Medicaid Planning

New York Nursing Homes & Poor Dental Care

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

Most horror stories about poor nursing home care include tales of grotesque “bed sores,” broken bones gone undiagnosed, and similar cases of obvious caregiving lapses. But the best way to measure the quality of long-term care facilities may not be to see how many of these “big” mistakes are made. Instead, it might be more appropriate to look into resident’s mouths.

As a New York Times article discussed last week, there is a chronic problem of poor (and virtually non-existent) dental care provided at far too many nursing homes. A facility’s attention to dental care may be a key indicator of their overall commitment to proper support.

For one thing, many seniors do not have dental insurance. Medicare usually does not cover basic dental care. Medicaid might, but many have reported problems finding local dentists who accept Medicaid coverage. Without private insurance, many seniors simply go without regular cleanings and preventative care. Following a medical setback, dementia, or other challenge, many of these seniors land in nursing homes already in poor dental health.

Back to the Basics: Understanding Medicaid Asset Protection Trusts in New York

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

The tremendous benefit of planning ahead for possible long-term care needs cannot be explained enough. The typical New York family is understandably most concerned about paying monthly bills, attending birthday parties, fixing up the house, and the thousand other activities that fill the day. Taking the time to think about serious illness, death, and inheritance often falls quite low on the priority list.

The motto, “I’ll cross that bridge when I get there” may work well for issues that cannot be dealt with ahead of time, but that is certainly not the case when it comes to long-term care and similar elder issues. Planning makes all the difference, not just for the senior, but also their family. That is why it is critical to fight the inertia and be prudent about planning.

The MAPT

Comptroller Claims New York Medicaid Still Rife with Waste

Published on: July 16, 2013 | by Ettinger Law Firm

News about potential fraud and waste within the New York Medicaid system keeps on coming. It seems as if every week there is a new allegations of practices which unnecessarily cost the state money in unnecessary Medicaid payments. With Governor Cuomo’s continued focus on rooting out problems with the system, we can likely expect even more information to come out regarding these issues in the next few months.

In fact, just last week the Capitol Confidential published a story discussing how the New York Comptroller, Tom DiNapoli, recently released two new audits which suggest widespread waste in the system.

One of those audits suggests that the NY Department of Health paid out more money for certain procedures than is allowed under current Medicaid rules. The administrative rules for Medicaid set specific maximum rates for certain procedures. Care providers—from nursing homes to hospitals–know those set rates. Those facilities do not necessarily get to set their own price.

DOMA Decision May Affect Medicaid Long-Term Care Benefits

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

Does the high-profile U.S. Supreme Court opinion in Windsor v. US related to the Defense of Marriage Act (DOMA) affect elder law issues?

It might.

As discussed in a new release from a long-term care insurance think tank, the Supreme Court’s ruling will have an effect on same sex couples and Medicaid benefits. As noted in detail elsewhere, because of the DOMA decision, same sex couples lawfully married in their own state (like New York) are now treated as married by the federal government.

Battles Continue Over New Medicaid Eligibility for NY Home Health Programs

Published on: June 25, 2013 | by Ettinger Law Firm

In an effort to more efficiently use state funds, over the past few years the New York Medicaid program has been closely analyzed by state groups looking to root out fraud. Those investigations have returned hundreds of millions of dollars back into the programs following problematic practices at New York nursing homes, senior day care facilities, and many other settings.

While rooting out excess and fraud is a net positive, one must not forget the real lives that are affected any time that changes are demanded by program officials. Many New York seniors are in delicate situations, and any time that a nursing home, at-home provider, or other entity is no longer able to operate as a result of bad practices, many seniors struggle to deal with caregiving changes.

Finding Good Elderly Home Care in New York

Be Careful With “Pop Up” Senior Centers in New York

Published on: June 21, 2013 | by Ettinger Law Firm

Long-term care is big business. For many years now, companies that work in these fields have grown in size, scope, and influence, emerging as powerful entities making significant profits. There is nothing inherently good or bad about the changing nature of the industry so long quality, affordable options exist for seniors and their families.

Yet, in recent years observers have noticed that the increase in need for senior care services creates a natural business opportunity which are leading to some questionable practices. Take, for example, the growth of “pop up” senior centers in New York. The Brooklyn Eagle recently reported on these facilities and the scrutiny that is being directed their way.

City Council Questioning

NY Nursing Home Kickback Settlement – Reminder of Need to Make Careful Nursing Home Choices

Published on: June 19, 2013 | by Ettinger Law Firm

The New York Medicaid program has been making many headlines in recent months. Implementation of the Affordable Care Act and efforts to control state spending all have significant implications for the program. Interestingly, these developments have opposing outcomes. As the Affordable Care Act provisions are unrolled the program will be expanded, offering services to more New Yorkers. Conversely, the state’s push to control costs and root out fraud limits services in a few ways, sometimes impacting local seniors and their families.

Fraud Repayment From Estate

On the fraud issue, the NY Daily News reported last week on a settlement reached between the Attorney General and the estate of a former nursing home owner.

Audit of NY Office of Medicaid Inspector General

Published on: May 29, 2013 | by Ettinger Law Firm

The latest developments with the NY Medicaid program relate to concerns about the performance of the state Office of Medicaid Inspector General (OMIG). The OMIG’s role is to ensure maximum efficiency of the program. Considering the constant chatter about possible program changes in order to save costs, the work of the OMIG is critical for all New York residents who rely on Medicaid assistance in any number of ways.

The OMIG identifies that its goal is “to enhance the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive, and wasteful practices within the Medicaid program and recovering improperly expended Medicaid funds while promoting high-quality patient care.”

However, many observers have grown worried that the office is not maximizing its capabilities, allowing unnecessary funds to go out, hurting the overall efficiency of the Medicaid program. Those concerns were likely amplified in recent weeks as information came out regarding the potential abuse of adult day care programs funded by Medicaid. In addition, a congressional panel recently issued sharp criticism of the NY Medicaid program. That panel noted that New York maintains the largest Medicaid program in the country ($56 billion), and that the ballooning costs may be related, in part, to poor investigation of Medicaid fraud and abuse. The federal government pays for a portion of all Medicaid services, and so federal decision-makers can play in role in state Medicaid policy,.

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