Each TPA may have its own certification process. Ensure you’re contracted with all major TPAs in your state.
Keep Contracts Active: Regularly review and renew contracts to avoid losing reimbursement opportunities.

Step 3: Fill Your Facility with Medicaid Residents

Once certified, it’s time to connect with Medicaid-eligible residents. Here’s how:

Build Relationships with Case Managers: Medicaid residents often have assigned case managers. These professionals can refer potential residents to your facility.
Partner with Medicaid Agencies: Your state’s Medicaid office can provide lists of case management companies or resources to help you find residents.
Engage the Community:
- Hospitals and Rehab Centers: Work with discharge planners for referrals.
- Social Media: Use Facebook ads to target local families.
- Local Events: Participate in senior fairs or community events to meet families.

Step 4: Market Your Facility

Even Medicaid families want the best for their loved ones, so marketing is still key.

Highlight your Medicaid certification in ads.
Showcase your quality of care, staff, and amenities.
Use testimonials to build trust.
Combine online efforts (social media, Google) with offline outreach (flyers, networking).

Step 5: Master Medicaid Billing

Getting paid is critical, so make billing a priority.

Daily Rates: Work with case managers to set accurate daily reimbursement rates based on care needs.
Assessments: Conduct regular resident assessments to ensure rates align with care levels. Notify case managers of any changes.
Accurate Records: Document all services provided. This reduces delays and ensures smooth reimbursement.
Billing Frequency: While Medicaid pays weekly, bi-weekly billing often balances cash flow well.

Key Takeaways

Stay Organized: Ensure your documentation, contracts, and systems are up to date.
Build Relationships: Strong connections with case managers, TPAs, and Medicaid agencies are essential.
Market Your Facility: Highlight your Medicaid certification and quality of care to attract residents.
Keep Cash Flow Steady: Stay on top of billing and maintain accurate records to avoid payment delays.

Final Thoughts

Becoming Medicaid-certified is a big accomplishment, but it’s just the start. By taking these next steps, you can grow your business, fill your facility, and continue making a meaningful impact in your community.

What’s your next move? Let’s get started on making your Medicaid certification work for you!

Next Steps?

Launching an assisted living facility is significant, but becoming a certified Medicaid provider is crucial in securing your facility's financial health. Download our Business Plan Checklist here for a comprehensive guide on building your assisted living business plan. This tool will help you outline every necessary step to ensure your facility's success. Additionally, explore the Assisted Living Investing Mastermind program. This 12-month program is designed to guide you through every step of owning an assisted living facility and provide invaluable coaching support.

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