Additional Nursing Home Medicaid Funds
Approved
Written
By:
Jeffrey A. Marshall
, Certified Elder Law Attorney*
Like
other states,
Pennsylvania
is struggling with the staggering cost of
providing care for its nursing home residents.
A majority of
Pennsylvania
nursing home residents qualify for Medicaid.
This is the joint federal/state health care program that covers
nursing home costs for poor elderly and those who have become poor after
paying for the high cost of care. Medicaid
provides funding for over 70,000
Pennsylvania
nursing home residents.
Using Medicaid to pay for
long term care is especially beneficial to the state since a majority of
Medicaid funding is provided by the federal government.
This means that Medicaid allows
Pennsylvania
to leverage its limited state resources to meet
the needs of its elderly and disabled citizens.
As a result of the rapid
inflation in health care costs, states have been seeking ways to increase
the amount of Medicaid funds they receive from the federal government. In
2003
Pennsylvania
enacted Act 25 as a back-door way to increase
the amount of federal Medicaid matching funds it receives for nursing home
care. Act 25 assessed a fee on
nursing homes.
Pennsylvania
would pay the money generated by the assessment
back to nursing homes along with federal Medicaid matching funds. In this
way,
Pennsylvania
could increase its federal Medicaid funding.
All revenues generated by the assessment, plus the related federal
matching funds, would be used solely to increase payments for nursing
facility services provided by Medicaid nursing facility providers.
Unfortunately, the federal
government is interested in limiting its payments to the states and
refused to approve the
Pennsylvania
plan. For the past year and a half, state and
federal officials have sought to resolve this dispute.
In the meantime, without adequate rate increases, many
Pennsylvania
nursing homes suffered from a lack of
much-needed cash flow. Emergency
advances were required out of the Commonwealth’s reserves.
Just before Christmas,
Governor
Ed
Rendell and Senator Arlen Specter announced
that the stalemate has finally been broken.
The federal government has approved the
Pennsylvania
plan. This
means just under $300 million per year in additional Medicaid funding for
Pennsylvania
nursing homes for the entire four year life of
the nursing home assessment law. Almost all of the additional $1.3 billion
will be passed through to
Pennsylvania
nursing homes.
The governor announced that 78 percent of nursing homes in
Pennsylvania
will benefit from the additional federal money,
with increases averaging $267,000.
At a press conference, the
Governor said, "It would have been a disaster had we not received the
federal match." However Governor Rendell went on to note that, while
helpful, the federal approval does not solve
Pennsylvania
’s problems.
He stated that an early analysis of the budget for the next fiscal
year indicates that $1.6 billion more in funding will be needed just to
keep the same level of nursing home services.
The Governor’s comments
presage a looming battle over Medicaid between the states and the federal
government. Medicaid is high
on the Congressional Agenda for 2005 and attempts to restrict federal
outlays to the states are likely. Congressional
attempts to shift more of the cost of long term care for the elderly and
disabled to the states will be met with strong resistance by both
Democratic and Republican state governors.
If federal matching funds are reduced, states, nursing facilities,
and nursing home residents will all be big losers.
A copy of the Governor’s
Press Release on the Agreement is available online at http://www.state.pa.us/papower/cwp/view.asp?Q=439729&A=11
Attorney Marshall can be contacted at webmail@paelderlaw.com
or at 1-800-401-4552
________________________________________________________________________________
Department
of Public Welfare to Remove Homebound Requirement for Home Health Agency
Services
Written
By:
Jeffrey A. Marshall
, Certified Elder Law Attorney*
The
Pennsylvania Department of Public Welfare (DPW) has issued proposed
regulations which will remove the requirement that individuals must be
homebound to receive Medical Assistance-covered home health services. When
final, the new rules will allow for medically-necessary treatment to be
provided in the home for recipients who normally remain in the home, but
who from time to time may, with assistance, be able to go to a doctor's
appointment or to visit family for a holiday.
This change is part of the redirection of the system
of public financed health care to provide more services at home rather
than in more restrictive and expensive settings such as nursing
facilities.
DPW also proposes to soften the provision which
limits payments after the first 28 days of unlimited home health care to
15 home visits per month, per treatment plan. Under the new regulations, a
program exception may be granted to exceed this limit if ordered by the
attending physician's plan of care and deemed medically necessary. The
purpose of this change is to allow added flexibility in meeting medical
needs of recipients in the least restrictive and most cost-effective
setting possible.
The proposed regulation was published on
December 11, 2004
in the Pennsylvania Bulletin. It
is available online at www.pabulletin.com.
Attorney
Marshall can be contacted at webmail@paelderlaw.com
or at 1-800-401-4552
________________________________________________________________________________
Changes in Patient Pay Obligations for Nursing Home Residents
Written
By: Marshall & Associates’ Planning Specialist Lisa Barner
Typically,
when a nursing facility resident’s social security increases, his or her
patient pay obligation increases as well.
(The patient pay obligation is that portion of income a nursing
home resident must pay to the facility once he or she has qualified for
Medical Assistance benefits.) The
social security benefit amount changes in January of each year.
Therefore, the nursing home resident’s patient pay obligation
also changes in January. However,
in 2005, the patient pay obligation will not change until March.
Since the personal needs allowance of the nursing
home resident will increase from $30 to $40 a month in March, the County
Assistance Office will make their only change in the patient pay
obligation then. They will change the nursing home resident’s obligation
to reflect both the change in the social security benefit and the increase
in the personal needs allowance.
Lisa
can be contacted at lbarner@paelderlaw.com
or at 1-800-401-4552.
________________________________________________________________________________
Caregiving in the
United
States
Written
By: Marshall & Associates’ Planning Specialist
Josephine Balsamo
The
National Alliance For Caregiving in collaboration with AARP has published
a new research report about caregiving in the
US
. The report is intended to
update and expand knowledge about the activities of caregivers, the impact
of caregiving on their daily lives, and their unmet needs.
The study defined caregivers as individuals over age
18 who are providing one or more activities of daily living (helping
another get in and out of beds and chairs, get dressed, get to and from
the toilet, bathe or shower, eat, etc.) or instrumental activities of
daily living (helping another manage finances, shop for groceries, do
housework, etc.) for someone 18 years of age or older.
Here are just some of those findings that I found interesting:
It is estimated that there are 44.4 million American
caregivers providing unpaid care to individuals 18 years and older. More
than half (52%) say they provide 8 hours or more of care per week, and 1
in 5 (17%) say they provide more than 40 hours of care per week.
The average length of care-giving is 4.3 years.
A great majority of caregivers (83%) are helping relatives.
Nearly 8 in 10 care recipients are age 50 or older,
with the average age being 75. Caregivers who help someone age 50 or older
say the main problem or illness the care recipient has is aging, followed
by diabetes, cancer, and heart disease. (The most commonly reported
problem in caring for those between ages 18 - 49 was mental or emotional
illness). 23% of caregivers
reported providing care to someone who has Alzheimer’s, dementia, or
mental confusion. Caregivers
who say they care for someone who has Alzheimer’s, dementia, or other
confusion average more than 20 hours of care per week.
Half of all caregivers (50%) assist with activities
of daily living (ADL). About
one-quarter of caregivers (26%) provides assistance with three or more
ADLs. The most commonly
performed ADLs are helping the care recipient to get in and out of bed and
chairs, to get dressed, and personal grooming.
Although the majority of caregivers say they receive some level of
help from others, the majority say they assume the role as a primary
caregiver. 40% of caregivers
for care recipients who do not live in a nursing home supplement the care
with paid care through an aide or nurse, a housekeeper, or other paid
helpers. Nearly half of
caregivers (48%) say they have used some type of supportive service to
help care for the care recipient.
Requesting information for financial help for the
care recipient was the most common service sought.
The biggest unmet need reported by caregivers to find more time for
themselves. Caregivers say
they turn to the internet, a doctor, family, or friends, and other health
professionals for information about aspects of caregiving.
Caregivers say they use a range of coping mechanisms
to deal with the demands of caregiving.
The most commonly reported method was praying, followed by talking
with friends or relatives.
For further details go to www.caregiving.org,
click on “Reports and Products”, then click on “Caregiving in the
US
2004.”
Josephine
Balsamo
can be contacted at jbalsamo@paelderlaw.com
or at 822-6919.
________________________________________________________________________________
PA to
Send
SSI
State
Supplement Directly to Recipients
Written
By:
Jeffrey A. Marshall
, Certified Elder Law Attorney*
The
PA Department of Public Welfare has announced that it will begin
sending the state supplement portion of SSI payments directly to
beneficiaries. Supplemental Security Income (SSI) is a cash assistance program for
people who are aged, blind, or disabled and who have limited income and
resources. It is funded and administered by the Federal Government. In
addition to the federal grant, many states (including
Pennsylvania
) provide a small
amount of state supplemental funds to many SSI recipients.
The
2004 maximum PA state supplement for an individual living independently
was $27.40 a month, and $43.70 for a couple. (The supplement can be much
higher for individuals residing in domiciliary care or personal care
boarding homes.) Until now, the
Pennsylvania
supplement was
included in the federal check received by SSI recipients. As an
incentive for states to provide these optional supplements, the Social
Security Administration (SSA) had initially administered the state
supplements at no charge to the states; however, SSA eventually began to
charge an administration fee. That fee has now risen to $9 per check
and
Pennsylvania
has determined that it
will save money by sending a separate state check to beneficiaries.
“We
want to assure people that the amount of their payments won’t change,
nor will the date they receive the payments,” stated Public Welfare
Secretary Estelle Richman. “We will begin to make the payments directly
as a cost-saving measure.”
Individuals
who would like to know how to apply for the state supplement should
contact their County Assistance Office, or call the Helpline at
800-692-7462 (TTY/TDD users 800-451-5886).
Attorney
Marshall can be contacted at webmail@paelderlaw.com
or at 1-800-401-4552 ________________________________________________________________________________
Paralegal Catherine Lattin Joins M&A
Staff
Marshall
& Associates is pleased to announce the addition of Catherine A.
Lattin to our Estate Administration Department staff.
She has extensive experience in the legal field having worked in
legal services since 1977. A
life-long resident of
Williamsport
, Catherine received her Associate's Degree in Business Management from
Williamsport
Area
Community College
. She lives in
Loyalsock
Township
with her husband Tom and daughter Crystal.
Catherine can be contacted at clattin@paelderlaw.com
or at 570-321-9008.
________________________________________________________________________________
New Law Modifies Rules for Fiduciaries
and Survivors of Veterans
The
Veterans Benefits Improvement Act was signed into law on December 10th.
Title V of the law makes changes to the manner in which the VA deals with
fiduciaries for incompetent veterans. The Act requires VA to re-issue
veterans' compensation and pension benefits to beneficiaries when those
benefits were misused by a fiduciary if the fraud can be attributed to
negligence by VA. [A fiduciary is a person who is a guardian, curator,
conservator, committee, or person legally vested with the responsibility
or care of a claimant (or a claimant's estate) or of a beneficiary (or a
beneficiary's estate); or who has been appointed in a representative
capacity to receive VA payments.]
Several sections of the Act affect veterans'
compensation, pension, and burial benefits. For example, the Act requires
the VA to exclude life insurance payments from "income" when
determining veterans' death pension benefits. In the past, lump-sum
insurance payments often caused the surviving spouse of a veteran to have
deemed income that exceeded the threshold for pension qualification. The
text of the new law is available online at http://thomas.loc.gov/cgi-bin/query/z?c108:S.2486.
________________________________________________________________________________
In the Community…
The professional staff of Marshall and Associates will be presenting to
the following groups and organizations over the next couple of weeks.
Many of these events are open to the public.
If you would like more information or would like to schedule
someone to speak at your group, please contact Melissa at 321-9008 or at mbottorf@paelderlaw.com
-Managing Attorney Jeff Marshall will be interviewed
about Estate
& Long Term Care Planning on Lock Haven Radio Station WBPZ
this Monday, January 10th at
10:00AM
.
- Attorney Matthew Parker and Planning Specialist
Suzanne Starr will be presenting a full-day training on Elder Law to the Recreational
Coordinators Conference on
January 11, 2005
from
9:00AM-3:00PM
at Kramm’s Nursing Home in Watsontown.
CEUs will be offered for Recreational Coordinators.
-The Central
Pennsylvania
Food Bank is offering an
educational session on Essential Estate Planning Tools at the West
Ed
win Street Highrise on
January 19th, 2005
from
9:30AM-10:00AM
. Attorney Matthew Parker from
Marshall & Associates will be the speaker.
- Attorney Kevin Grebas will be making a presentation
on Essential
Estate Planning Tools for the members of the Trinity House at St. Stephen’s Church in
Plymouth
on January 19th from
11:00AM-12:00PM
.
-Health South
will be holding an open house at their new Lock Haven facility on January
27th from
3:00-6:00PM
. Planning Specialist Lisa
Barner and Attorney Matthew Parker will make a presentation on How
to Pay for Long Term Care at
4:00PM
.
________________________________________________________________________________
Marshall & Associates Now Offering
FREE In-Office Workshops
Marshall
& Associates is now offering free workshops for seniors, their
families and professionals who want to know more about paying and planning
for long term care. The
workshops are held in our
Williamsport
and
Wilkes-Barre
offices and last about an hour. These
informal discussions with our planning experts are a great opportunity to
learn about the options available to pay for care.
Reservations
are suggested, but not required. SIGN
UP ONLINE or call 1-800-401-4552 for
more information or to reserve your spot.
________________________________________________________________________________
Back
issues of The
Elder Care Law Alerts
are available on our website.
You
can even search our site by a keyword
or phrase!
________________________________________________________________________________
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_________________________________________________________________________
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________________________________________________________________________________
*Attorney
Marshall
is certified as an
Elder Law Attorney by the National Elder Law Foundation under
authorization from the Pennsylvania Supreme Court
© 2000-2005
Marshall & Associates www.paelderlaw.com
