Articles Posted in Medicaid Applications

Yesterday we discussed the release of the federal Long-Term Care Commission’s final report. As mentioned, the major glaring issue with the report was its relative silence on financing solutions for this care. The Commission was made up of individuals with varying interests–from owners to residents–who have very different incentives. Issues regarding payment for long-term care services, particular Medicaid, is always a contentious topic. In that vein, it is perhaps not surprising that the report did not issue conclusive recommendations on that front.

Yet, that did not stop a subset of the Commission from issuing their own dissent which directly addressed the financing issue. A full version of that 17-page alternative report can be read online here.

Alternative Report

Last week the United Hospital Fund published a comprehensive new report that examines how nursing home care in New York has changed in the last two decades. The report is a good read for all New York families who are seeking to better understand how these facilities operate and what options are available today for loved ones in need of extra help on a day-to-day basis.

The Findings

The main take-away from the study is the fact that nursing homes in New York are evolving from “primarily providing residential care for seniors to focusing on both post-acute services and long-term care today.” Put another way, these facilities are providing more diverse services, helping those who need short-term rehabilitation aid as well as providing more permanent homes for those with chronic medical issues.

Most know that in order to qualify for Medicaid one must “spend down” assets. This often means selling a house, emptying retirement accounts, and otherwise depleted resources that one spent a lifetime acquiring. New York Medicaid attorneys work with families to protect assets from loss in this way, often by using a Medicaid Asset Protection Trust. (MAPT).

Life insurance is also lost in this way, as some are required to “surrender” their insurance policy in order to receive Medicaid support. Usually the surrender value is a small cash amount–far less than what would actually be paid out after passing to beneficiaries.

The real winner of this requirement is the insurance company itself, as the company avoids the obligation of paying on a death claim. The seeming injustice of this scenario is leading some states to consider an alternative process known as “Medicaid life settlements.”

What causes the staggering costs of nursing home care? Just as with the mass confusion about the cost of regular medical care, there are no easy answers. So many different factors play a role in the cost, and there are many unknown variables, that it is difficult to gain a general understanding of the dynamics. The one thing all New York residents know clearly, though, is that they often need to come up with six figures every single year (or more) to pay for the best quality NY long-term care.

Recently, however, there has been a growing chorus of voices who suggest that a big problem is simply the profit maximization strategies of the nursing home industry itself. Those making these claims often suggest that steps need to be taken to reign in the profit, ensure prices are fair, and guarantee that adequate resources are committed to guaranteeing reasonable care for residents at all time.

For example, last week The Street published a post which talked about recently changes in the industry and the growth of larger companies focusing solely on nursing home care. In other words, more and more facilities are being owned by fewer and fewer companies. Those large conglomerates are able to create standardized practices that apply to hundreds and thousands of facilities. Those practices are almost always gearing toward maximizing profits for the companies and shareholders.

New York Medicaid attorneys help families understand the intricacies of the program, help with applications, and assist in protecting assets from the “spending down” requirement. Many families only seriously think about Medicaid when a senior loved one suffers a medical setback and needs to go into a nursing home?

But what can be done to avoid the nursing home altogether? With only a few exceptions, most seniors are willing to do everything reasonable to age in place, without the need to move out of their home and enter an alternative facility. Independence is important for everyone, and maximizing one’s ability to live on their own should be one of the key goals of all long-term planning.

Finances are often front and center. A Main Street article last week published this year’s Genworth’s “Cost of Care” study results which noted how the average cost of nursing home stays rose 3.3% from last year. This rise is a common trend over the past few years and something that will undoubtedly continue. As we often point out, it often costs well over six figures for a year’s stay in a skilled nursing home in New York.

The tremendous benefit of planning ahead for possible long-term care needs cannot be explained enough. The typical New York family is understandably most concerned about paying monthly bills, attending birthday parties, fixing up the house, and the thousand other activities that fill the day. Taking the time to think about serious illness, death, and inheritance often falls quite low on the priority list.

The motto, “I’ll cross that bridge when I get there” may work well for issues that cannot be dealt with ahead of time, but that is certainly not the case when it comes to long-term care and similar elder issues. Planning makes all the difference, not just for the senior, but also their family. That is why it is critical to fight the inertia and be prudent about planning.

The MAPT

News about potential fraud and waste within the New York Medicaid system keeps on coming. It seems as if every week there is a new allegations of practices which unnecessarily cost the state money in unnecessary Medicaid payments. With Governor Cuomo’s continued focus on rooting out problems with the system, we can likely expect even more information to come out regarding these issues in the next few months.

In fact, just last week the Capitol Confidential published a story discussing how the New York Comptroller, Tom DiNapoli, recently released two new audits which suggest widespread waste in the system.

One of those audits suggests that the NY Department of Health paid out more money for certain procedures than is allowed under current Medicaid rules. The administrative rules for Medicaid set specific maximum rates for certain procedures. Care providers—from nursing homes to hospitals–know those set rates. Those facilities do not necessarily get to set their own price.

In an effort to more efficiently use state funds, over the past few years the New York Medicaid program has been closely analyzed by state groups looking to root out fraud. Those investigations have returned hundreds of millions of dollars back into the programs following problematic practices at New York nursing homes, senior day care facilities, and many other settings.

While rooting out excess and fraud is a net positive, one must not forget the real lives that are affected any time that changes are demanded by program officials. Many New York seniors are in delicate situations, and any time that a nursing home, at-home provider, or other entity is no longer able to operate as a result of bad practices, many seniors struggle to deal with caregiving changes.

Finding Good Elderly Home Care in New York