DPW Announces Increased Resource Limits

Written By: Attorney Jeffrey A. Marshall , CELA*

  The Department of Public Welfare (DPW) has announced that the resource limits for qualification for Medical Assistance (Medicaid) benefits has been raised to $8,000 for applicants for home and community-based waiver programs and for many nursing home residents.  In an Operations Memorandum issued November 4^th,2003 , DPW stated that it is increasing the resource disregard by $6,000 in order to facilitate the ability of individuals to receive services in the community rather than institutional settings. 

The change is intended to allow persons in need of long term care services in the home to have "additional resources to maintain their residence in the community," and to enable "those in an institutional setting to have sufficient resources to maintain or establish residency in the community."

The available resource limit has been raised to $8,000 for recipients of home and community-based service waivers, including the PDA 60+ Waiver Program, and for recipients of long term care services under Categorically Needy Non-Money Payment (NMP) Medicaid. 

The change is significant for individuals who are seeking to qualify for Medicaid to help pay for nursing facility or home care.  However, to benefit from the increase in the resource limit, applicants must meet certain income requirements. 

Residents of long term care facilities must qualify for Medical Assistance under the "categorically needy" classification.  Qualification as categorically needy requires the resident to have income of no more than 300% of the Federal Benefit rate.  This income cap is currently $1,656 per month with a scheduled rise to $1,692 per month in 2004. 

In the past, most nursing home residents qualified for Medicaid under a separate classification referred to as "medically needy" because it had the higher resource limit of $2,400. The medically needy program allows individuals to qualify for Medicaid by deducing medical and long term care expenses to reduce their qualifying income. The resource limit under the medically needy program remains unchanged at $2,400. 

Now, most nursing facility residents will likely prefer to qualify for Medical Assistance under the categorically needy classification, if possible, due to the new higher resource limit for that program.  For nursing home residents who meet the income requirements, the new rules effectively raise the amount of available resources they may retain by $5,600.  However, nursing facility residents who have income in excess of the cap will have to continue to seek qualification under the unchanged medically needy program rules.

To qualify for Medicaid home waiver program benefits, individuals were previously required to have no more than $2,000 in countable assets and income not exceeding the 300% of Federal Benefit rate ceiling. Under the new rules, the countable asset limit is raised to $8,000, although the income limit remains unchanged. Home care recipients who have income in excess of 300% of the Federal Benefit rate do not qualify for the Waiver program.  The new rules effectively raise the amount of available resources that may be retained by applicants for the PDA 60+ Waiver Program by $6,000. 

The PDA 60+ Wavier Program is a significant option for Pennsylvania residents age 60 and older who are in need of long term care services in the home.  Under this program, as an alternative to nursing facility placement, services in the home can be provided to people who are nursing facility clinically eligible.  It is called a "Waiver" program because the services are funded through a special waiver of certain Medicaid restrictions, freeing-up funds originally allocated for nursing facility payments.  The local Area Agencies on Aging (AAAs) have the responsibility of administering the PDA 60+ Waiver Program for each county, with financial eligibility being determined by the County Assistance Office.   

The new limits became effective October 31, 2003 .  They are unlikely to be applied to retroactive benefits for periods prior to the effective date.  

Expansion of State Prescription Drug Program Near

Written By: Attorney Jeffrey A. Marshall, CELA*

  On October 28th, the Pennsylvania Senate unanimously approved a bill to expand eligibility limits for the state's PACE and PACENET prescription drug programs for seniors.  A similar expansion was approved earlier by the Pennsylvania House.  Although the Governor supports the expansion, the two arms of the state legislature must reconcile differences in the two bills before submitting it to the Governor. 

It is anticipated that the legislation will be approved before the end of November with changes taking effect on January 1st.  Currently, approximately 224,000 Pennsylvania seniors are enrolled in these prescription drug programs and the expansion should make some benefits available to at least an additional 300,000 seniors.    

Federal Government Acts to Stem Importation of Canadian Drugs

Written By: Attorney Jeffrey A. Marshall, CELA

A recent issue of the Elder Care Law Alert discussed the growth in the number of Americans who are purchasing prescription drugs from Canada . That article can be found on our website at http://www.paelderlaw.com/assessmentlaw.html.

  On November 6^th, a federal judge approved a government petition to shut down Rx Depot, one of the firms helping seniors buy drugs from Canadian pharmacies.  U.S. District Judge Claire Eagan granted a request by the Food and Drug Administration to shut down Rx Depot and Rx of Canada, saying the companies were violating a federal law that allows only manufacturers to bring drugs into the country.  Rx Depot says it plans to appeal, but will comply with Judge Eagan's order unless another court blocks the decision.

It is estimated that between 1 million and 2 million Americans currently buy Canadian drugs through the Internet, through storefront operations like Rx Depot, or by crossing the border.  Savings vary depending on the drug, with some drugs costing over 50% less in Canada . 

In her decision, Judge Eagan wrote that, ``This court is not unsympathetic to the predicament faced by individuals who cannot afford their prescription drugs at U.S. prices.  However, the defendants are able to offer lower prices only because they facilitate illegal activity determined by Congress to harm the public interest.'' The judge suggested that the high price of prescription drugs should be addressed by Congress. (Congress is currently working on a Medicare "reform" package that could include provisions permitting importation of drugs from Canada ). 

In another action intended to deter the importation of less expensive drugs from Canada, the FDA has informed CanaRx Services, which supplies drugs to the city of Springfield, Massachusetts, that its operations are illegal. Springfield hoped to save $9 million by getting drugs for its employees from Canada .  Officials of many other state and local governments, including Illinois , Iowa , Michigan , Wisconsin and New York City , have all expressed interest in using Canadian pharmacies to lower drug costs for state employees and Medicaid patients.

Currently, the FDA does not appear interested in taking any actions to punish individuals who are purchasing drugs from Canada .  The FDA does warn individuals that imported prescription drugs may be unsafe. It contends that seniors should not trust the safety of drugs ordered from Canada .  However, given the substantial savings they can get, it is anticipated that many seniors will continue to purchase drugs from Canada .  As the FDA recognizes, it would be very difficult to prevent people from ordering drugs over the Internet, by phone, fax, or regular mail.

Government Website Provides Detailed Information on Providers of Home Health Services

Written By: Attorney Jeffrey A. Marshall, CELA*

  The Centers for Medicare and Medicaid Services (CMS) has released its Home Health Compare for the entire nation.  The data published on the CMS website provides information for consumers about all Medicare-Certified Home Health Agencies including the quality of care provided by individual home health agencies.  The data, which will be updated quarterly, is available at Medicare's consumer website at  www.medicare.gov  and through Medicare's help line at 1-800-MEDICARE (1-800-633-4227).

The information is intended to allow consumers to make more informed decisions about their health care while stimulating providers to improve the quality of home health care.  To develop the quality component, CMS convened a panel of experts and chose 11 home health quality measures for public reporting.  The quality measures include:

ü Four measures related to improvement in getting around (getting better at walking or moving around, getting in and out of bed; getting to and from the toilet and having less pain when moving around);

ü Four measures related to meeting basic daily needs (getting better at dressing, bathing and taking oral medicines correctly; staying the same and not getting worse at bathing);

üTwo measures related to medical emergencies (had to be admitted to the hospital and needed urgent, unplanned medical care); and

üOne measure related to improvement in mental health (being confused less often).

Home Health Compare is part of the federal government's continuing initiative to improve the quality of health care by expanding consumer access to quality-related information.  Last year CMS issued quality data about Medicare and Medicaid-certified nursing homes across the country.  The nursing home information is also available on the Medicare website. 

The Elder Care Law Alert has published several articles regarding nursing home comparisons and online guides to choosing a nursing home.  These articles are available online at:

http://www.paelderlaw.com/penaltydivisor.html

"Online Nursing Home Comparison Guides Provide New Resource for Nursing Home Shoppers"( June 25, 2003

http://www.paelderlaw.com/nhquality.html

"Government Publishes Information About Nursing Home Quality" ( Dec 20, 2002 )  

Spousal Protection Increases Set for January 1, 2004

Written By: Attorney Jeffrey A. Marshall, CELA*

  In general, when your spouse is in a nursing home, he or she will not qualify for Medical Assistance (Medicaid) benefits until your combined savings are reduced to a certain level.  That permitted level of so-called "available resources" varies with each situation.  The general rule is that the community spouse can keep ½ of the amount of available resources that were owned by the couple on the date of admission to the nursing facility.  However, this protected "Community Spouse Resource Allowance" is subject to a ceiling and a floor. 

In addition to being allowed to keep the resource allowance, the community spouse is also entitled to have a certain minimum level of income called the Minimum Monthly Maintenance Needs Allowance. The income allowance is also subject to a ceiling and a floor.  If the community spouse does not have the required level of income, the spouse may be allowed to keep additional resources or receive some of the institutional spouse's income.  

These community spouse resource and income allowances are adjusted annually.  Effective January 1, 2004, the new standards will be as follows:

ü Minimum Resource Allowance - $18,552.00.
ü Maximum Resource Allowance - $92,760.00.
ü Maximum Monthly Income Allowance - $2,319.00.

The Minimum Monthly Income Allowance remains $1,515.00 - it will be adjusted on July 1, 2004 .

 November is National Alzheimer's Awareness Month

  Since 1982, November has been National Alzheimer's Awareness month.  It's a time to re-commit to the fight against the disease and also raise awareness.  The Northeast Chapter of the Pennsylvania Alzheimer's Association is planning their 3^rd Annual Legislative Day in Harrisburg on Tuesday, November 18^th.  It will be an opportunity for volunteers to raise awareness about the Disease, share personal stories with elected officials and lend your voice as an advocate.  To make reservations, please call 822-9915.

 For more information about the Pennsylvania Alzheimer's Association, visit their website at www.alzpa.org  or call Estella at 822-6919.

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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

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