NC · guidance
N.C. Medicaid Clinical Coverage Policy No. 3D § 5.8
Coordinating Medicaid and Medicare Benefit Periods
Medicaid and Medicare benefit periods are identical and run concurrently. When the
beneficiary is dually eligible, he or she shall elect the hospice service for both programs
simultaneously. Medicare hospice covers payment in full. Medicaid coverage is available
only for nursing facility room and board. The benefit period for starting the Medicaid
service must mirror the current Medicare benefit status when the coverage does not start
concurrently.
Note: The Preadmission Screening Resident Review (PASRR) program is a federal
statutory requirement that mandates the review of every beneficiary who applies to or
resides in a Medicaid-certified nursing facility, regardless of the source of payment for
nursing facility services. Refer to Clinical Coverage Policy 2B-1, Nursing Facility
Services on NC Medicaid’s website at https://medicaid.ncdhhs.gov/ and according to 42
CFR 483 Subpart C.
Provenance
- Source
- medicaid.ncdhhs.gov
- Retrieved
- 2026-10-01
- Edition
- ccp-3d-2024-03-15
- Content hash
631ced15340111d6acf7a5cdebfe14d0ea63bda584b0e4a133741e35cfe14078
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