Call your Service Coordinator if you think you might want to go into a nursing facility. Your Service Coordinator can work with you to find out what help you need.
No. Your Medicaid health benefits and services will not change if you go into a nursing facility.
Each nursing facility has its own Service Coordinator. If you move to a new nursing facility, you will have a new Service Coordinator. The nursing facility can tell you the name of your Superior Service Coordinator. They can give you the phone number for your Service Coordinator. You can also call Superior Member Services at 1-877-277-9772, and get their name and phone number.
To find a nursing facility close to you, look through the provider directory or call Member Services at 1-877-277-9772.
If you want to change your nursing facility, talk to your Service Coordinator. Your Service Coordinator can help you find another Superior nursing facility. Your Service Coordinator can also work with the nursing home where you live and the one you want to change to. They can help to make sure you have a good move.
If you ask to change your nursing facility, it can be denied because:
- The new nursing facility does not have an available room.
- The new nursing facility is not a Superior nursing facility.
*Note: Members can move to a nursing facility outside of their current service area, but they would need to select a new health plan.
The cost of a nursing home depends on where you live and the services you get. Nursing homes provide for your medical, social and psychological needs. That includes:
- Room and board.
- Social services.
- Over-the-counter drugs, medical supplies and equipment.
- Rehabilitative services.
- Personal needs items such as soap, toilet paper and lotion.
If you like items or brands other than what the nursing facility has, you may have to buy those yourself.
You will have a set amount you pay the nursing facility for room and board. This is called your “applied income.” That amount will depend on how much income you get. It is important that you always pay the nursing facility your applied income on time and in full.
You can keep $60 each month for things like haircuts, stamps or clothes. If you need, the nursing facility can set up a trust fund to deposit your $60.
There are other things you may have to pay for yourself. One is called a “bed hold.” If you are gone from the nursing facility, you can pay them to hold your spot. Your nursing home can give you details. They can also tell you how much that will be.
At Superior, members can get many great services in addition to their regular benefits. These are called Value-added Services.* Superior is proud to offer extra services to help keep our members healthy. Visit our Value-added Services webpage for more information.
- A 24-hour nurse advice line.
- General Educational Development (GED) preparatory materials and resources to help pass the GED test for members with an IDD diagnosis.
- An online "caring community" enabling members to engage friends and family as it relates to their healing or healthcare journey. Create a Careopolis.
- Nursing facility welcome kit provided for members who enter a nursing facility for the first time. Welcome kit includes personal items to help with the transition to living in a long-term care facility.
- Online resources. Online and mobile-accessible mental health and nicotine recovery resources. Findhelp online directory to help locate community services.
Note: The Value-added Services listed below do not apply to dual eligible members.
- $50 reward for female members ages 21-64, at average risk for cervical cancer, who complete a recommended cervical cancer screening.
- Extra dental benefits. Members may get up to $250** or $500*** annually for exams, x-rays, cleanings, fluoride treatments and simple extractions.***
- Extra vision services. Members may get up to $150 for choice of upgraded eyeglass frames and lenses or contact lenses not covered by Medicaid each year.
- Online resource to help with entering or discharging from facilities for eligible members and their caregivers. Members must have a qualifying diagnosis.
These services are valid from 9/1/22 through 8/31/23.
*Restrictions and limitations may apply.
** Excludes members in Dallas and Nueces.
*** Only for members in Dallas and Nueces.
You can contact the Office of Consumer Credit Commissioner (OCCC) to get assistance regarding a third-party debt collector or if you have a complaint about a business. They can also help you file a complaint. You can call the OCCC at 1-800-538-1579. Or, you can access information about their services here.