Medicaid Eligibility

MEDICARE’S OBSERVATIONAL STATUS

Published on: April 8, 2016 | by Ettinger Law Firm

SOME LIMITED RELIEF

Patients who rely on Medicare sometimes experience sticker shock after being released from the hospital only to find out that because some hospital administrator classified their stay as “observational” that they must pay a large portion of the final bill. Many times a doctor will seek to have a patient admitted for any number of reasons, only to have a bureaucrat reclassify the patient’s time at the hospital as observational. Such a designation will mean that Medicare will not pay for this time in the hospital. For Medicare to pay for a hospital stay, the patient has to be an admitted patient for at least three days (three midnights in the hospital).

Observational status does not equate to an admitted patient in Medicare’s own set of self defined definitions. That may be quite different to the patient who went to the hospital and received a number of drugs and tests during their time their and was consistent with the majority of their non-surgical stays in a hospital in life. In an effort to address these obvious problems that will only grow with time, President Obama signed a bill that required hospitals to warn patients that their stay will be considered observational in nature and that they are not being admitted under Medicare’s rules, which may result in a bill from the hospital that they will have to pay. The Notice of Observation Treatment and Implications for Care Eligibility Act would have to inform the patient that they are going to receive outpatient services under Medicare’s rules which requires cost sharing from the patient and that the observational status does not count towards the necessary three day inpatient in order to transition to a skilled nursing care facility.

Insurance Companies Receive Medicare Revenue Boost

Published on: April 30, 2015 | by Ettinger Law Firm

Health insurers across the United States received a welcome surprise when they discovered that they will be receiving a 1.25% increase next year in Medicare revenue benefits. This declaration reverses a previous proposal by the U.S. government to decrease the amount of Medicare benefits that insurance companies would receive in order to bring it in line with other government programs for the elderly and disabled.

Medicare Benefits for Insurance Companies

The U.S. government has been slowly decreasing the amount of Medicare benefits received by insurance companies in a bid to bring private Medicare coverage equal to other government aid programs. This year, insurance companies received four percent less in benefits than 2014, and the original proposal for 2016 included benefits cuts of another 0.9%.

Back to the Basics: NY Medicaid Eligibility & Protecting Assets

Published on: March 24, 2014 | by Ettinger Law Firm

The New York Medicaid program is a critical lifeline for millions of residents. Unfortunately, many remain confused by some of the complex details. It is common to have only a fragmented understanding of how Medicaid works from random discussions with friends and neighbors or by hearing snippets of news clips discussing the program.

One of the most misunderstood aspects of the system is the “spend down” requirement. Medicaid is a need-based program, and so qualification requires one to have assets below a very low threshold. But that does not mean that everything you own will be lost before qualifying for Medicaid.

Medicaid Misunderstandings.

New York Medicaid “Look-Back” Period & Proper Records

Published on: January 22, 2014 | by Ettinger Law Firm

The price of nursing home care in New York is staggering. It is not uncommon for a stay to cost upwards of $15,000 – $20,000 per month. This is a burden that many New York seniors can not afford to pay. After all , many local residents are only living on small fixed incomes, and coming up with $180,000 – $240,000 per year to live in a skilled nursing facility is unthinkable.

For most resident the only alternative is support via the New York Medicaid system. But residents can usually only qualify for Medicaid if their non-exempt assets are “spent down.” In our state, the allowable amount of total assets is only $14,550. There are complex rules about what assets count toward this amount, but a NY Medicaid lawyer can explain whether things like a long-time family home can be saved or if retirement accounts must also be drained.

Look-Back Period

New York Nursing Home Evacuation Plans

Published on: May 3, 2013 | by Ettinger Law Firm

The reverberations of Hurricane Sandy’s impact on the city are far from finished. We will be cleaning up and adapting for many months–likely years–into the future. Considering the predictions of some, we may even have to deal with large storms of this magnitude on a far more consistent basis. It affects all areas of life–including things like senior care and nursing home operations.

Many New Yorkers were shocked to learn of the goings-on at some long-term care facilities hit hardest by Sandy. Stories have been told of seniors stuck in upper levels of flooded facilities for days without power. Many questions have been raised about the management of the long-term care facilities and confusion over why the senior residents were not evacuated. In fact, in large part because of the struggle with NYC nursing home evacuations during Sandy, the Center for Medicare and Medicaid Services (CMS) will release new disaster planning for all nursing homes in the coming year.

Looking to the future, local residents are advised to understand evacuation plans for long-term care facilities where loved ones reside–or to ask about such plans when making nursing home choices. An AARP story recently profiled nursing home evacuation plans, pointing out the critical issues that facility caregivers need to consider. It is worth browsing the list to get an idea of the questions that owners and operators in New York need to be asked to ensure that seniors are protected in case any manner of natural or man-made disaster strikes requiring quick action.

NAELA Journal Article on Future of Medicaid

Published on: April 18, 2013 | by Ettinger Law Firm

It can can a confusing, scary, and stressful time for all New Yorkers who use the Medicaid system for necessary health care or for those who suspect they may need it down the road. Not a day goes by that news does not break at either the state or national level regarding payment cuts, service trimming, changes to qualifications, and more.

Considering the complex political dynamics involved in any major decision regarding the New York Medicaid system, it is next to impossible to make predictions with certainty. But many experts in the field are more than eager to share their ideas about what the program might look like in the future.

For example, some may be interested in a recent article a the journal published by the National Association of Elder Law Attorneys (NAELA). Entitled “Whither Medicaid,” the comprehensive article takes a look at all of the major notions about how Medicaid might disappear in coming years and how it may be saved via different alternative arrangements. The article can be read for free online in it’s entirety here.

Audit Raises Questions About New York Medicaid Financial Situation

Published on: March 22, 2013 | by Ettinger Law Firm

Reuters published a story this week on the latest audit of the New York Medicaid system which has given leverage to those hoping to use financial worry to trim the system and the state budget overall.

We have previously discussed the audit by the Centers for Medicare and Medicaid Services which found that the federal government overpaid the state by billions of dollars in recent years. The actual audit is still not yet complete, but federal officials are set to conclude by the end of this month. It is only then that the full scope of the situation will be known and the effect considered. The story notes how the overpayment may ultimately wreck havoc on the state’s financial health just as some were hoping things were finally settling down.

All of this has placed a pall over the current work in Albany where legislators are working to approve the state’s next budget–around $140 billion.

Legislators Issue Call to Protect Medicare & Medicaid From Fiscal Cliff Talks

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

Talks between President Obama and Speaker of the House John Boehner to avert the “fiscal cliff” continue this weeks. While not the only leaders involved in the effort, most disagreement on the issues exist between the President and House Republicans. Some observers are confident that the parties will reach an agreement before the January first cliff. However, members of the public remain skeptical, and many are rightly worried about how the automatic cuts and tax increases will affect them.

New York seniors are likely wondering whether their Medicare or Medicaid support will be changed in any way as a result of going over the cliff or in a compromise to avoid it. While we will not know for sure until things are more settled, some members of Congress recently came forward to issue their support for protecting the full value of the programs.

As reported by Now NY, the group of Democratic Senators and House members held a conference this week arguing that no deal to avoid the cliff should include cuts to Medicare or Medicaid. This is stark contrast to some other policymakers who argue that there is no way to get a deal without actually conceding some budget cuts for those programs.

Happiest Nursing Home Staff Members Work at Nonprofit Facilities

Published on: January 5, 2012 | by Ettinger Law Firm

Making the decision to place a loved one in a nursing home is no routine matter. Emotions run deep during this time, when families struggle to balance the senior’s need for close care and safety with their concerns about the quality of life available in these assisted-living facilities. Our New York elder law estate planning attorneys have helped many families with this process. We appreciate that there are usually two big questions that come up: (1) What is the best facility for our loved one? and (2) How are we going to pay for it?

In answering the latter question, New York elder law attorneys will explain that the costs can either be paid out of pocket, via use of private long-term care insurance, or through the New York Medicaid system. The former question is a bit more challenging, because so much subjectivity is involved. The answer for each family is different. The exact type of care needed, proximity to loved ones, and similar details need to be considered when choosing which nursing home is best. Of course, as a general matter, every family will want to ensure that the nursing home they chose is one free of chronic neglect, mistreatment, and abuse. Many elder care advocates have explained that when it comes to safety measures, study after study has found that nonprofit nursing homes outperform for-profit facilities. One long-term care doctor explained, “Most studies show that nonprofits do a better job of caring for patients, but we’re not sure why that happens.” This is an important consideration for families deciding where to send their loved one.

A post this week in the New Old Age blog from the New York Times recently discussed another interesting comparison between for-profit and nonprofit homes: the employees are happiest at nonprofit nursing homes. This may be part of the reason why care at these facilities is superior. At the end of the day, the quality of life for those in these facilities is dependent on the work performed by the hands-on caregivers. Therefore, how those caregivers perceive their job is likely to play a key role in their day-to-day actions. The nonprofit employees were happier overall for a variety of reasons: their ability to help set policy, more supportive managers, and availability of adequate resources.

The Medicaid Asset Protection Trust (MAPT) – Do’s and Don’ts

Published on: April 13, 2010 | by Ettinger Law Firm

by Michael Ettinger, Attorney at Law The Medicaid Asset Protection Trust (MAPT) is a technique commonly used by elder law attorneys. It consists of an irrevocable trust, usually set up by a parent of parents sixty-five and older. One or more of the adult children are named as “trustees” to manage the trust for the benefit of the “beneficiaries” who remain the parents during their lifetimes. For example, the parents retain the right to the exclusive use and enjoyment of the home and the income from all of the trust assets. The establishment and “funding” of the trust, i.e. retitling the home and the investments in the name of the trust, starts the five year look-back period running. After five years, those assets become exempt and are protected from the costs of long-term care.

Once the MAPT is established, there are certain things the parties can and cannot do. Below are a list of the “Do’s and Don’ts” concerning the MAPT.

Do’s