Legislation
Could Slash Medicaid, Child Support, Food Stamps and other Social
Welfare Programs
Written
By: Attorney
Jeffrey A. Marshall
, CELA*
Congress
has turned its attention to budget cuts designed to reduce federal
spending on social welfare programs.
The cuts are intended to precede the passage of an additional $70
billion in tax cuts, later this fall.
The two houses of Congress are considering two
widely differing approaches to the budget cuts.
The House
Proposal
The more draconian House budget reconciliation bill
would cut $51 billion from entitlement programs for low-income children,
people with disabilities, the elderly, working families and legal
immigrant.
The House bill, HR 4241, would make it much more
difficult to qualify for Medicaid assistance to cover the costs of
long-term care. It would
change the penalty date resulting from transfers of assets from the date
someone gave money away to the date when care is needed and other assets
are exhausted. The House bill would also extend the "look-back
period" to five years.
The House’s proposed changes to Medicaid are
opposed by 39 aging advocacy organizations representing tens of millions
of Americans. Those opposing included:
AARP, The Alzheimer’s Association, The National Academy of
Elder Law Attorneys, National Committee to Preserve Social Security and
Medicare, Catholic Health Association of the
United States
, National Association for Home Care, Older Women’s League, and The
Retired Officers Association. In
testimony provided to the Finance Committee on June 15th, the nursing
home industry specifically opposed changing the start date of the
penalty period.
AARP CEO Bill Novelli stated "This would mean
that a lower income stroke patient could be prevented from entering a
nursing home, even if there were no alternatives, simply because she had
helped a grandson with college tuition years earlier. A private-pay
nursing home resident could be forced out of the home for a period of
time, even after all his assets were exhausted, because he contributed
to a hurricane victim."
The House bill would also curtail existing laws
designed to protect the home of a Medicaid recipient. It would deny
Medicaid coverage for lower income individuals who have substantial
equity in their homes. Many
seniors have seen their property values increase over the years.
AARP’s Novelli said, "In cities and states across the
country, older Americans may be watching their property values increase
while watching their health security fade away." Medicaid already
has the ability for estate recovery after a beneficiary dies. Novelli
went on to explain that, "Prohibiting coverage up front could
unnecessarily force people to sell homes that they have lived in for
decades or use reverse mortgages that require thousands of dollars in
transition costs.
The House bill also weakens current rules designed
to prevent spouses of nursing home residents, generally older women,
from becoming impoverished. It would force states to adopt the
“income-first” rule which can lead to poverty for low-income women
after the death of their husbands.
The House package was initially scheduled for a
vote on Thursday, November 10. However,
the vote was postponed when Republicans in the House conceded they did
not yet have the votes needed to pass it. All the Democratic members of
the House and a number of Republican moderates opposed the cuts to
social welfare programs. Other
House members opposed other provisions of the budget bill.
It is anticipated that the Republican leadership in
the House will try to bring the measure to a vote again.
The
Senate Proposal
The Senate passed much more moderate legislation on
November 3rd. The Senate bill, S.B. 1932, would have much
less impact on the poor and middle class.
The Senate bill achieves cuts to Medicaid and Medicare mostly
through provisions aimed at insurance and pharmaceutical companies
rather than at low-income beneficiaries. Unlike the House bill, the
Senate proposal does not cut Medicaid, food stamps, foster care, SSI, or
child support enforcement.
The Senate bill would close various Medicaid
“loopholes,” including the use of balloon annuities. It would
require states to impose partial months of ineligibility on transfers of
assets and treat certain promissory
notes, loans, and mortgages as countable assets.
It would treat
the purchase of certain life estates as a transfer of assets.
The Senate bill would also authorize the expansion
and coordination of Medicaid long-term care (LTC) insurance partnership
programs. Under these programs certain persons who have exhausted (or
used at least some of) the benefits of a private long-term care
insurance policy may access Medicaid without meeting the same
means-testing requirements as other groups of Medicaid eligibles. For
these individuals, means-testing requirements are relaxed at: (1) the
time of application to Medicaid; and (2) the time of the beneficiary's
death when Medicaid estate recovery is generally applied.
The LTC partnership program amendments would become effective on
October 1, 2007
and apply to long-term care insurance policies sold on or after that
date.
The
Future
The future of the Congressional budget proposals is
unclear. As described above,
the House and Senate proposals are at fundamental odds.
Republican conservatives and moderates are deeply divided,
especially in the House.
If the House is able to pass a budget
reconciliation bill, the different House and Senate versions must go to
conference where it may be difficult to draft a compromise bill that can
thereafter pass both chambers.
The Senate bill is available online at http://thomas.loc.gov/cgi-bin/bdquery/z?d109:s.01932
The House bill is available online at http://thomas.loc.gov/cgi-bin/query/query
(Search bill # H.R. 4241)
A more in-depth discussion of the provisions of the
House and Senate bills is available on the Marshall & Associates
website at http://www.paelderlaw.com.pdf/discussions.pdf
Advocacy organizations are asking individuals to
contact their Congressional Representatives, especially Pennsylvania
Senators Santorum and Spector, and express their opposition to the House
proposal and strong support for the Senate approach.
Attorney Marshall can be contacted at webmail@paelderlaw.com
or at 1-800-401-4552
New
Medicaid Qualification Amounts Announced for 2006
Written
By: Attorney
Jeffrey
A. Marshall
,
CELA*
The
Centers for Medicare and Medicaid Services (CMS) has announced a number
of new qualification and protected resource and income levels for
Medicaid programs beginning
January 1, 2006
.
Community
Spouse Allowances
In
general, when your spouse is in a nursing home or needs home care under
the PDA Waiver program, 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. For nursing
facility residents, 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, 2006
, the new base standards will
be as follows:
ü
Minimum Community Spouse Resource
Allowance - $19,908.00.
ü
Maximum Community Spouse Resource
Allowance - $99,540.00.
ü
Maximum Community Spouse Monthly
Income Allowance - $2,488.50.
Note:
The Minimum Monthly Income Allowance remains $1,604 - it will be
adjusted on
July 1, 2006
.
Federal
Benefit Rate
The
Social Security Administration has announced the SSI Federal Benefit
Rate Standards for 2006 as follows:
ü
Individual - $603.00 per month
ü
Couple - $904.00 per month
PDA
60+ Home Waiver Program
The
Federal Benefit rate is used to determine qualification for many
Medicaid public benefit programs including the Department of Aging 60+
Home Waiver program. The income limit for the Waiver program is equal to
300% of the SSI Federal Benefit rate. This means that effective
January 1, 2006
the new income ceiling should
be:
ü
$1,809 per month - PDA 60+
Medicaid Waiver Program Income Limit
Individuals with income above this limit cannot
qualify for the 60+ Home Waiver program.
Attorney Marshall can be contacted
at webmail@paelderlaw.com or
at 1-800-401-4552
Medicare Part D
--Do You Need to Join?
Written By: Lisa Barner, Marshall &
Associates’ Planning Specialist
Everyone with Medicare,
regardless of income, health status, or prescription drug usage is
eligible to sign up for prescription drug coverage (Medicare Part D)
from
November 15, 2005
through
May 15, 2006
. If you join by
December 31, 2005
, your coverage will begin
January 1, 2006
.
Before you decide to
enroll in Medicare prescription drug coverage, consider the kind of
health care coverage you have now. If you currently have creditable
coverage, you may not need to join a prescription drug plan. Creditable
coverage is prescription drug coverage that pays out, on average, as
much as or more than Medicare’s standard prescription drug coverage.
If you do not have
creditable coverage, and you fail to enroll in a Medicare drug plan, you
may have to pay a penalty if you later enroll.
But, If you currently have creditable coverage and lose that
coverage in the future, you have 63 days in which to enroll in a
Medicare Part D plan without being subject to the penalty in the
premium.
If you have coverage
through TRICARE, the Department of Veteran’s Affairs, or FEHB, you
should not have to do anything. These
plans are considered to be creditable coverage (as good as Medicare Part
D).
Coverage through PACE or
PACE Net (in
Pennsylvania
) is also considered to be creditable coverage, therefore, you will most
likely not need to do anything. You
can continue to receive your medications through the PACE program.
However, if you are a PACE recipient who would qualify for the
Medicare “extra help” lowest income subsidy, applying for Medicare
may actually save you money on your prescriptions.
Medicare’s lowest
income subsidy has current annual income limits of $12,290 for an
individual and $17,321 for a couple.
The resource limits are $6,000 for an individual and $9,000 for a
couple.
If you are a PACE
recipient and you would not qualify for the lowest income subsidy, you
are most likely better off with your PACE coverage and not enrolling in
a Part D plan.
If you have prescription
drug coverage through your (or your spouse’s) current or former
employer (or union), you need to find out if this coverage is
creditable. If it is
creditable, you may want to just keep this coverage and skip Medicare
Part D. You should have
received notice from the plan as to whether or not this coverage is
creditable. (If you have not
received this notice, you should contact your plan to obtain this
verification.)
Once you have received
this letter of creditable coverage, you should keep it as it will serve
as your proof at a later
date that you did indeed have creditable coverage.
You may need this proof so that you will not be subject to the
premium penalty should you decide to enroll in a Medicare Part D plan
after
May 15, 2006
.
If your coverage is not
creditable, you should consider either enrolling in one of the PACE
programs (if you meet the income limits) or enrolling in a Part D plan.
If you have a Medicare
Advantage plan (like an HMO, PPO, or PFFS), you should receive a notice
from your plan about your prescription drug choices.
If your Medicare Advantage plan is offering prescription drug
coverage, you will generally be required to obtain your prescription
drug coverage through that plan (if you should decide to join a Medicare
Part D plan). If you choose
to enroll in a Part D plan with a company other than your Medicare
Advantage plan, you may lose your other health insurance coverage with
the Medicare Advantage plan. You
should check to be sure that the coverage offered by your Medicare
Advantage plan is considered to be creditable coverage.
If you have coverage
through Medicare supplemental plans H, I, or J, you may need to take
some action. Most prescription drug coverage offered by Medigap policies
is not creditable coverage. This means that, in most cases, if you keep
your Medigap prescription drug coverage, and do not join a Part D plan
by
May 15, 2006
, you will have to pay a penalty in the premium if you choose to join
later.
If you choose to enroll
in a Part D plan, you should switch to a Medicare supplement (Medigap)
policy without drug coverage. (Be
careful in switching Medigap policies.
There are very strict rules on switching plans and companies.)
You should have received a notice from your Medigap insurance
company describing your choices.
If you are currently
receiving your prescriptions through the Medical Assistance program, you
will automatically be enrolled in a Part D plan if you do not do so on
your own. If you do not like
the new drug plan Medicare assigns you to, you can switch anytime to a
plan that you prefer. Just
call the new plan to obtain your enrollment materials.
When you join the new plan, your coverage under the old plan will
end automatically.
If you are one of the
beneficiaries that will be automatically enrolled in a Part D plan, you
can call 1-800-MEDICARE if you do not want Medicare prescription drug
coverage and you do not want Medicare to enroll you in a plan.
Or, as mentioned above, you do not have to take the plan that
Medicare chooses for you. You
have the option of choosing your own plan.
If you need help in making a decision about
Medicare’s new prescription drug coverage there are resources
available:
-
1-800-MEDICARE
-www.medicare.gov
-Area Agency
on Aging
-State
Health Insurance Assistance Program (1-800-783-7067 in PA)
Lisa can be contacted at lbarner@paelderlaw.com
or at 1-800-401-4552
Appealing a
Department of Public Welfare Decision
Written By: Perry Landon, Marshall &
Associates’ Planning Specialist
Individuals,
couples, and families receiving or applying for Medical Assistance
benefits may disagree with the reason for the denial or discontinuation
of their benefits. The PA Department of Public Welfare has a very well
defined system to hear appeals from applicants or recipients who are
affected by: 1) a denial or discontinuation of a service; 2) a change in
the amount of a service; or, an undue delay in acting upon an
application. Chapter 275.1
of 55 PA Code contains the general provisions regarding the
applicant’s or recipient’s right to appeal and to have a fair
hearing, whether it is related to an action or failure to act.
Applicants or recipients applying for Medical Assistance for
nursing facility or Pennsylvania Department of Aging Waiver services
must use the Department of Public Welfare hearings and appeals system if
they do not agree with the level of care decision or financial
eligibility determination.
Under the regulations, the request for the hearing
must be made within 30 days from the date of the written notice of a
decision or action by the County Assistance Office. The County
Assistance Office will provide whatever help the person needs in
requesting a hearing. The
County
Assistance
will offer the person the opportunity for an agency conference to
resolve the appeal. If the
appeal is not resolved at the agency level, then a hearing is held
either in person, or by a phone conference that is scheduled through the
Office of Hearings and Appeals.
The hearing officer will render the final
administrative action on the appeal within 90 days from the date of the
appeal. When the final
administrative action is not rendered within 90 days of the appeal, the
Deputy Secretary will notify the county office to authorize the
assistance effective the first day after the 90 day time limit expires.
This interim assistance is not subject to restitution except in the case
of deliberate misrepresentation of facts by the appellant.
Either party may request reconsideration of the
decision by the Secretary of Public Welfare within 15 days of the date
of the decision of the Director of Hearing and Appeals.
The Secretary is to respond to this reconsideration within 15
days of receipt of the request.
Perry can be contacted at plandon@paelderlaw.com
or at 1-800-401-4552
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
-Attorney
Jeffrey Marshall will present an update on Congressional Legislative Proposals to Change Funding for Long-Term Care
to the Elder Law Section of the
Pennsylvania Bar Association,
at the Holiday Inn East,
Harrisburg
, on November 17th at
11 AM
. (See the article above for more
information on these proposals.)
-Planning
Specialist Lisa Barner will talk about The
New Medicare Part D Changes to the Christian
Women’s Group at Mater Delorosa Catholic Church in
Williamsport
on November 17th at
12:00 PM
.
-Planning
Specialist Lisa Barner will provide a presentation on The New Medicare Part D Changes
to the American Women’s
Business Association on November 21st at
6:30 PM
.
It will be held at the Genetti Hotel in
Williamsport
.
-Attorney
Kevin Grebas and Planning Specialist Perry Landon will co-present an
in-service sponsored by the Lackawanna
County Area Agency on Aging. The
in-service is intended for aging care providers and will cover the
changes regarding Act 42 and its effect on married couples who are
applying for Medicaid funded long term care.
The in-service will be held on November 30th at
9:00
at the
University
of
Scranton
, Brennan Hall.
-Planning
Specialist Lisa Barner will provide a presentation on The New Medicare Part D Changes to Guy and Mary Felt Manor in Emporium on December 2nd at
2:00 PM
.
Back
issues of The
Elder Care Law Alerts
are available on our website.
You
can even search our site by a keyword
or phrase!
Do you have a friend or
colleague who would enjoy reading the
Elder Care Law Alert? If
so, please feel free to forward it to them. Simply use the “Forward” button on
your e-mail program.
To subscribe or unsubscribe to the Elder Care
Law Alert,
simply send your request to:
webmail@paelderlaw.com
*Attorneys
Marshall and Parker are certified
as Elder Law Attorneys by the National Elder Law Foundation under
authorization from the Pennsylvania Supreme Court.
