New
Medicaid Proposal Threatens coverage for
Millions
of Elderly
{In
the last issue of the Elder Care Law Alert we discussed the President's
recently announced proposal to change the fundamental nature of the
Medicaid Program. Because
this proposal is of such significance to the elderly, we are reprinting
below an Article on the subject that was written by ElderLawAnswers, a
National Web-Based Elder Law Information Service of which Marshall and
Associates is a member}.
Date:
02/06/2003
Written
By: ElderLawAnswers.com
The
Bush administration's proposal to overhaul Medicaid jeopardizes the health
and safety of millions of elderly and disabled Americans who could
suddenly find themselves ineligible for Medicaid coverage, elder law
experts and patient advocates tell ElderLawAnswers.
Although
it is unlikely that current nursing home residents would be evicted,
millions of frail elderly and disabled individuals who would qualify for
Medicaid coverage under the current system could fail to qualify under the
Bush administration's proposal.
Unable
to pay for nursing home care on their own, these patients "would stay
where they are now, with family caregivers or many times alone,"
predicts Priscilla Chapman, Counsel and Director of Government Relations
and Policy for the National Committee to Preserve Social Security and
Medicare. "Those persons would die much more quickly as well because
they don't have any type of care."
"The
administration has decided these types of entitlements and social
insurance programs really shouldn't continue, that this is not in their
view the most appropriate use of government money," Chapman told ElderLawAnswers.
To
understand the administration's plan and how it would affect the elderly
and disabled, it is useful to know that there are two kinds of Medicaid
beneficiaries: those whose incomes are so low that the states must
cover them, and those with slightly higher incomes who are covered under
optional state Medicaid programs. More than half of the more than 4
million elderly Medicaid recipients are eligible through such optional
programs, according to the Kaiser Commission on Medicaid and the
Uninsured. In 35 states, for example, the elderly and disabled can qualify
for Medicaid coverage of nursing home care by deducting their medical
costs from their income.
It
is these optionally eligible individuals who would be affected by the
administration's proposal. Currently, the states must obtain permission
from the federal government to set up such optional coverage and must
adhere to strict federal rules aimed at protecting those who are covered.
The administration's plan would do away with all such guidelines and
protections. States could create their own rules regarding who should be
covered and what protections they would receive.
"The
states could apparently make up whatever rules they wanted for spend-down,
or not have spend-down at all," says Charles Sabatino, Assistant
Director of the American Bar Association Commission on Legal Problems of
the Elderly. "They could wholesale rewrite the Medicaid spousal
impoverishment rules and the transfer of asset rules and pretty much have
a free hand."
Patricia
Nemore of the Center for Medicare Advocacy raises one dire possibility.
Without federal protections, "possibly adult children could be asked
to supplement nursing home rates and could be held financially responsible
by states for their parents' care," she warns.
Despite
all this freedom, in the long run the states could end up with far less to
spend on Medicaid recipients. The administration's proposal, which must be
approved by Congress, would give states an extra $12.7 billion over seven
years, but then would effectively ask for that money back later. In the
meantime, the money would be in the form of inflexible "block
grants". If a state's Medicaid spending rose because of an economic
downturn or higher medical costs, the state would have to make up the
difference. Under the current program, the federal government shares the
costs, even as they rise.
"If
state spending went up beyond the cap, states wouldn't get any federal
financial participation, they'd be on their own," Sabatino told ElderLawAnswers.
"And costs are going to go up, so this fiscal relief, the block
grant, is pretty much a wolf in sheep's clothing. It's labeled as fiscal
relief but it's a real straightjacket fiscally and could result in a
reduction in benefits, a reduction in populations covered, and a reduction
in the rights of beneficiaries."
Chapman
points out that Medicaid is the only source of public funding for
long-term care. "Although Medicaid may not be the best way to do it,
the solution is certainly not to do away with the Medicaid program,"
she says. "The solution is perhaps to put in place a long-term care
financing system that would include self-pay, long-term care insurance for
those who can afford it, but retain a social insurance program for the
most vulnerable among us."
[Added
Note from Jeff Marshall:
Here in
Pennsylvania
Medicaid
{Medical Assistance} provides health care coverage for 1.5 million
Pennsylvanians, including low income children and persons with
disabilities, as well as the elderly. The Federal Government matches every
dollar
Pennsylvania
spends
on Medical Assistance with $1.21 of federal revenues.
This allows
Pennsylvania
to
stretch its dollars to provide more of the health care benefits needed by
its citizens. If implemented,
the Administration's Medicaid block grant proposal can also be expected
to have a severe impact on Pennsylvania nursing facilities and safety net
providers such as hospitals which will have to continue to provide care to
individuals who, without Medicaid coverage, no longer have the ability to
pay.]
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Medicaid
Misconception #5.
If
I get Medicaid, the State will put a lien on my home
Here
is the next instalment in our discussion of some of the most prevalent
misconceptions about Medicaid and the rules for payment of nursing home
costs.
Misconception
# 5
If
I get Medicaid, the State will put a lien on my home
The
Truth:
No. If you apply for Medicaid, the state will not put a
lien against your home. However,
after your death,
Pennsylvania
may attempt to be repaid for the
amount of Medicaid benefits that you received - but only under certain
limited circumstances.
The state can
only try to get repaid if you own a home or other assets which will pass
to your probate estate at your death.
Even if your home does pass to your estate, the state must
nevertheless postpone its claim:
(1)
Until the death of your surviving spouse;
(2)
Until the death of your child who is blind or totally and permanently
disabled;
(3)
Until the date your surviving child turns age 21;
(4)
Until the death of, property transfer by, or vacating of a home by your
brother or sister who has an equity interest in the property and who has
been living in the home for at least a year.
If you own
your home jointly with your spouse, and your spouse is still living at the
time you die, the state has no estate recovery claim against your home.
The state's
repayment claim is referred to as the "Medical Assistance Estate
Recovery Program" or just "estate recovery" for short.
Pennsylvania only has a claim against your estate if you were age
55 or older when you received Medicaid payments for nursing facility care
or Medicaid financed home care or related hospital care and prescription
drugs.
Estate recovery
acts somewhat like a death tax because it takes effect only upon the death
the person who received the benefits. It is curious that, while the
federal government is doing away with the federal death tax for the
wealthy, it requires states to seek estate recovery when a Medicaid
recipient dies owning nothing but a modest home.
If you want
more information about how Medicaid Estate Recovery works in
Pennsylvania
, read Attorney
Marshall's article on our website.
Other
examples of Medicaid Misconceptions are posted on the Marshall &
Associates website at www.paelderlaw.com/news.html.
In
future editions of the Elder Care
Law Alert, we will discuss
additional
Medicaid misconceptions.
Stay
Tuned!
7th
Annual Professional Update Scheduled
in
Williamsport
and
Wilkes-Barre
The
Elder Law Firm of Marshall & Associates will soon be presenting its 7th
Annual Elder Law Update. This
year our topic is: Caring
For the Elderly, A Crisis in
America
.
Among this year's speakers will be Robert Rosenberger, President
of the Greater Pennsylvania Alzheimer's Association and Ron D. Hill,
head of the Pennsylvania Department of Public Welfare's Estate Recovery
Program. In addition,
attendees will get an update of important new legal developments by
Certified Elder Law Attorney Jeff Marshall's.
And you can get those confusing Medicaid questions answered at our
popular Question and Answer Session.
The professional update is FREE and open to social workers,
financial
planners, and other elder care network professionals.
Space
is limited, so make your reservation today!
Call
1-800-401-4552
Dates
& Times of the 2003 Update
Tuesday,
April 22nd
7:30 AM to 12:00 PM
The
Radisson Hotel,
Williamsport
or
Thursday,
May 8th,
7:30 AM to 12:00 PM
The
Woodlands,
Wilkes-Barre
Also
From Marshall & Associates .
Upcoming
Seminars
"Understanding the Rules: How to Qualify for Medicaid
Payment for Home and Nursing Facility Care"
-Wednesday,
March 19th,
6:30
PM
,
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-Thursday,
March 20th,
6:30
PM
,
The Radisson,
Scranton
-Saturday,
March 22nd, 10 AM,
Evangelical
Hospital
,
Lewisburg
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March 25th at
6:30
PM
,
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-Wednesday,
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6:30
PM
,
The Radisson,
Williamsport
-Saturday,
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10:00
AM
,
The Radisson,
Scranton
-Saturday,
April 26th at
10:00
AM
,
The Radisson,
Williamsport
-Wednesday,
April 30th at
6:30
PM
,
Evangelical
Hospital
,
Lewisburg
-Saturday,
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10:00
AM
,
The Woodlands,
Wilkes-Barre
Reservations
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