Medical Cannabis in Nursing Homes: A battle between Federal and State law

Mar 08, 2020 at 04:15 pm by pj




As more states legalize the use of medical cannabis, the stigma around cannabis for medical purposes continues to decline. However, since cannabis is still illegal under federal law, it creates a tremendous amount of challenges for access to medical cannabis for patients in Skilled Nursing Facilities (SNF).

In the state of Florida, medical marijuana has been legal for physicians to recommend via a physician “certification” since 2015.  There are currently over 300,000 qualified medical cannabis patients in the state. These numbers continue to increase 3,000-5,000 per week and the most common diagnosis prescribed is chronic non-malignant pain.  However, there is no data available regarding qualified patients who are receiving medical cannabis residing in SNFs. Most patients who live in SNFs have diagnoses which would qualify under the Florida Medical Marijuana law (f.s.381.986)


SNFs in Florida and the United States receive a majority of their funding through Federal insurance programs such as Medicare and Medicaid. In order for these SNFs to receive this funding, they must not violate federal law. If the SNFs were to purchase medical cannabis for patients or dispense, hold, or somehow contribute to the use of medical cannabis for patients, they could be at risk of violating federal law and losing their federal insurance payments. 

However, all states have a list of resident rights in which each SNF must grant or face citations and/or fines. One of the most common rights of residents is the right to self-medicate. SNFs are required (by state law) to allow residents who are deemed physically and mentally capable of self-medicating a system to do so. SNFs must provide a lock box for the patient to put the medication in for safe keeping. If the patient is physically or mentally unable to perform self-medication, a family caregiver is allowed to administer the medication to the patient (if given proper permission legally via health care surrogate designation or through other legal means). 

However, most SNF operators are extremely hesitant to allow medical cannabis in their facilities for fear of losing their federal insurance payments. 

The only SNF in the United States to publicly admit they are allowing medical cannabis to be self-administered to their patients is in the Bronx, NY. A link to their medical cannabis program is below.




The facility implemented a policy to allow residents to use medical cannabis under the following conditions:

  • Patients must purchase the medical cannabis on their own with no payment coming from the SNF.
  • Patients were provided with a lock box to store their medication and were required to self-administer the medication.
  • The SNF was not allowed to record the use of the medication in the Medication Administration Record (MAR), and no staff were allowed to assist the resident in taking their medication.
  • A copy of the resident’s medical cannabis state certification/ approval must be on file at the facility prior to self-administration of medical cannabis.
  • Since smoking/vaping was against SNF policy, medical cannabis had to be in oil or pill form.


Once the policy was implemented, the SNF had 10 patients who became certified and approved through the state of New York to use medical cannabis. Once approved, the residents started to use medical cannabis within the facility. Most of the residents reported using the medicine and having a decrease in severity of symptoms such as chronic pain and tremors. There were no reports of any issues with government funding to the SNF (Medicare/Medicaid) during or after the residents were using medical cannabis. 

The issue of medical cannabis in SNFs is not going away. As more Florida citizens use medical cannabis, they will become accustomed to it. If they require short-term rehabilitation at a SNF and have been using medical cannabis for many years to control their diagnoses, they will be very reluctant to enter a SNF that does not allow medical cannabis use. The SNFs who begin to allow use of medical cannabis in their facilities will see an increase in revenue via increased census and increased patient satisfaction, which will lead to decreased facility citations. 


Michael C. Patterson, founder and CEO of U.S. Cannabis Pharmaceutical Research & Development of Melbourne, is a consultant for the development of the medical marijuana industry nationwide and in Florida. He serves as a consultant to Gerson Lehrman Group, New York and helps educate GLG partners on specific investment strategies and public policy regarding Medical Marijuana in the U.S. and Internationally. He can be reached at