Medicaid Eligibility Varies by State and by Unique Case

Medicaid is a government program that provides access to medical care for individuals and families who are otherwise financially unable to receive healthcare or medical treatment.  Eligibility for Medicaid is primarily determined by an individual or couple’s financial assets and income.  The maximum monetary limit for each of these is determined by each state, but consistency does exist among most states’ requirements.  

Medicaid financial requirements for participation, with the exception of a handful of states, require an asset limit of $2,000 for an individual or $3,000 for a couple.  This is the norm across the nation.  In addition, most states placed a limit at less than $1,000 for an individual’s income and a limit of less than $1,300 for a couple’s income.  Additionally, Medicaid typically allows an individual or couple to retain ownership of a house and vehicle and does not include these possessions in its consideration of assets.  A financial “look back” of 5 years further exists nationwide, which prevents individuals from quickly transferring their assets to another’s possession in order to qualify for Medicaid.   

Interesting trends in Medicaid income and asset limits reveal that states that maintain higher costs of living reflected these costs in their Medicaid eligibility requirements - Hawaii, Florida, and New York allowed the highest income and asset limits.  For example, Hawaii has the highest income limit, allowing nearly $2000 for a couple and nearly $1500 for an individual.  New York exceeded the asset limit of every other state by far, allowing an individual to retain nearly $15,000, while a couple is allowed more than $20,000 in assets.

While most states make their asset and income limits public, some states require an individual to file an application for Medicaid or to speak with a state worker about their situation in order to determine if they are eligible.  However, nearly all states with publicly displayed financial qualifications for Medicaid include a disclaimer that individuals may still be eligible even if they do not meet the listed qualifications.

Qualifying for Medicaid seems to be a highly personalized process.  While guidelines and limits are presented by many states, the lack of Federal regulation for Medicaid allows for customized cases and flexible financial limits.  Find more information on Medicaid qualifications in your state and search for a Medicaid nursing home in our directory of 18,000 nursing homes nationwide. 

Angela Manhart, Caregiverlist Blogger

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Chicago Hospital CEO's Discuss New Healthcare Law

Chicago area hospital CEO's actually are welcoming the new healthcare law - - yes, it is not perfect, they admit, but it is a step in the right direction.  It is refreshing to hear the viewpoints straight from those who provide health care.

Crain's Chicago Business hosted the panel which included Pamela Davis, CEO of Edwards Hospital, Ramanathar Raju, CEO of Cook County Hospital, Sandra Bruce, CEO of Resurrection Health and Jim Skogsbergh, CEO of Advocate.

Some of the issues they all agreed upon:

Medicaid pays far less than the cost of care

Current Course is Unsustainable (people are living longer and Medicare not set-up to handle)

Social Issues and Obesity Impact Higher Care Costs

Unreimbursed Costs are Hindrance (Provena wrote off $124 million in unreimbursed costs last year)

Listen to this panel of hospital CEO's to learn more about the realities of the current healthcare system and why these CEO's are welcoming changes through the new healthcare law, with concerns that everyone may not be covered due to political wrangling.  They predict that hospitals of the future will be more accountable and efficient and integrative.  This means more integration of home care and physician care and accountability for outcomes.

Caregivers for seniors, many times, do not have health insurance under our current system and because many people never have healthcare until they retire and qualify for Medicare or Medicaid, health issues are allowed to escalaate.

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Doctors Soon Required to Report Payments from Drug Companies

Medical doctors often receive payments from drug companies for "consulting", speaking and conducting research.  Sometimes this is a good thing and sometimes, research has shown, this is not so good.  This then contributes to influencing treatment decisions and contributes to higher costs via more expensive drugs and medical devices.

For instance, blood pressure can be naturally lowered through diet and breathing exercises - naturally.  How many doctors prescribe daily relaxation breathing for their patients with high blood pressure?

Diabetics can also greatly influence their outcomes by proper diet and exercise - even up to 50% or more according to studies.

Now, the new health care law will require the medical doctors to disclose the payments they may receive from drug and medical device companies each year.  An analysis by the New York Times found that about a quarter of medical doctors take cash payments from drug and device makers and nearly two-thirds accept routine gifts of food, including fancy lunches and dinners for themselves and their staff.

And, doctors who accept these payment perks do prescribe more drugs than those who do not.

Under the new standards, if a company has just 1 product covered by Medicare or Medicaid, it will have to disclose all of its payments to doctors other than its own employees.  The federal governemtn will post the payment data on a website where it will be available for the public. This will hold everyone accountable.

Companies will be fined as much as $10,000 if they fail to report payments.  This should help curb Medicare and Medicaid fraud which has been as much as $6 billion in the past.

Senior caregivers should also report fraud when they see it, as they are the eyes for many seniors and their families.  Unneeded medical equipment and prescriptions have been popular ways for companies to tap into unnecessary Medicare and Medicaid reimbursements in the past.



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Medicaid Redesign in New York

Guest Blog Post By David A. Cutner, Esq.

Last January, New York Governor Andrew Cuomo appointed a Medicaid Redesign Team and tasked it with reversing a decades-long crisis of overspending and waste in our Medicaid system. The Redesign Team made a variety of proposals, a couple of which would have been devastating to the elderly and their spouses, and to disabled children and their parents.

Fortunately, two of the most problematical proposals were not included in the State budget that was approved on March 30th, but there are some changes in the law that are significant for Medicaid planning.

Probably the most controversial proposal from the Redesign Team was to use the 5-year penalty period in connection with applications for community-based benefits, including Medicaid home care. Since February 2006, as required by Federal law, New York has applied the 5-year look back to Medicaid nursing home applications, and has penalized uncompensated transfers.

The purpose of the 5-year look back is to determine whether the Medicaid applicant has transferred assets that could have been used to pay for care. The penalty calculation involves dividing the amount or value of the transferred assets by the monthly regional rate of nursing home care, yielding a period of time in months during which the applicant is ineligible to receive benefits. For example, a $100,000 transfer divided by the current New York City regional rate of $10,579 yields a 9.5 month Medicaid penalty.

While superficially it might seem logical to apply the look back and penalty to community-based Medicaid, any attempt to do so would be extremely difficult to implement, and very detrimental to patient care in many cases. This is because home care patients have widely-varying needs, and Medicaid does not cover any living expenses. Happily, the Redesign Team's proposal was omitted from the budget.

Many people are unaware that, in New York, there is no look back or penalty for transferring assets when applying for Medicaid home care. This remains the law.

The other highly controversial proposal from the Redesign Team was the elimination of spousal refusal and parental refusal. By eliminating spousal refusal, many applicants would have been ineligible for Medicaid benefits until the couple had spent down virtually all of their savings (including the individual assets of the well spouse) and had contributed a substantial share of both spouses income. Similarly, parents would have been required to spend down all of their savings before their disabled child became eligible for benefits.

Fortunately, this proposal was not accepted either. Spouses and parents need not be forced into poverty in order to secure care for their loved ones. (However, they remain subject to claims by Medicaid for contribution if their resources or income exceed certain limits).

One of the Redesign Team's proposals that was enacted is a revised and expanded definition of an individual's estate for Medicaid purposes. The expanded definition is obviously aimed at giving Medicaid the ability to recover greater amounts from the estates of Medicaid recipients. The expanded definition includes interests that have traditionally never been a part of the probate estate of a deceased person. These include retained life estates, jointly held property, and interests in trusts.

The expanded definition is problematical in certain respects, and at odds with legal precedent. For example, a life estate is extinguished upon death, and the holder of the remainder interest automatically becomes the 100% owner. Similarly, if property is jointly owned with right of survivorship, the survivor automatically becomes the 100% owner. It will be interesting to see how the courts decide Medicaid's estate recovery claims when they collide with these long-established rules.

Until the courts provide clarity regarding the application of Medicaid's expanded definition of estate, Elder Law practitioners will want to carefully consider their use and choice of trusts in Medicaid planning. While grantor, income only, trusts have been extensively used in the past, it may be prudent to consider substituting a family trust where the grantor retains no rights in the trust whatsoever.

Budgetary constraints at the Federal and State levels are going to put continuing pressures on Medicaid benefits, making it increasingly important for seniors and their families to seek advice from an Elder Law attorney and plan ahead.  Understand the costs for senior care and plan for your care before you need it.

Contributed by New York Elder Law Attorney, David A. Cutner.

Remember, Medicaid rules and benefits change by state. Learn about your particular state services.

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CLASS Act Passes Senate: Natl. Long-term Care Insurance

The Senate passed the Community Living Assistance and Support Services (CLASS) Act on Friday, December 4th, making this act an approved portion of the healthcare reform bill.  The word on the street is the healthcare bill will pass, in some form, and this portion of the bill has now been approved.

What is it?

The CLASS Act allows Americans to contribute, through payroll deductions, to this long-term care insurance program.  After 5 years of paying into the program, benefits may be paid, if assistance is needed for a minimum of 2 Activities of Daily Living.

The purpose of the program is to provide an alternative to nursing home care for people with disabilities and seniors.  It will also allow family members to be able to continue to work and pay for a caregiver. 

Average policy premium?  About $50 per month.

Average amount of daily benefit?  About $75 per month.

How will the benefit be paid for? Through the insurance policy premiums - - this was fashioned to follow how private insurance is operated - which can be extremely profitable when managed well.  The government did have actuaries crunch the numbers for this insurance program (yep, there is a reason why Warren Buffett, one of the wealthiest guys in the U.S.A., likes to buy insurance companies - - many more people pay into premiums than collect on them and interest can be earned on the money in the meantime).  The premiums will be age-adjusted and contributions must be made for 5 years before someone can file a benefit claim.  And, the government can't "borrow" from this money to pay for other programs.

By delaying and preventing nursing home admissions, the CLASS Act will also decrease costs for Medicaid, which only provides for care in a nursing home. 

The risk?  It will be important for participation rates to be high.

Learn more about the CLASS Act and read the statement prepared for the Senate by Massachusett's Senator Kirk, who filled former Senator Edward Kennedy's seat - - Senator Kennedy had been a proponet of the CLASS Act as a way to allow seniors and the disabled to remain in their homes and afford at least part-time care.



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Computerization of Health Records Benefits Seniors

President Obama's stimulus bill has passed and now we must hope that it is implemented with some oversight and accountability (the same accountability we want the banks and others receiving bail out dollars to uphold).

As with all bills that pass the House and Senate, this one too will include many items that cannot please all of us.  But one item I am happy about in the Economic Stimulus bill, and think all seniors and caregivers should celebrate, is this one:

"Making the immediate investments necessary to ensure that within five years, all of America’s medical records are computerized."

Many seniors and their family members have walked into the office of a new doctor - usually a specialist for a new diagnosis such as cancer, Alzheimer's Disease or Parkinson's Disease, only to find they must fill out pages and pages of paperwork to provide information about their medical history and insurance.  And we are the country that invented the internet?  We can drive past a toll booth without tossing a dime into the basket because of technology and we can pay all of our bills with a few clicks on a computer.  But walk into a hospital and they have no way to access your medical records, no way to find out what medications you are taking and no idea what Medicare insurance plan you are on.

It is time for our medical care to get up to speed with technology.  It is possible to do this in a safe and secure way (we transfer millions of dollars a day from one bank account to another via online bill payment).

This seems especially important knowing the senior population will more than double within the next 20 years.  With many industries already communicating information via cell phones, it is time for health care to at least be able to communicate via computers in preparation for a wired society.  This will be a massive benefit for seniors and their family members who often do not live in the same city and need a way to monitor the care.

You may learn more about the health care initiatives included in the stimulus plan on the White House website.  Definitely check in with your local Congressman and Senator to share any concerns you may have with them.  Corporations know that when you track all of your activity, you increase profitability and performance ---- definitely healthcare will benefit in many ways beyond just convenience by the computerization of medical records.

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