Medicaid Planning

Modernization to New York Medicaid Coming As Part of Affordable Care Act?

Published on: November 29, 2012 | by Ettinger Law Firm

Speculation was rampant over the past year regarding exactly how full implementation of the Affordable Care Act (ACA) (Obamacare) would actually affect the current healthcare programs, like Medicare and Medicaid. Now, with President Obama’s re-election in place and the long-term security of the ACA secure, we are beginning to see some possible ways that the program is going to alter current state practices. For one thing, it may act as a spur to modernize the interaction between various state agencies, including Medicaid.

For example, as discussed in a recent Albany Times Union editorial, the federal Centers for Medicare and Medicaid (CMS) is making a one-time offer to states of 90% matching funds for “modernization” efforts. What does this mean? States will have a significant incentive to spend some resources to improve the efficiency of its programs, including Medicaid. This increased matching fund effort was spurred by the “health exchange” components of the ACA.

In general, CMS pays 50% of Medicaid costs, and the state pays the remaining 50%. That is why Medicaid is deemed a joint state and federal program. However, as part of this new push to improve certain aspects of the program, when a state wants to work on a modernization project, instead of paying for half of the cost of the project, they would only have to pay 10%, with federal coffers taking care of the remaining 90%.

Medicare Funding & Nursing Home Overbilling

Published on: November 20, 2012 | by Ettinger Law Firm

One question many New York seniors (and their loved ones) considered during the presidential campaign was how each candidate’s election might affect programs like Medicare and Medicaid. While it is hard to say with certainty what changes, if any, will be made to these areas, much of the discussion between candidates centered around general approaches to tackling financial problems as they relate to Medicare and Medicaid.

In general, Governor Romney’s approach was more far-reaching, favoring structural changes to the programs, including shifting more responsibility to the states. It was claimed that this would result in more flexibility on top of cost savings. Conversely, President Obama was more inclined to focus on attacking “waste” within the system as well as fully implementing Obamacare to lower healthcare costs overall by better insuring all Americans.

Of course, with the President’s re-election, Obamacare is preserved and the approach championed by his opponents is less likely to become law. In fact, a new report out last week from the U.S. Department of Health and Human Services suggests that the administration may be going strong with its attempts to root out overbilling, waste, and fraud in the system.

Ensuring LTCI Fairness

Published on: October 30, 2012 | by Ettinger Law Firm

Elder law attorneys and senior care advocates frequently remind community members of the value of long-term care insurance (LTCI). The New York legal professionals at our firm advise those who we are assisting with elder law estate planning of the immense value of having this insurance in place so that family assets are not decimated in the event (often likely) that skilled nursing home or at-home care is needed down the road. There are ways to save some assets without LTCI when Medicaid is used, but the best approach is always to have the necessary insurance.

When deciding on LTCI, however, it is critical that you understand the details of the policy and act to ensure it will work as desired when necessary. In fact, with the importance of this insurance increasing, many state are getting more invovled, offering more regulations and guidelines so that community members are protected from unfair practices where LTCI is at issue. A story last week by NY Now discussed the ways that some states are hoping to iron out some “kinks” in the system.

The main concern is ensuring that policyholders actually receive full and timely payments from the providers. Of course, having an insurance claim denied or not paid quickly can lead to serious repurcussions, because familes are forced to scramble to find alternative arrangements for necessary long-term care. Even if they are eventually vindicated, the delay in insurance coverage can cause significant financial (and emotional) damage that cannot be fully recuperated. To avoid that situation, some states are implementing more streamlined appeals processes, so that those who have claims denied or delayed can press for their rights more efficiently.

Editorial on Presidential Medicaid Proposals

Published on: October 26, 2012 | by Ettinger Law Firm

In the back-and-forth of the presidential debates and the obviously skewed TV ads, it is hard for local seniors to make heads or tails of the different proposals that candidates have on the Medicare and Medicaid system. Millions of New Yorkers rely on the programs for their healthcare and long-term care needs. Nearly one in five New York seniors participates in the Medicaid program, as it funds 70% of all nursing home stays. It is natural for residents to be confused and downright worried about what changes may or may not be coming to the program.

Most concern focuses on potential changes that the challenger, Governor Mitt Romney, might make in the event that he is elected. Those concerns are likely amplified by Governor Romney’s choice of Congressman Paul Ryan as a running mate. Congressman Ryan previously focused much of his attention while in the U.S. House of Representatives on various sweeping financial changes, including alterations to the Medicare and Medicaid programs.

What are those possible changes and how will they affect local seniors? A recent editorial in City and State New York took a look at the Romney proposals and offered a critique of the long-term impact of the program proposals. It is critical to note that this particular editorial was crafted by a current Democratic Congressman who previously worked with President Obama. It remains important to collect as many perspectives as possible to get an idea of the real impact of these possible changes. However, the editorial does offer a helpful discussion of one perspective.

Elder Caregiving By Family Members

Published on: October 12, 2012 | by Ettinger Law Firm

The acting commissioner of the Dutchess County Department of Services for Aging, Veterans and Youth penned an article this week on the toll that elder caregiving takes on family members throughout the state. The purpose of the piece was two-fold: to recognize the amazing work done by so many local residents and to remind community members of the immense benefit of planning for the elder care they will likely need down the road.

The article, published in the Poughkeepsie Journal this week, refers to the recent AARP study which found that a staggering 42% of working-age U.S. citizens provided some form of unpaid elder care, with half of all citizens expecting to do that in the coming five years. In other words, this is not an isolated concern that affects “other people.” All of us, at one time or another, will have to deal with this situation.

Sadly, as noted in the AARP Report, the effect of providing this care (averaging 20 hours per week) is often more far-reaching than many suspect. It is not uncommon for elder caregivers to face limited work flexibility, denied leave, or even termination from their own paid job as a result of the care they are providing to their senior friend or family member. All of this is on top of data which suggests that senior caregivers has negative health consequences of their own. A MET Life study on the issue found that poor health was more common among those helping senior in poor health themselves.

Bronx Nursing Home Offers One-of-a-Kind Dementia Care

Published on: October 2, 2012 | by Ettinger Law Firm

In recent years there has been a push to alter care for seniors with dementia. Most arguments about superior elder care focus on limiting medication-only treatment options. These “chemical restraints” are still overused, with seniors in many nursing homes lulled into a near-stupor as a result of antipsychotic medication. In overcrowded or understaffed long-term care facilities, these drugs are often the only way that caregivers feel that they can handle the challenges that come with dementia and Alzheimer’s care.

However, just because medication is the most common way to deal with a resident with dementia does not mean that it is the best way. In fact, many elder care advocates argue that the best care steers clear of overuse of medication and provides tailored care that focuses on the individual senior and not the cognitive disease.

What does that individual care look like? One Bronx nursing home is receiving national plaudits for its work on the issue.

Proposed New York Medicaid “Personal Care” Cuts Halted By Court

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

Not long ago a few residents received some disturbing news–the New York Medicaid support that they counted on to survive was being cut back. Many of these community members had severe disabilities, needing help with every aspect of their life, from dressing and bathing to eating and traveling. Many seniors and those with disabilities receive help from at-home care workers around the clock so that they are able function in the least invasive setting possible despite their challenges.

Yet, in an apparent effort to recoup funds given back to federal officials following an overbilling case that settled in November, the New York City Human Resources Administration decided to alter the way some personal care was provided to residents. In particular “split-shift” at home care was curtailed. This care is provided to those who need help 24 hours a day, with two different care workers each taking a 12 hours shift. In it’s place, the city wanted to provide just a single care worker who lived with the Medicaid recipient.

New York City Medicaid Lawsuit

Massive Medicaid Fraud and Texas’ O.I.G Dollar Recovery Strategy

Published on: July 31, 2012 | by Ettinger Law Firm

Medicaid and Medicare frauds have been weighing heavily on states’ financial resources in the past years and New York is not an exception.

In the midst of solutions to this inter-state problem, eyes are focused on the Office of Inspector General at Health and Human Services Commission (O.I.G) – charged with investigating fraud among health care providers in Texas- who has revolutionized its method of dealing with frauds. Our New York Medcaid attorneys are intimately familiar with the important role the program plays in the lives of so many local residents.

The O.I.G’s strategy: A Fair Solution to Medicaid Fraud?

Is PACE Program Future of Senior Health Care?

Published on: July 6, 2012 | by Ettinger Law Firm

CBS News recently reported on glowing praise for a relatively small program seeking to help seniors live independently. Known as the Program of All-Inclusive Care for the Elderly (PACE), the program is being credited with helping many on New York Medicaid avoid being forced to move into nursing homes. For example, one New Yorker interviewed for the story is a 65-year old woman who faces a series of health challenges. Her osteoporosis has left her wheelchair bound, as she can only walk in small doses. Like many, the woman faced serious financial setbacks and is currently unemployed. With a history of chronic depression, the woman admitted that if she was forced to move into a nursing home, she doubts she would survive.

Yet, so far, she has been able to avoid the nursing home as a result of PACE. The program allows this woman, any other seniors is similar situations, to live at home and receive support from area day care center. Seniors can visit the center for various services, from coordinated medical care, social work support, and various activities, like yoga.

Our New York elder care attorneys appreciate the immense value of this program which allows more seniors to age in place.

Federal Government Overpays New York Medicaid System by $700 Million

Published on: May 18, 2012 | by Ettinger Law Firm

The Medicaid program is a joint federal and state effort–the public bodies split the cost. The state cost itself is further subdivided into payments made by county governments and those coming straight from Albany. This interconnected relationship is helpful in that it doesn’t place the burden too heavily on any single public entity. Yet, it also means that the New York Medicaid system is at risk for cuts and changes whenever either the county, state, or federal government faces budget problems.

That means that local residents are constantly bombarded with stories about how one government or another is seeking to alter the way the system works to trim costs. The program is an essential lifeline for many local residents. Each New York Medicaid attorney at our firm appreciates the stress that comes with wondering whether a loved one will be able to stay in a long-term care facility or be admitted to a new facility when faced with health problems.

The latest scare came this week as federal officials admitted that they overpaid New York State by a shocking $700 million in 2009 for Medicaid services. The causes for the overpayment are still being rooted out. Essentially, officials believe that the main problem was a faulty reimbursement formula for nine centers for the developmentally disabled. The Poughkeepsie Journal explains that the rate paid per resident at those facilities was four times higher than the actual cost of care and ten times higher than reimbursement rates paid at similar facilities.