Medicaid Applications

Proposed New York Medicaid “Personal Care” Cuts Halted By Court

Published on: September 13, 2012 | by Ettinger Law Firm

Not long ago a few residents received some disturbing news–the New York Medicaid support that they counted on to survive was being cut back. Many of these community members had severe disabilities, needing help with every aspect of their life, from dressing and bathing to eating and traveling. Many seniors and those with disabilities receive help from at-home care workers around the clock so that they are able function in the least invasive setting possible despite their challenges.

Yet, in an apparent effort to recoup funds given back to federal officials following an overbilling case that settled in November, the New York City Human Resources Administration decided to alter the way some personal care was provided to residents. In particular “split-shift” at home care was curtailed. This care is provided to those who need help 24 hours a day, with two different care workers each taking a 12 hours shift. In it’s place, the city wanted to provide just a single care worker who lived with the Medicaid recipient.

New York City Medicaid Lawsuit

Massive Medicaid Fraud and Texas’ O.I.G Dollar Recovery Strategy

Published on: July 31, 2012 | by Ettinger Law Firm

Medicaid and Medicare frauds have been weighing heavily on states’ financial resources in the past years and New York is not an exception.

In the midst of solutions to this inter-state problem, eyes are focused on the Office of Inspector General at Health and Human Services Commission (O.I.G) – charged with investigating fraud among health care providers in Texas- who has revolutionized its method of dealing with frauds. Our New York Medcaid attorneys are intimately familiar with the important role the program plays in the lives of so many local residents.

The O.I.G’s strategy: A Fair Solution to Medicaid Fraud?

Is PACE Program Future of Senior Health Care?

Published on: July 6, 2012 | by Ettinger Law Firm

CBS News recently reported on glowing praise for a relatively small program seeking to help seniors live independently. Known as the Program of All-Inclusive Care for the Elderly (PACE), the program is being credited with helping many on New York Medicaid avoid being forced to move into nursing homes. For example, one New Yorker interviewed for the story is a 65-year old woman who faces a series of health challenges. Her osteoporosis has left her wheelchair bound, as she can only walk in small doses. Like many, the woman faced serious financial setbacks and is currently unemployed. With a history of chronic depression, the woman admitted that if she was forced to move into a nursing home, she doubts she would survive.

Yet, so far, she has been able to avoid the nursing home as a result of PACE. The program allows this woman, any other seniors is similar situations, to live at home and receive support from area day care center. Seniors can visit the center for various services, from coordinated medical care, social work support, and various activities, like yoga.

Our New York elder care attorneys appreciate the immense value of this program which allows more seniors to age in place.

Federal Government Overpays New York Medicaid System by $700 Million

Published on: May 18, 2012 | by Ettinger Law Firm

The Medicaid program is a joint federal and state effort–the public bodies split the cost. The state cost itself is further subdivided into payments made by county governments and those coming straight from Albany. This interconnected relationship is helpful in that it doesn’t place the burden too heavily on any single public entity. Yet, it also means that the New York Medicaid system is at risk for cuts and changes whenever either the county, state, or federal government faces budget problems.

That means that local residents are constantly bombarded with stories about how one government or another is seeking to alter the way the system works to trim costs. The program is an essential lifeline for many local residents. Each New York Medicaid attorney at our firm appreciates the stress that comes with wondering whether a loved one will be able to stay in a long-term care facility or be admitted to a new facility when faced with health problems.

The latest scare came this week as federal officials admitted that they overpaid New York State by a shocking $700 million in 2009 for Medicaid services. The causes for the overpayment are still being rooted out. Essentially, officials believe that the main problem was a faulty reimbursement formula for nine centers for the developmentally disabled. The Poughkeepsie Journal explains that the rate paid per resident at those facilities was four times higher than the actual cost of care and ten times higher than reimbursement rates paid at similar facilities.

Is Medicaid Funding Getting Harder to Come By?

Published on: April 3, 2012 | by Ettinger Law Firm

A Wall Street Journal article this weekend asked some tough questions about the availability of Medicaid nationwide. Our New York Medicaid attorneys realize that many local residents are understandably concerned about the program in our state–it is an essential lifeline for many seniors. The latest WSJ article suggest that some states are making it harder for individuals to receive Medicaid help to pay for long-term care costs–however, the “crack down” on Medicaid expenditures is advancing very differently in certain states.

According to the Kaiser Family Foundation, Medicaid now accounts for about 40% of long-term care spending nationwide. The program is a joint state and federal effort that provides healthcare resources for those unable to afford it. There are federal qualification guidelines, but states are free to work within those guidelines to set specific standards about what is required before a resident is able to receive Medicaid support. As a result of this state flexibility, there can be significant differences in qualification factors in different parts of the country.

Considering that most state are experiencing budget shortfalls, many are looking into different ways to save on these costs. Of course, New York Medicaid changes and proposals are frequently in the news, as local policymakers continue to explore various ways to save money. As the article notes, some of those proposed changes include tinkering with the ways that the state can recover costs from the estates of those who used the program. Our New York elder law estate planning attorneys work closely on those issues, following along with all changes in the law so that local families are best positioned to receive the care they need while saving as many assets as allowable under the law.

State Takes Steps to Eliminate New York Medicaid Caseworkers

Published on: October 20, 2011 | by Ettinger Law Firm

Syracuse News reported this week on public concern over changes that are about to take effect within the New York Medicaid system. Per the planned alterations, many local residents with developmental disabilities will lose their caseworkers as that task is soon to be outsourced to non-profit agencies in the state. Currently, many of these residents receive assistance from a group of public employees known as Medicaid service coordinators. However, these residents have been instructed that by the end of this week they must select a non-profit to take over this function.

Many community members are concerned about the effect the changes will have on their vulnerable family members with disabilities who have grown familiar with their personal caseworkers over many years. The service coordinators function as advocates for program participants, developing relationships with the clients and helping their family find the services that they need. Many coordinators have helped families find appropriate educational opportunities, arrange for respite care, and have linked participants with employment programs. Our New York Medicaid attorneys are aware of the complications that are intrinsic in working through the Medicaid system, as we also devote our time helping local residents work within the system to protect their assets while receiving the resources that they need to get by each day.

Cost-cutting is the state’s motivation for changing the way the services are provided. The state spokesman for the Office for People with Developmental Disabilities reported that non-profit agencies already handle roughly eighty percent of Medicaid service coordination in the state. Nonprofit agencies explain that they are prepared to handle their expanded role. However, they also report that it may be difficult to complete the transition in a month–which is the goal of the administration. Even if the changes go through, there is a chance that families may be able to remain with the same service coordinator if that coordinator is hired by a nonprofit after leaving the state payroll. The program shift will allow the state to cut 300 service coordinators who had previously served about 10,000 local residents. Current service coordinators may try to approve an amended contract and submit it to the state in an effort to halt the layoffs. However, there is no guarantee that the privatization effort will be halted.

Advocates Call for Tighter New York Medicaid Rule Enforcement

Published on: September 27, 2011 | by Ettinger Law Firm

Last week state legislators proposed New York Medicaid changes which would eliminate the financial involvement of local county governments–a state take-over of the program. However, this change would do nothing to curb the overall costs of the program. Lawmakers explain that reigning in Medicaid costs remains a top priority, and so additional alterations to the program are likely. Many observers are calling for tighter enforcement rules to root out fraud. Stricter enforcement of the program will likely target medical care providers who seek to collect money, but these changes may also affect individual residents who are working through the New York Medicaid application process.

An editorial in last Friday’s Albany Times Union called upon the legislature not to go “soft” on Medicaid users. Recent problems of fraud in institutions serving those with developmental disabilities were used to highlight the current problem with the program. Some observers believe that homes for those who are unable to live independently because of age or disability are the site of the clearest patterns of excessive Medicaid utilization. Several years ago the New York Commission on Quality of Care and Advocacy for the Mentally Disabled noted that Medicaid billing for these services were “costly, fragmented, sometimes unnecessary, and often appeared to be revenue-driven, rather than based on medical necessity.”

Senior care advocates believe that many disabled seniors find themselves in need of dental care, hearing aids, and similar basic services only to be shuffled to alternative medical appointments not of their choosing or tailored to their need. These advocates claim that Medicaid changes are necessary to correct the disconnect between needed services and the ones actually provided. On top of the programmatic problems, the state’s Long Term Care Coalition noted that the Health Department lacks the resources to oversee these adult homes properly. The state body struggles to ensure that nursing homes and senior living facilities are abiding by state rules and regulations. The quality of elder care suffers as a result.