Articles Posted in Medicaid Applications

The sequester cut deadline came and went late last week without action in DC. This will not come as a surprise to observers of the situation, but that doesn’t mean the unrolling of the cuts did not cause severe worry and concern for those affected. One group that is raising alarm about the possible consequences of keeping the cuts in place is the long-term care industry. In short, the industry is set to lose millions of dollars in reimbursements, and many are concerned that the losses will affect the quality of care provided to all in the homes, including current residents.

AQNHC Care Report

Last week, in anticipation of the sequester cuts, the Alliance for Quality Nursing Home Care (AQNHC) released a report which demonstrated how the Medicare cuts included in the automatic budget reductions will affect traditional nursing homes. Most long-term stays at nursing homes are covered under Medicaid (not Medicare). However, shorter, rehabilitative stays connected to a hospital discharge are covered by Medicare. Right now, if no compromise is reached on the sequest cuts, then an across the board Medicare cut of 2% will take effect on April 1st.

It is a well discussed fact that American demographics are shifting such that the percentage of the population over 65 years old (and over 80 years old) is growing steadily. Those most familiar with the data suggest that this trend will continue for the next several decades. It is hard to underestimate the significance of the change. By 2030 the total number of Americans at retirement age (over 65) is expected to double from today’s total.

This shift has serious ramifications for all Americans–both old and young. For one thing, we will continue to see growing pressures on programs which currently provide much needed support to seniors, like Medicaid and Medicare. The larger the number of people who are counting on this support for long-term care, like at nursing homes, the harder it will be for public coffers to provide the same level of care. That is one of many reasons why it is absolutely critical for New York residents of all ages to take steps now to plan for their later years–often by visiting a New York elder law attorney.

Another consequences of the changing demographics that we are already seeing is a rise in elder abuse and neglect. Unfortunately, much of the mistreatment is perpetrated by friends and family members of the seniors. A recent ABC News article on the topic noted how one of the only options for those seniors who are mistreated by friends and family is to find an emergency senior shelter. Although they are growing in popularity, those shelters are few and far between. The need greatly outpaces the current availability.

Medicaid is a joint federal-state program. As such, payments are made by both the federal government and state government. However, that simple dichotomy can be deceiving, because it lumps the actual state government with the local governmental entities (like counties). Each state can operate differently, but in New York, the “state” portion of the bill is actually divided between the government in Albany and local governments.

This payment system has actually led to much controversy in recent years, mostly as counties have struggled to keep up with their obligations. The New York Medicaid system is the largest in the country, and that comes with significant costs. Many county officials have argued that it is becoming increasingly impossible for the local governments to keep up with costs–particularly as those costs have risen.

Some counties are going to significant lengths to cut Medicaid obligations. For example, recently one county–Oneida–hired a team of lawyers in an attempt to recoup Medicaid payments that it believes were above their obligations. According to WKTV, the county is arguing that they are owed somewhere between $4 million and $6 million from New York State. The discrepancy stems from overpayments allegedly made by the county for in-house care for those with mental illnesses.

All those who have an interest in the New York Medicaid system will be watching closely in coming months as more aspects of the landmark Affordable Care Act (Obamacare) are unrolled. While it has been several years since the law was passed–and recently upheld from legal challenge by the U.S. Supreme Court–many provisions in the legislation were only scheduled to be enrolled over several years. The passage of the bill did not change anything overnight, and it is only over the long-term that the full impact of the provisions will be felt by community members, including many who use the Medicaid program.

A recent report from the Brookings Institute on the coming changes compared the situation to a hurricane. The high-profile political battle over its passage and legal wrangling over its constitutionality was the first half of the storm. We are now in the “eye” with little discussion or interest in the mater. However, that will soon change. As more aspects of the program are unrolled the political battle may intensify yet again.

So what can we expect in the future?

As everyone knows by now, U.S. President Barack Obama was re-elected to a second term on Tuesday. In addition, the U.S. House of Representatives will remain in the control of the Republican Party with a similar make-up of the last four years. Also, the Democrats will keep control of the U.S. Senate, gaining two seats to slightly cushion their advantage in the chamber. The short summary is that that governing system will be remarkably similar to how it has been the last few years.

So what does this mean for senior long-term care issues?

It is impossible to say with precision, because claims made by various actors in the system during an election are often different than the final policy results once various issues make their way through the give-and-take of American lawmaking. However, it is possible to make a few observations about how certian issues/ideas might play out in the coming years as a result of the President’s re-election.

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.