Michigan Nursing Home Administrator (NHA) Practice Exam

What happens to a recipient who refuses to enroll in Medicare Part A?

1. They remain eligible for Medicaid

2. They are automatically denied Medicaid

3. They can appeal the decision

4. They lose their health benefits temporarily

The correct answer is: They are automatically denied Medicaid

When a recipient refuses to enroll in Medicare Part A, they can face significant consequences concerning their Medicaid eligibility. Medicare Part A is designed to cover inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. It serves as the primary payer for many healthcare services. If an individual chooses not to enroll in Medicare Part A when they are eligible, they will generally be denied Medicaid coverage. This is because Medicaid often serves as a secondary payer to Medicare, and in order to receive Medicaid benefits, individuals must typically enroll in Medicare if they are eligible. Thus, refusing to enroll in Medicare Part A can result in the automatic denial of Medicaid benefits, as the program is structured to require eligible individuals to first use Medicare coverage before relying on Medicaid assistance. In contrast, the other options do not accurately reflect the relationship between Medicare and Medicaid. Individuals do not remain eligible for Medicaid if they refuse Medicare when they are eligible, they cannot appeal for continued Medicaid benefits solely based on this refusal, and they do not lose health benefits temporarily; instead, their qualifications for Medicaid are directly affected by their decision regarding Medicare enrollment.