What criteria must be met for Medicaid to reimburse a nursing facility for holding a bed?

For Medicaid to reimburse a nursing facility for holding a bed, the requirement that total available bed occupancy must be 98% or more is crucial. This high occupancy threshold is designed to ensure that the facility is operating at nearly full capacity, indicating a consistent demand for its services. The rationale behind this requirement is to prioritize resources for facilities that are actively servicing a high volume of residents, thereby justifying the need for reimbursement for vacant beds due to temporary situations, such as a resident's hospitalization.

A lower occupancy percentage would typically suggest that the facility may not be in high demand, and as such, holding a bed in that scenario might not align with Medicaid's intent to maximize efficient use of funds. Therefore, by mandating a high occupancy rate of 98%, Medicaid aims to support those facilities that are actively serving a substantial number of residents, while also ensuring fiscal responsibility within the program.