Elder Law Firm of Marshall & Associates

Some Seniors Will Lose Home Care Services Under Act 42

Written By: Attorney Jeffrey A. Marshall , CELA*

Some Pennsylvania seniors will lose their home care services as a result of a law passed by the state legislature in July. The new law will affect some low-income married seniors who are receiving benefits under the Department of Aging 60+ Waiver program.

The Waiver program provides home services to seniors who are so frail that they would qualify for nursing home care. Under this Medicaid-funded program, seniors who qualify can receive up to 6 hours a day of assistance to allow them to live at home instead of in a nursing institution. Most beneficiaries receive much less than the maximum amount of assistance. The Waiver program merely supplements the help being given by families, who still must meet most of their loved one's care needs.

The Waiver program saves money for the state because home care costs the Medicaid system less than half of what it pays if the senior is in a nursing home. It relies on family members rather than nursing home staff to provide the primary support for the frail senior. It represents a partnership and sharing of responsibility between government and families to meet the care needs of chronically ill seniors. It is a family support program that rewards personal responsibility and keeps families together.

Providing long-term care at home is a win-win for both government and consumers. Financially, the state pays much less for home care than for nursing facility care and seniors usually prefer to remain at home. As a result, use of the Waiver program has been expanding dramatically over the past few years. Currently about 15,000 seniors are receiving home Waiver benefits.

In the past, the state made it easier to qualify for Medicaid for home services than for nursing home care. Before Act 42, Pennsylvania did not pool together the assets of both spouses when determining financial eligibility for the PDA 60+ Waiver. The income and savings of the non-applicant spouse were not counted. As a result, it was often much easier for a married applicant to qualify for the home Waiver program than for institutional Medicaid benefits. The goal was to encourage nursing-facility eligible seniors to stay home, if possible.

Act 42 changed the rules. Under Section 441.8 of Act 42, the assets of both spouses must now be pooled together, the same as if one spouse were in a nursing home. Assets owned by the healthy spouse will make the frail spouse ineligible for benefits. This will make it much more difficult for married individuals to qualify financially for Waiver. In addition, the new rules will be applied to seniors who are currently receiving home care under the program. Many of these individuals are going to lose their benefits.

Section 441.8 of Act 42 represents a curious policy decision by the state. It will discourage families from choosing the home care option in favor of more costly nursing facility care. It wastes family care-giving resources. It separates families. It may end up costing the state more than it saves, since many seniors whose care needs could be met at home with just a little government assistance, will instead be institutionalized.

As of this writing (mid-September 2005), the provisions of Section 441.8 have not yet been implemented. However, it is anticipated that the new rules will be in force before the end of this calendar year.

The Pennsylvania legislature could postpone the implementation Section 441.8. This would give the Welfare and Aging Departments time to train staff and issue appropriate regulations. It might even give the state the chance to "run the numbers" and reconsider whether this change is good policy for Pennsylvania .

If you agree that the new home care rules should be postponed, please contact your state representatives and express your opinion. Ask them to "amend Act 42 to postpone the effective date of Section 441.8 and require the Welfare Department to follow the regular rule-making process."

People can make a difference if they make their voices heard. Information on how to contact your Senate and House representatives appears below. You can write, phone, or e-mail your representatives.

For an illustration of the effects Act 42 is likely to have on one couple, click on the following link http://www.paelderlaw.com/waiver_illustration.html

To find your state representatives and contact them, click on the following link or paste it into your browser: http://www.legis.state.pa.us/cfdocs/legis/home/find.cfm.

Attorney Marshall can be contacted at webmail@paelderlaw.com or at 1-800-401-4552

Saving on Prescription Drug Costs

Written By: Attorney Jeffrey A. Marshall , CELA*

Like most Americans, seniors are struggling to meet the surging cost of the prescription drugs they need.

U.S. retail sales of prescription drugs totaled $179.2 billion in 2003 and drug costs are rising faster than overall national health spending. It's unfortunate, but seniors pay an especially large share of the price.

The government reports that consumers pay 30 percent of prescription drug costs out of pocket - $53.2 billion of that $179.2 billion. By comparison, consumers have much more extensive insurance for hospital costs; they pay just 3 percent of those costs from their pockets.

This is why prescription drugs accounted for 11 percent of national health spending, but 23 percent of total out-of-pocket spending by consumers.

Later this year, seniors and others on Medicare will have the opportunity to sign up for Medicare subsidized prescription drug coverage. Beginning January 1, 2006 they can enroll in a Medicare prescription drug plan. Between now and then, seniors will be flooded with information about their choices. For more information on the Medicare's upcoming Prescription Drug Coverage go to www.medicare.gov.

But Medicare will not be the only way for seniors to save on drug costs. Here are some other ideas you can use right now.

1. PACE and PACENET. Pennsylvania offers wonderful prescription coverage for seniors who have low or moderate incomes.

These programs cover seniors age 65 and over with incomes below $23,500 (single) and $31,500 (married). Many seniors who have qualified for PACE or PACENET may not even need to sign up for a Medicare drug plan. Information on PACE is available at your local area agency on aging or online at http://pacecares.fhsc.com/.

2. Veterans Benefits. Are you a Veteran? If so, the Department of Veterans Affairs (VA) covers prescription drugs (after a small co-payment) for veterans who meet certain guidelines. The drugs must be prescribed by a VA doctor. Further information is available from the VA at 1-877-222-8387 or online at www.va.gov.

3. Pharmaceutical Company Programs. Most pharmaceutical companies and drug store chains offer discounts to many of their customers. These programs may have income limits (but sometimes do not) and co-payment requirements. They may require that applicants be Medicare recipients and have no other prescription coverage. These drug discount cards are usually free and there are no enrollment or annual fees.

Most major drug companies even provide free medications in some circumstances.

Many manufacturers participate in the Pharmaceutical Research and Manufacturers' Association (PhRMA). This program is particularly helpful to persons between 55 and 64 years of age or disabled who do not receive any prescription coverage. Each manufacturer has set its own eligibility guidelines, which include income limits. Typical income limits are $20,000 (single) and $25,000 (married). For more information on PhRMA call 1-800-955-0989.

Consumers can also research company programs through the Partnership for Prescription Assistance website at www.pparx.org/Intro.php.

4. Nonprofit Warehouse. If you are not eligible for any of the above drug discount card programs because you exceed the annual income limit or other requirements, you may still be eligible for the Nonprofit Warehouse Drug Discount Card Program which covers all drugs, has no income limits and has no age requirement. There is no charge for the card. The phone number is 1-770-541-7777 and the website is http://www.nonprofitwarehouse.com/kscriptcard.asp.

5. Medical Assistance (Medicaid). This program can provide prescription drug coverage (and medical coverage) for people with limited income and resources who meet other program guidelines. To find out if you qualify for Medical Assistance, contact your local County Assistance Office or the Pennsylvania Department of Public Welfare at (800) 692-7462.

6. Other ways to hold down drug costs.

Here are some additional tips:

∙ Ask your Doctor for free samples at every visit. Ask for as many free samples as possible. Pharmaceutical companies give doctors millions of drug samples each year. These free samples often go unused, so be sure to ask.

∙ Buy a 90-Day Supply - You "per pill" cost may be much less if you purchase a 90-day supply versus a 30-day supply. In addition, if your insurance requires a co-payment each time you fill your prescription, you may have fewer co-payments if you purchase a 90-day supply.

∙ Ask your doctor to prescribe generic drugs as much as possible. Also, be sure to ask your doctor to consider less-pricey older drugs that may not cost as much as newer ones.

∙ Review your medications with your doctor at each visit. There may be medications that you no longer need. It is also a good idea to review your list with your pharmacist.

∙ Use an online or mail order pharmacy. They offer competitive pricing on hundreds of the most popularly prescribed medicines as well as over the counter medications.

∙ Talk to your Doctor and pharmacist about using a pill splitter. Manufacturers may price some of the medications the same for all strengths. If so, the medications can be broken in half and save you 50%.

Some seniors purchase medications across the border from Canada and the United Kingdom at significant discounts from the price in the U.S. (Warning: the legality of importing drugs from other countries is open to some question, and quality concerns may exist.)

A number of states are beginning to provide consumers with assistance in obtaining less-expensive prescription drugs from other countries. Minnesota was the first state to launch a website with links to Canadian pharmacies. This site provides information about accessing lower-cost prescription medicine from both Canada and the United Kingdom . For information go to www.state.mn.us and click on RX Minnesota connect.

(A version of this article was previously published by the Williamsport Sun-Gazette).

Attorney Marshall can be contacted at webmail@paelderlaw.com or at 1-800-401-4552

Alzheimer's Association Memory Walks Slated for October

Written By: Melissa Bottorf, Director of Public Ed ucation & Marketing

Alzheimer's Disease affects more than 4.5 million Americans of every race, gender and culture and costs our nation at least $100 billion a year. Unless we find a way to stop it, up to 16 million Americans will have the disease by 2050. Every step brings new hope for better treatments & a cure.

Memory Walk 2005 is the nation's number one fund-raiser to help people battling Alzheimer's Disease. About 80 cents of every dollar you raise for the Greater Pennsylvania Chapter goes directly to promote research, find effective treatments and improve the quality of life of those affected by the disease. For a list off all walks in Northeast PA , go to www.alzpa.org

Montoursville Walk at Indian Park

Saturday, October 8^th, 2005

Registration at 10:00 AM Walk at 11:00 AM

Contact: Melissa Bottorf, Walk Chairperson 321-9008 or mbottorf@paelderlaw.com

Wilkes-Barre Walk at Kirby Park

Saturday, October 8^th, 2005

Registration at 8:30 AM Walk at 9:30 AM

Contact: Estella Killian, Regional Director 822-9915 or estella.killian@alz.org

Bloomsburg Walk at Columbia Mall

Saturday, October 15^th, 2005

Registration at 10:00 AM Walk at 11:00 AM

Contact: Estella Killian, Regional Director 822-9915 or estella.killian@alz.org

Melissa can be contacted at mbottorf@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 Tammy Weber and Planning Specialist Perry Landon will make a presentation on Protecting Your Assets From Long Term Care to the Danville Senior Housing Community on Wednesday, September 21 at 2:00 PM .

-Attorney Kevin Grebas will talk about Essential Estate Planning Tools at The Village of Greenbriar in Dallas on September 22^nd at 6:00 PM .

-Planning Specialist Jerry Petro will make a presentation on Planning for Long Term Care to the First Presbyterian Church in Clarks Summit on Thursday, September 22^nd at 7:00 PM .

-Attorney Matthew Parker will present a speech entitled Do You Have A Plan? Elder Law & Estate Planning Tips as part of Evangelical Hospital's End Of Life Lecture Series. It will be held at the Community Health Center in Lewisburg on Thursday, September 22^nd at 7:00 PM . For more information or to register, contact Niki Hockenbrock at 570-522-2690.

-Attorney Kevin Grebas and Planning Specialist Jerry Petro will make a presentation for the Alzheimer's Association's Conference on Individuals with Alzheimer's Disease and Developmental Disabilities on Friday, September 23^rd in Stroudsburg.

-Planning Specialist Perry Landon will provide an in-service to the Northumberland County Area Agency on Aging Caseworkers about Act 42 on Tuesday, October 4^th at 10:00 AM .

-Attorney Jeff Marshall will talk about Legal & Financial Considerations in Retirement for Muncy Bank and Trust's Fall Seminar on Wednesday, October 12^th at 2:00 PM . For more information, contact Maggie Aderhold at 570-546-2211.

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*Attorneys Marshall and Parker are certified as Elder Law Attorneys by the National Elder Law Foundation under authorization from the Pennsylvania Supreme Court.

1-800-401-4552

www.paelderlaw.com

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