Articles Posted in Medicaid Applications

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.

Confusion often reigns when one learns that a family member will likely need long-term skilled care. Finances are always an issue. With the average stay in a local nursing home running $11,000 per month, our New York elder law attorneys are acutely familiar with the financial challenges facing local families at these times. Few can afford to pay those costs out of pocket. Without long-term care insurance (expensive in its own right), most families instead turn to Medicare and Medicaid for support.

Many seniors on Medicare get understandably confused when trying to determine what long-term care is provided by the program. The short answer is: very little. The Centers for Medicare and Medicaid Services have produced a handbook entitled Medicare Coverage of Skilled Nursing Facility Care which is a good starting point for those hoping to learn more. In general, the takeaway is that Medicare will only pay for certain skilled nursing stays and never for those staying longer than 100 days. The first 20 days of qualifying care are covered completely, while anything more (up to 100 days) often requires some sort of copayment. To even qualify for that care a resident must have a qualifying hospital stay, need the care immediately after the hospital stay, and meet a few other requirements.

Conversely, Medicaid is the joint state and federal program that provides the most support for extended nursing home stays. That is why on the elder law side of our practice our New York Medicaid attorneys work closely with local seniors to help them apply for the program and save their assets from being consumed in the qualification process. Unlike Medicare, Medicaid is an income-based program, meaning that local seniors will have to show specific financial need before receiving the help. The application process which takes all of this into account has complex asset and transfer rules. Because it is a joint state and federal program, the qualification process is different in each state.

Yesterday our New York elder law attorney Bonnie Kraham Esq., had another article published in the Times Herald-Record. In the piece Attorney Kraham explains how it is common sense for middle class families to work to protect their assets from long-term care costs. The basic idea behind asset protection for seniors is simple: take advantage of legal tools so that assets can be passed down to children instead of lost to pay for long-term care. The wealthiest families have been using these strategies for decades, but more and more middle class families are coming to appreciate the benefits of protecting assets that have often taken a lifetime to accumulate.

As Attorney Kraham explains in the story, long-term care costs are high everywhere, but they are particularly significant in New York–roughly averaging about $11,000 per month. At the end of the day there are only three ways to pay for those costs: (1) out of one’s own assets; (2) via expensive long-term care insurance; (3) through Medicaid. Few community members can afford long-term care insurance and most only have personal assets to pay for these costs for a limited time. That is why our New York elder law attorneys work with families by using available tools under the law to protect assets in these situations. The goal is to help families receive Medicaid assistance without losing their personal assets in the process.

To accomplish this goal Medicaid Asset Protection Trusts (MAPTs) are often created. Assets are then moved into the trust. Those assets can be protected from being taken to pay for long-term care costs. Government officials specifically designed the system to allow for such planning. For example, there is a five year “look back period” during which the government will evaluate to see if certain asset transfers were made. Those transfers will trigger a penalty period whereby Medicaid payments will be withheld. However, if planning is done beyond that five year window, then all assets can be protected without any such penalty.

The New York Times published a blog post last week on a new effort called the “Conversation Project” seeking to make long-term care planning a kitchen-table issue. The project, spearheaded by former journalist and Pulitzer Prize winner Ellen Goodman, is the first step in a comprehensive effort to ensure that long-term caregiving is considered when all local, state, and federal policy and financial decisions are made. Ms. Goodman became involved in the project while helping her 92-year old mother in her later years. Being 70 years old herself, the journalist became incredibly frustrated with the confusing nature of the senior caregiving process and the lack of advocacy for those involved. Ms. Goodman was actually on Medicaid for a few years at the same time as her mother, a situation that our New York Medicaid lawyers know is becoming more and more common.

Many details of the Conversation Project are still being developed. At this point Ms. Goodman is leading a webcast in late January, has an online forum, and has an article being published in the upcoming Harvard Business Review’s “12 Audacious Ideas” issue. The Institute for Healthcare Improvement in Cambridge is also acting as an unofficial sponsor of the project in its early stages.

In discussing the project, Ms. Goodman explains that the beginning of the advocacy effort involves massive communication. She noted, “Everyone has a story. We need to share stories of the good deaths and bad deaths of people we loved.” She explained that more community members must demand access and information to help them ensure their story is not one of pain and unhappiness. Of course, every New York elder law attorney at our firm is familiar with how prior preparation plays a huge role in the quality of life experienced by seniors in their later years.

For decades those involved in elder care research have known that the vast majority of seniors would prefer to age in place at their own home instead of moving into a long-term care facility. Yet, our New York elder law attorneys know that for most of that time little was done to actually help seniors leave a nursing home or not enter it in the first place. Historically, only those who had conducted elder care planning well ahead of time (or were independently wealthy) had choices when they reached a point when they needed day-to-day living care.

Fortunately, times have changes. As an online article in last week’s New York Times discussed, Medicaid rule changes now require senior and disabled care givers to be more proactive in helping these residents leave the facility if they are willing and able. In the past, most caregivers would ask residents if they wanted to move back to the community, but the law did not demand that they actually do anything to help the senior move. Now, if a resident mentions that they would like to move back home, the senior caregiver is obligated to connect the senior to an outside agency that will look into the feasibility of their moving back home.

The change reflects new national trends in long-term care. In the context of maximizing the quality of life for area seniors, this is a welcome development. The author notes that in the past “Medicaid, which pays for most long-term care, was spending way too much on care in the places nobody wanted to be–nursing homes–and very little on care in the places almost everyone preferred–their homes.” The shift has been steady. In 1999, roughly 75% of Medicaid spending in this area went to institutional care. However, ten years later that spending level was down to 55%, with 45% going to home and community based services. The shift will likely accelerate even more as President Obama’s “Money Follows the Person” program continues to take effect. It is helpful to note that this reallocation of resources still requires local residents to conduct New York Medicaid planning to shield assets from the going to pay for the program participation.

For years the New York Medicaid attorneys at our firm have helped local families navigate the Medicaid program’s complexities. We guide families as they sort through the application process, protect property through use of New York Medicaid Asset Protection Trusts, and engage in similar planning strategies. Millions of families throughout our state depend on the program to receive the care that they need to get by each day. However, the popularity of the service has also threatened its long-term stability. That is why many observers have been closely watching lawmakers as they propose various programmatic changes that may affect individuals currently using the program as well as those who will likely apply in the future.

Yet, for all the “doom and gloom” discussion that seems to perpetuate, the state has actually received praise for its ability to save money without drastically altering the services available to residents. The Ithaca Journal commented this week on a Kaiser Family Foundation report which found that the New York Medicaid system was outperforming other states in efforts to keep spending in check. The report found that nationwide Medicaid spending increased 28.4 percent this year. New York, however, actually spent slightly less money on these services. The state has been able to avoid the significant increase in spending, say some experts, because of their increased use of managed care. In addition, New York eliminated a separate prescription drug plan for Medicaid receipts; the plan was folded into the managed care service. Other states may follow our lead. The article explains that the state’s “redesigning the program appears to be the leading edge of a national trend.”

Not only has the redesign saved state money, it may also have improved the actual services provided to residents. For example, the state’s spokesman for the Division of the Budget claims that the restructuring has led to a major expansion in patient-centered medical homes and better care management for those with complex medical needs. The state has also added substance abuse screening procedures, expanded smoking cessation counseling services, and now requires hospitals to provide patient-centered palliative care.