Medicaid Planning

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?”

What Does Elder Law Even Mean?

Published on: January 23, 2013 | by Ettinger Law Firm

The legal professionals at our firm provide elder law and estate planning services. Many community members are familiar with the basics of estate planning. Tasks like designing wills, creating trusts, and putting inheritance plans into place are understood by most when thinking about “later in life” legal issues. However, elder law is a bit less clear. What does it actually mean?

While there are many definitions, a good one was put forward on a recent story on the issue published in Wealth Management. Essentially, the authors of the material suggested that elder law can be reconsidered as “quality of life planning” to maximize the value the last two to three decades of one’s life.

In general this focuses on long-term care. Securing the proper care is critical for seniors to thrive in their golden years. But even though seventy percent of Americans will need long-term care at some point in their lives, the process of obtaining it can be incredibly confusing, complex, and, in some cases, downright impossible. An elder law attorney is responsible for assisting at these times by either putting plans in place early on so that the long-term care is available in the future or working when “on the nursing home doorstep” to protect assets while ensuring the necessary care is available.

Consumer Voice Updates on Filial Responsibility Laws

Published on: December 17, 2012 | by Ettinger Law Firm

Few seniors have the resources to pay for long-term skilled nursing home stays. As we have previously discussed, New York maintains one of the highest average cost per day rates at these facilities. For most families, those costs are far more than they are able to pay from their own income and savings. That is one reason why the elder law attorneys at our firm urge consideration of long-term care insurance (LTCI). However, LTCI premiums remain too high for many, and so Medicaid is generally used to provide for necessary care.

Some facilities are actually resorting to another option to ensure they are paid for providing care–getting adult children to foot the bill. Recently, the Consumer Voice–one of the nation’s leading nursing home resident advocacy groups–published information on the use of filial responsibility laws. While enforcement of rules based on these statutes remains relatively rare, some argue that more and more facilities will take a look at pursuing adult children to increase payments.

Local residents should know that New York currently does not have a filial responsibility law on the books. Some neighboring states do have these rules however, including New Jersey, Pennsylvania, Massachusetts, and others. Those with loved ones in facilities in one of those states need to be aware of the possibility of a facility filing suit against an adult child for unpaid nursing home bills.