Medicaid Planning

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

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.

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?

Women May Pay More for Long-Term Care Insurance

Published on: March 5, 2013 | by Ettinger Law Firm

Many of the changes and new rules associated with health insurance as part of the “Affordable Care Act” (Obamacare) will only take effect over the next year or two. One of those new rules prohibits most health insurance providers from making premium pricing decisions based on one’s gender. However, those rules do not apply to companies that provide long-term care insurance.

Therefore it does not come as a huge surprise that the nation’s largest provider of such insurance–Genworth Financial–announced that they will soon being change rate plans to account for the fact that women are more likely to need paid long-term care. According to a Washington Post story, women seeking such insurance on their own will likely see anywhere from a twenty to forty percent increases in yearly long-term care insurance payments. Importantly, the change will only affect new policyholders, as current members should not be affected. Observers note that other long-term care insurance providers will likely follow suit.

The policy change was made, say the company, because of the fact that over ⅔ of all claims on the insurance are made by women. In order to stabilize prices, the company claims that the premium rates needed to better reflect the risk and ultimate need for long-term care. The increased claims by women are likely a product of the fact that they generally live longer and provide care to their own spouses. Men are far likelier to avoid having to make claims on the insurance because their health declines sooner and their spouse often provides care. Elderly women, however, often come to need support after their spouse has passed, and they do not have the luxury of receiving free care from a relative.

Does New York Need a Mandatory Elder Abuse Reporting Law?

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

It is commonly understood that elder abuse is a serious concern that often goes unreported. But there remains less certainty about the best ways to address the problem. A recent Buffalo News editorial argued that more needs to be done at the state and federal level to tackle the issues.

For one thing, New York is one of only three states in the country that does not have a law which requires reporting of elder abuse and financial exploitation. The idea is that community members–particularly those in situations where elder abuse might be observed–must be made aware of the gravity of the situation and effectively forced via the law to report their suspicions.

The story points to recent research by Cornell University academics entitled “Under the Radar: New York State Elder Abuse Prevention Study.” Disturbingly, the report found that for every case of elder abuse that is reported to authorities, another 44 cases are never shared. That estimate is similar to those made by previous researchers. When all forms of elder abuse are considered (including financial exploitation by family members), other studies have found that upwards of 95-99% of exploitation is not reported.

Challenging the New York Nursing Home Surcharge Tax for Private Payers

Published on: February 7, 2013 | by Ettinger Law Firm

Many seniors and their families only learn about the significant cost of nursing home care when they begin planning for it later in life. New York is one of the most expensive in the country, with annually costs reaching $100,000 or more to live in a skilled nursing facility. NY elder law attorneys and other senior advocates always recommend as early preparation as possible, because getting a jump on the issue keeps more options open. For the majority of residents, Medicaid support is usually needed. The earlier this is planned for, the more property can be spared for being “spent down” to qualify for Medicaid.

Conversely, some seniors of more means (or more early planning), may have saved enough personal assets to pay for nursing home care on their own. Some pay for care for a few years and then switch over to Medicaid when their resources are exhausted.

Unfair “Granny Tax?”