Can Medicare Cover Skilled Care When Improvement Is Not Expected?
A resident does not have to be expected to improve in order for skilled nursing or therapy to be covered by Medicare.
CMS’s Jimmo guidance clarifies that Medicare coverage can apply when skilled care is needed to maintain the person’s condition or prevent or slow deterioration, as long as the other coverage requirements are met.
The key question is whether skilled professional knowledge is required—not whether the resident is getting better.
What Jimmo clarified
CMS states that Medicare’s SNF, home health, and outpatient therapy coverage does not turn on a beneficiary’s potential for improvement.
Skilled care may be covered when it is necessary to:
- maintain current condition;
- prevent decline; or
- slow deterioration.
Skilled care still has to be necessary
Maintenance coverage is not automatic.
CMS explains that if the maintenance activity can be safely and effectively carried out by the patient or unskilled caregivers, ongoing skilled therapy may not be covered.
The record should show why the specialized judgment of skilled nursing or therapy is needed.
Ask what skilled element remains
Examples of useful questions:
- What clinical complexity requires skilled assessment?
- What does the therapist need to adjust or monitor?
- What deterioration is the plan trying to prevent or slow?
- Why can’t the maintenance program be safely handled by unskilled caregivers alone?
- How is the need documented?
“Plateau” is not enough explanation
If someone says Medicare is ending because the resident has “plateaued,” ask:
“Is the decision based on lack of improvement, or has the team determined that skilled care is no longer medically necessary?”
Those are not the same.
Maintenance can be therapy or nursing
The Jimmo clarification applies to skilled nursing and skilled therapy benefits in the relevant settings.
An individualized clinical assessment still controls.
Maintenance-coverage worksheet
Current condition/function: ____________________
Goal: improve / maintain / slow decline: ____________________
Skilled service needed: ____________________
Why skilled judgment is required: ____________________
Can unskilled caregiver safely do it?: ____________________
Documentation reviewed: ____________________
Coverage notice received: ____________________
Frequently asked questions
Does Jimmo mean Medicare pays forever?
No. All other Medicare coverage rules, benefit limits, and medical-necessity requirements still apply.
Does no improvement mean automatic coverage?
No. Skilled care still must be required.
Can family cite Jimmo in an appeal?
You can raise the maintenance coverage standard when relevant and ask the reviewer to apply the correct Medicare criteria.
The practical goal
Do not let “not improving” become the entire coverage analysis.
Ask whether skilled care is still required to maintain function or prevent/slow decline, and make sure the clinical record explains why.
Related NHP guides
- What Happens When Medicare Stops Paying for Rehab?
- Medicare Advantage Denied Rehab: What Can Families Do Next?
Primary sources checked
*Editorial/source review: October 15, 2026. General education only. Medicare coverage depends on the individual benefit period, clinical documentation, notices, plan rules, and applicable appeal procedures.*
