Medicaid Applications

Landmark Medicaid Study on Effect of Program Expansion

Published on: May 6, 2013 | by Ettinger Law Firm

The results of a comprehensive new research effort on Medicaid’s effects on low-income residents was just published in the New England Journal of Medicine. The full summary of the article can be found online here.

As discussed in the New York Times late last week, the project compared individuals who received Medicaid support over a period of two years with those in similar income brackets who were not enrolled in Medicaid. The idea was to compare these groups on a wide range of indicators–financial well-being, physical health, mental health, and more. As such, it provides the most comprehensive understanding yet of how wide-ranging Medicaid changes may impact various community members.

Counterintuitive Results?

NY Medicaid Supported Adult Day Care Suspended Following Fraud Concerns

Published on: April 30, 2013 | by Ettinger Law Firm

Last week we shared information about the revelations in the New York Times that efforts to curb New York Medicaid costs have been less than successful–mostly because of expanded enrollment in certain programs, like senior day care centers. These assistance centers are locations where frail and sometimes vulnerable elderly community members can stay during the day, while other caregivers–usually adult children–are at work. The facilities offer a way for seniors to avoid being forced to move into a long-term care home.

While useful, concerns have mounted regarding the tactics used by the operators of these facilities to increase enrollment. Owners of the adult care facilities are paid based on the number of eligible New York Medicaid recipients who attend. Therefore, it is in the best interest of the operators financially to increase enrollment–and that is exactly what they have been doing. The increase has been so stark, that some worry that the cost-savings intended (by averting expensive nursing home stays) may be illusory.

Temporary Suspension

Managed-Care Medicaid in New York

Published on: April 26, 2013 | by Ettinger Law Firm

A New York Times article this week took a look at the consequences of a Medicaid change engineered by Governor Cuomo in the hopes of saving money: switching to “managed-care” for NY Medicaid programs.

The basic idea is straightforward: switch from paying providers a “fee for service” and instead make a specific payment to provide proper care–whatever that care might be. The logic goes that when medical care providers receive a fee for specific actions performed, they are incentivized to provide more services, even if they aren’t needed. By switching to a set payment amount, those providers will be incentivized to simply provide the most efficient care possible. They will also be more competitive, trying to increase quality of care to attract more Medicaid participants.

The Reality

House GOP Proposal & Medicaid

Published on: March 14, 2013 | by Ettinger Law Firm

As most know, the March 1st “sequester” cut deadline came and went without much serious action by policymakers to avert the automatic cuts. This was not unexpected considering policymakers have been very far off on goals for a compromise and because the $85 billion in first year cuts will not necessarily take effect immediately. The real layoffs and consequences that might be felt by most community members will roll out slowly throughout the year, stalling the public outrage and pushing off the political pressure that might force an ultimate budget agreement.

It is important to clarify that while Medicaid cuts were not part of the sequester, potential changes to Medicaid are very much part of potential compromise that could be reached in the coming weeks and months. For that reason, it is important for all local families who rely in any way on New York Medicaid (or who expect to in the future) to understand how potential changes may alter their options.

Latest GOP Proposal

Editorial Calls for Preserving Medicaid Spousal Refusal in New York

Published on: March 12, 2013 | by Ettinger Law Firm

It is not easy for many local residents to understand all of the ins and out of the Medicaid program. While Medicaid is a critical tool that provides support for local seniors who need long-term care, it can be a whirlwind of stress, anxiety, and frustration when families attempt to navigate the administrative waters and understand what they need to do to join. Making matters worse is that fact that Medicaid qualification is based on income, and so most families are forced to “spend down” assets before receiving aid. Without proper planning, this means that many families are forced to shed most of their assets just to receive the extra care they need–loosing property and savings built up over a lifetime.

This situation seems particularly damaging for certain families, including those with one healthy spouse and the other in need of care. Fortunately, in those situations the option of “spousal refusal” exists. This essentially allows a healthy spouse to divest property from the other, such that the sick spouse qualifies for care without the healthier spouse losing most everything as well.

Eliminating the Refusal?

Modernization to New York Medicaid Coming As Part of Affordable Care Act?

Published on: November 29, 2012 | by Ettinger Law Firm

Speculation was rampant over the past year regarding exactly how full implementation of the Affordable Care Act (ACA) (Obamacare) would actually affect the current healthcare programs, like Medicare and Medicaid. Now, with President Obama’s re-election in place and the long-term security of the ACA secure, we are beginning to see some possible ways that the program is going to alter current state practices. For one thing, it may act as a spur to modernize the interaction between various state agencies, including Medicaid.

For example, as discussed in a recent Albany Times Union editorial, the federal Centers for Medicare and Medicaid (CMS) is making a one-time offer to states of 90% matching funds for “modernization” efforts. What does this mean? States will have a significant incentive to spend some resources to improve the efficiency of its programs, including Medicaid. This increased matching fund effort was spurred by the “health exchange” components of the ACA.

In general, CMS pays 50% of Medicaid costs, and the state pays the remaining 50%. That is why Medicaid is deemed a joint state and federal program. However, as part of this new push to improve certain aspects of the program, when a state wants to work on a modernization project, instead of paying for half of the cost of the project, they would only have to pay 10%, with federal coffers taking care of the remaining 90%.

Medicare Funding & Nursing Home Overbilling

Published on: November 20, 2012 | by Ettinger Law Firm

One question many New York seniors (and their loved ones) considered during the presidential campaign was how each candidate’s election might affect programs like Medicare and Medicaid. While it is hard to say with certainty what changes, if any, will be made to these areas, much of the discussion between candidates centered around general approaches to tackling financial problems as they relate to Medicare and Medicaid.

In general, Governor Romney’s approach was more far-reaching, favoring structural changes to the programs, including shifting more responsibility to the states. It was claimed that this would result in more flexibility on top of cost savings. Conversely, President Obama was more inclined to focus on attacking “waste” within the system as well as fully implementing Obamacare to lower healthcare costs overall by better insuring all Americans.

Of course, with the President’s re-election, Obamacare is preserved and the approach championed by his opponents is less likely to become law. In fact, a new report out last week from the U.S. Department of Health and Human Services suggests that the administration may be going strong with its attempts to root out overbilling, waste, and fraud in the system.

Ensuring LTCI Fairness

Published on: October 30, 2012 | by Ettinger Law Firm

Elder law attorneys and senior care advocates frequently remind community members of the value of long-term care insurance (LTCI). The New York legal professionals at our firm advise those who we are assisting with elder law estate planning of the immense value of having this insurance in place so that family assets are not decimated in the event (often likely) that skilled nursing home or at-home care is needed down the road. There are ways to save some assets without LTCI when Medicaid is used, but the best approach is always to have the necessary insurance.

When deciding on LTCI, however, it is critical that you understand the details of the policy and act to ensure it will work as desired when necessary. In fact, with the importance of this insurance increasing, many state are getting more invovled, offering more regulations and guidelines so that community members are protected from unfair practices where LTCI is at issue. A story last week by NY Now discussed the ways that some states are hoping to iron out some “kinks” in the system.

The main concern is ensuring that policyholders actually receive full and timely payments from the providers. Of course, having an insurance claim denied or not paid quickly can lead to serious repurcussions, because familes are forced to scramble to find alternative arrangements for necessary long-term care. Even if they are eventually vindicated, the delay in insurance coverage can cause significant financial (and emotional) damage that cannot be fully recuperated. To avoid that situation, some states are implementing more streamlined appeals processes, so that those who have claims denied or delayed can press for their rights more efficiently.

Editorial on Presidential Medicaid Proposals

Published on: October 26, 2012 | by Ettinger Law Firm

In the back-and-forth of the presidential debates and the obviously skewed TV ads, it is hard for local seniors to make heads or tails of the different proposals that candidates have on the Medicare and Medicaid system. Millions of New Yorkers rely on the programs for their healthcare and long-term care needs. Nearly one in five New York seniors participates in the Medicaid program, as it funds 70% of all nursing home stays. It is natural for residents to be confused and downright worried about what changes may or may not be coming to the program.

Most concern focuses on potential changes that the challenger, Governor Mitt Romney, might make in the event that he is elected. Those concerns are likely amplified by Governor Romney’s choice of Congressman Paul Ryan as a running mate. Congressman Ryan previously focused much of his attention while in the U.S. House of Representatives on various sweeping financial changes, including alterations to the Medicare and Medicaid programs.

What are those possible changes and how will they affect local seniors? A recent editorial in City and State New York took a look at the Romney proposals and offered a critique of the long-term impact of the program proposals. It is critical to note that this particular editorial was crafted by a current Democratic Congressman who previously worked with President Obama. It remains important to collect as many perspectives as possible to get an idea of the real impact of these possible changes. However, the editorial does offer a helpful discussion of one perspective.

Man Tries to Kill Senior Girlfriend in Nursing Home for Financial Reasons

Published on: September 25, 2012 | by Ettinger Law Firm

It is perhaps every senior’s worst nightmare: a dispute over their finances influences the care they receive in their later years. It seems self-evident that nothing should get in the way of making medical and caregiving decisions based on maximizing a senior’s quality of life–not maximizing an inheritance for others once a senior passes on. Unfortunately, case after case demonstrates that some elderly community members suffer in their later years unnecessarily for financial reasons–not because they cannot afford proper care but because other want their money.

This confluence of elder law and estate planning was perhaps most vividly illustrated by a case discussed this week in SF Gate.

According to the story, a 63-year old woman was staying at a local care center because she was not able to care for herself at home. The details of her family situation are not known, however, she had been dating a 67-year old man for the past three years. Unfortunately, the boyfriend appears to have been motivated in the relationship mostly by the way that it could benefit him financially.