New York Elder Law Attorney Blog

This week the USA Today reminded readers of the role that family members play in catching the onset of cognitive mental diseases in seniors, such as dementia and Alzheimer's. As any New York elder law estate planning attorney can attest, these issues are of particular importance in the legal context because mental issues can affect one's legal capacity. The ability to conduct estate planning, receive New York Medicaid help, or otherwise make prudent decisions for the future will be made more difficult if begun after dementia or Alzheimer's has set in.

By the very nature of the condition, the one who is suffering from these issues has difficultly identifying the problem themselves. That is why a family plays a crucial role in identifying the cognition problem and addressing it. As the article notes, "dementia can sneak up on families. Its sufferers are pretty adept at covering lapses early on." Often it is not until there is some major accident or life-threatening complication that adult children, spouses, and others become fully aware of the problem.

To combat the challenges of early detection, experts are calling on family members to be more involved. As part of the first "National Alzheimer's Plan," advocates are trying to raise awareness about the need for relatives to be diligent about a senior's actions to ensure mental cognition issues are caught as soon as possible. One advocate noted, "family input should be mandatory...it's the only way to know if the person really is eating enough and taking her medicines as she claims, and not forgetting to turn off the stove."

In addition, there is a growing call for primary-care doctors to take a more active role in detecting dementia early. For example, in a regular visit the doctor might ask "How are you doing?" Usually the senior patient replies, "Fine," and then the matter is dropped. This minimal discussion of basic life circumstances is too brief for the physician to have any way to ensure that the senior's mental condition has not reached a dangerous level.

On top of that, as part of the early detection programs, government officials working on dementia and Alzheimer's issues are trying to get families to conduct advanced planning. Having a Power of Attorney and Health Care Proxy are crucial as soon as dementia is diagnosed. No one is fully prepared for the challenges that aging can bring--particularly conditions that attack the mind. No amount of financial preparation or long-term care plans can make the process easy. However, the overall stress of the situation is less taxing when steps have been taken ahead of time to ensure that sticky matters like estate preparation and proper long-term care planning are decided ahead of time.

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Many residents remain completely unfamiliar with most aspects of New York elder care until the need for skilled long-term treatment is thrust upon them by a loved one's sudden health decline. For one thing, the high costs of the service catch most community members completely off-guard. Coming up with over $10,000 a month (or more) for this care is simply impossible for most areas families that have not planned ahead of time. On top of that, our New York elder law attorneys know that many are also surprised by the challenge of simply finding a suitable facility in the first place, regardless of the costs.

One peculiar aspect of the process, for example, is that men have a harder time finding a bed in nursing homes than women do. The situation was discussed last week in a post at the New York Times' "The New Old Age" blog.

It was explained that the problem has to do with nursing home demographics. A 2010 CMS Report noted what most intuitively suspect: two-thirds of all nursing home residents are female. In some specific areas, the rate of female use of these facilities is much higher. As our New York Medicaid lawyers often explain to clients, Medicaid--which pays for most nursing home care--only covers "semiprivate" rooms. These rooms usually house at least two residents with privacy provided, as in a hospital, by a curtain. Only residents of the same gender can live in each room.

That is where the demographic problem comes in.

Men who are seeking to enter these facilities cannot be put into a room where a woman already resides--even if there are open beds. Therefore, the man is forced to wait until there is a bed available in a room with another man. Considering the skewed demographics, there are a lot fewer male rooms, and the wait can last longer than many expect.

The financial demands on these skilled long term care facilities also play a role. For example, when residents leave a facility, there are often ways to make bed changes so that a room opens up to serve as a male room. However, many facilities are reluctant to do that, because the chance of a bed going unused in a male room is higher than in a female room. If the facility accepts a man and then three woman immediately call and want to move-in, they may have to turn those three down because they used an open room for the man instead of making it another female room. Most long-term care facilities are understandably loathe to not lose money on unused space, and so decisions about room assignments are often affected by the financial motives.

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The vast majority of residents receiving long-term care in nursing homes in our area participate in the New York Medicaid program. The program is a crucial state-federal effort that ensures seniors and the disabled have the access to life-saving, day-to-day care that they need. Recently, several influential federal officials have begun asking questions about one crucial aspect of the program: drug prescriptions. Essentially, the officials are focusing attention on the potentially excessive practices of some doctors in the program. The officials want to know if the alarmingly large amounts of drug prescriptions by some medical professionals are necessary (and safe) for the consumers who receive them.

Financial concerns are obviously involved in this particular investigation, but our New York Medicaid attorneys understand that this oversight can also be an important way to ensure that quality of care standards are met at these homes. For example, as discussed in a Pro Publica story published yesterday, many states, including New York, are being pressured to crack down on doctors who prescribe massive amounts of potentially dangerous drugs to seniors. The effort is being led by Senator Chuck Grassley who sent letters to three dozen states asking about efforts underway to investigate physicians who prescribed antipsychotic drugs and anti-anxiety painkillers with seemingly reckless abandon.

In the elder law context, these drugs have very real consequences for seniors. Nursing homes have long been known to provide antipsychotic medicine to residents for "off label" purposes in an effort to make the residents easier to control. However, recent studies have found that not only does this practice deprive seniors of the ability to be fully engaged in the world around them, but overmedication can be downright dangerous. There is actually a black box warning on antipsychotic medications explaining that use by a patient with dementia can lead to an increased risk of death. Yet, dementia patients still receive this medication in nursing homes across our area each day.

Now the Senator is hoping to crack down on the doctors who overprescribe these drugs. Unfortunately, a lot of work still needs to be done in this regard as most doctors face few punishments for prescribing large amounts of medications, even when they are unable to show that the prescription rates were necessary. Some doctors issued tens of thousands of prescriptions each year. For example, one physician wrote nearly 19,000 prescriptions for the antipsychotic drug Seroquel last year alone, totaling almost nine an hour for every hour of every workday.

In one bit of positive news, over the past few years New York was actually praised for cutting down on some of the most abusive practices. A few of the highest-prescribing physicians in our state who could not explain their actions have been kicked out of the Medicaid program--saving taxpayer dollars while keeping seniors safer.

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Yet another company, Northwestern Mutual, has recently issued a "Cost of Long-Term Care" study. Of course, the results indicate that the actual cost depends on a range of factors including what part of the country one lives, whether an at-home aide is hired, or whether one moves into a skilled nursing facility. As any New York elder law attorney can attest, our area is always at the very top of the list when it comes to long-term care costs. It is for that reason that it is particularly incumbent upon area resident to meet with an elder law attorney to plan ahead before the costs actually need to be paid. It is simply impossible for most families to bear the financial burden of this care on their own.

This latest research effort from Northwestern Mutual involved surveys from 6,000 different sources, including a mix of assisted living facilities, home health care organizations, and nursing homes. The researchers found that the hourly rate for home healthcare workers was anywhere from $33 per hour to $15 per hour. New York assistance was near the highest of the group.

Assisted living facilities had rates anywhere from $1,500 a month to just shy of $7,000 per month. As with home health care workers, our area has particularly expensive assisted living facility prices. In addition, it is often difficult to even get into one of these facilities, as many of the best have long waiting lists of folks hoping to get a spot when there is an opening.

Nursing home care is particularly expensive, both in New York and throughout the country. The average cost throughout the country is around $90,000 a year. However, rates in our area can rise to more than double that amount, usually over $10,000 a month. It is important to note that these costs do not even include related expenses like use of medical equipment, transportation, and medicine.

The research project also determined that right now there is a 66% chance that a senior over the age of 65 will eventually need long-term care. Similar surveys have identified that rate as even higher. Overall, that means that for most residents the question is not a matter of if they will need this care but when. With odds like those it is simply common sense to take the time to plan for the care ahead of time. Local residents who conduct even basic New York elder care planning can save hundreds of thousands of dollars in assets that otherwise would vanish had the preparations not be taken.

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Our New York elder law estate planning lawyers understand that handling long-term planning issues can be particularly delicate when there are second marriages involved. However, it is in these situations, with blended families, when this sort of planning is absolutely critical. Many adult children have natural concern when their parent remarries. Obviously there are inheritance planning issues, and it is vital that seniors who remarry make their wishes very clear about who they'd like to receive what. Failure to do so opens the door to strong disagreement and infighting between those involved. The family glue can come undone even among blood relatives, and there are often even less ties keeping fights in check when blended families are involved.

Beyond inheritance issues, local families should also take note of the New York elder law concerns which are implicated by second marriages and blended families. Decisions about naming a Health Care Proxy and Power of Attorney in the event of disability can present some disagreement when seniors remarry.

An article this weekend in the Laurel Leader-Call referred to another issue regarding the long-term care planning problem in the context of second marriages. The story discussed two seniors who met at an assisted living facility, fell in love, and married. Eventually one of the partners began a physical and mental decline and needed to be moved to a nursing home. The couple did not realize that Medicaid could have been applied for to help support those nursing home costs. If the partner whose health deteriorated passes away, their life savings may be entirely exhausted in providing for the long-term care. As a result, the surviving spouse is often left in dire straits when his or her own health deteriorates and they have a need for skilled nursing care. What often happens is that adult children are forced to scramble in crisis mode to figure out how to pay for the care the elder needs. A range of issues are present when those adult children are step-children who may not have as close a connection with the senior.

Blended families and second marriages raise a variety of concerns that should be accounted for by prudent families. Both estate planning and elder law issues are raised. The issues are often complex, and so professional help is always advisable. It is particularly important to ensure that the professional which is sought out has experience in both areas: elder law and estate planning. Failure to account for disability and long-term care issues may make inheritance and tax planning ineffective (and vice versa). All parts of the planning must work together to ensure that they are effective at the moment when they are needed.

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Confusion often reigns when one learns that a family member will likely need long-term skilled care. Finances are always an issue. With the average stay in a local nursing home running $11,000 per month, our New York elder law attorneys are acutely familiar with the financial challenges facing local families at these times. Few can afford to pay those costs out of pocket. Without long-term care insurance (expensive in its own right), most families instead turn to Medicare and Medicaid for support.

Many seniors on Medicare get understandably confused when trying to determine what long-term care is provided by the program. The short answer is: very little. The Centers for Medicare and Medicaid Services have produced a handbook entitled Medicare Coverage of Skilled Nursing Facility Care which is a good starting point for those hoping to learn more. In general, the takeaway is that Medicare will only pay for certain skilled nursing stays and never for those staying longer than 100 days. The first 20 days of qualifying care are covered completely, while anything more (up to 100 days) often requires some sort of copayment. To even qualify for that care a resident must have a qualifying hospital stay, need the care immediately after the hospital stay, and meet a few other requirements.

Conversely, Medicaid is the joint state and federal program that provides the most support for extended nursing home stays. That is why on the elder law side of our practice our New York Medicaid attorneys work closely with local seniors to help them apply for the program and save their assets from being consumed in the qualification process. Unlike Medicare, Medicaid is an income-based program, meaning that local seniors will have to show specific financial need before receiving the help. The application process which takes all of this into account has complex asset and transfer rules. Because it is a joint state and federal program, the qualification process is different in each state.

There are actually two forms of Medicaid: Community and Chronic Care. As the name implies, Community Medicaid is much different in that it provides certain resources for individuals who wish to remain at home in their community. When that is no longer an option and close nursing home care is needed, then Chronic Care Medicaid comes into play. It is this form of Medicaid that has a "five year look back" period for assets and transfers. That means that if assets--a home, stocks, savings accounts--were handed over to another within that period, the value of those transfers may take the form of a penalty period where Medicaid services will not be provided. However, there are various strategies that can be employed to protect against the loss of all of one's assets while qualifying for Medicaid. This is true even if one is on the nursing home doorstep. Professionals in the area will be able to explain those strategies and decide on the right course in your case.

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Yesterday our New York elder law attorney Bonnie Kraham Esq., had another article published in the Times Herald-Record. In the piece Attorney Kraham explains how it is common sense for middle class families to work to protect their assets from long-term care costs. The basic idea behind asset protection for seniors is simple: take advantage of legal tools so that assets can be passed down to children instead of lost to pay for long-term care. The wealthiest families have been using these strategies for decades, but more and more middle class families are coming to appreciate the benefits of protecting assets that have often taken a lifetime to accumulate.

As Attorney Kraham explains in the story, long-term care costs are high everywhere, but they are particularly significant in New York--roughly averaging about $11,000 per month. At the end of the day there are only three ways to pay for those costs: (1) out of one's own assets; (2) via expensive long-term care insurance; (3) through Medicaid. Few community members can afford long-term care insurance and most only have personal assets to pay for these costs for a limited time. That is why our New York elder law attorneys work with families by using available tools under the law to protect assets in these situations. The goal is to help families receive Medicaid assistance without losing their personal assets in the process.

To accomplish this goal Medicaid Asset Protection Trusts (MAPTs) are often created. Assets are then moved into the trust. Those assets can be protected from being taken to pay for long-term care costs. Government officials specifically designed the system to allow for such planning. For example, there is a five year "look back period" during which the government will evaluate to see if certain asset transfers were made. Those transfers will trigger a penalty period whereby Medicaid payments will be withheld. However, if planning is done beyond that five year window, then all assets can be protected without any such penalty.

A few have questioned the morality of asset protection. It is important to keep these New York elder law asset protection strategies in context. Asset protection measures have been used in various capacities for centuries. Estate taxes are routinely guarded against, and corporations shield personal assets from private ones. It is not be surprising or unfair for middle-class families to use the same strategies to pass on the fruit of their labor to the next generation.

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The New York Times published a blog post last week on a new effort called the "Conversation Project" seeking to make long-term care planning a kitchen-table issue. The project, spearheaded by former journalist and Pulitzer Prize winner Ellen Goodman, is the first step in a comprehensive effort to ensure that long-term caregiving is considered when all local, state, and federal policy and financial decisions are made. Ms. Goodman became involved in the project while helping her 92-year old mother in her later years. Being 70 years old herself, the journalist became incredibly frustrated with the confusing nature of the senior caregiving process and the lack of advocacy for those involved. Ms. Goodman was actually on Medicaid for a few years at the same time as her mother, a situation that our New York Medicaid lawyers know is becoming more and more common.

Many details of the Conversation Project are still being developed. At this point Ms. Goodman is leading a webcast in late January, has an online forum, and has an article being published in the upcoming Harvard Business Review's "12 Audacious Ideas" issue. The Institute for Healthcare Improvement in Cambridge is also acting as an unofficial sponsor of the project in its early stages.

In discussing the project, Ms. Goodman explains that the beginning of the advocacy effort involves massive communication. She noted, "Everyone has a story. We need to share stories of the good deaths and bad deaths of people we loved." She explained that more community members must demand access and information to help them ensure their story is not one of pain and unhappiness. Of course, every New York elder law attorney at our firm is familiar with how prior preparation plays a huge role in the quality of life experienced by seniors in their later years.

The Conversation Project is hoping to combine with other efforts which are pursuing similar goals. For example, a former head of the AARP has launched the Coalition to Transform Advanced Care (C-TAC). C-TAC states its mission as one to empower long-term care consumers and deliver policy changes for the benefits of an aging population.

Many of the activists involved in these efforts are surprised that there has not been more community outrage based on the often inadequate care provided to many seniors. They argue that Medicare and Medicaid have not kept up with the changing dynamics of the elderly population. One advocate noted that these days seniors "live too long and die too slowly, at enormous financial and emotional cost to themselves and their families."

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The Nieman Watchdog--Harvard's journalism faculty blog--recently published a commentary speaking to the looming "retirement crisis" and the problems with the federal government's current approach to dealing with it. The author notes that retirement planning is not what it used to be as many workers today are "facing a grim future in which the kind of retirement plans their parents were able to take for granted is out of reach." Our New York elder law attorneys have discussed these changing dynamics and the demand they place on thinking about long-term care plans in new ways.

The commentary notes that it is folly to presume that one will be taken care of in the future, because the growth of "defined contribution plans" (as opposed to "defined benefits plans") means that retirement savings often hinge on the performance of the markets. It is argued that this shift has made income from private pensions smaller and less reliable than in the past. That issue, coupled with rising health care costs, places a real strain on many retirement plans.

Considering those concerns, it is perhaps surprising that federal policymakers have spent most of their time discussing cuts to Social Security, Medicare, and Medicaid. The problem also exists at the state level, as New York Medicaid planners have been forced to watch as state policymakers consider a wide range of proposals to revamp the healthcare system that so many local seniors rely on for long-term care support.

Some suggest that the aging population combined with possible cuts to stalwart federal programs like Medicaid will ultimately send many more seniors into poverty. This is particularly true of those who have not conducted any elder care planning ahead of time. According to the latest figures from the U.S. Census Bureau, last month roughly 16% of all seniors were living in poverty. It is likely that the rate will rise significantly as seniors are forced to pay more for their health care to make up for possible program cuts. Right now seniors spend about 16% of their income in out-of-pocket health care costs. However, even under the current law, that rate is expected to increase to roughly 30% in the next few decades.

These frightening statistics are one of the reasons that researchers at the Center for Retirement Research at Boston College suggest that more than 50% of all baby boomers will not have economic security in retirement. The research identified "economic security" as income at 70% to 80% of their working wage.

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For decades those involved in elder care research have known that the vast majority of seniors would prefer to age in place at their own home instead of moving into a long-term care facility. Yet, our New York elder law attorneys know that for most of that time little was done to actually help seniors leave a nursing home or not enter it in the first place. Historically, only those who had conducted elder care planning well ahead of time (or were independently wealthy) had choices when they reached a point when they needed day-to-day living care.

Fortunately, times have changes. As an online article in last week's New York Times discussed, Medicaid rule changes now require senior and disabled care givers to be more proactive in helping these residents leave the facility if they are willing and able. In the past, most caregivers would ask residents if they wanted to move back to the community, but the law did not demand that they actually do anything to help the senior move. Now, if a resident mentions that they would like to move back home, the senior caregiver is obligated to connect the senior to an outside agency that will look into the feasibility of their moving back home.

The change reflects new national trends in long-term care. In the context of maximizing the quality of life for area seniors, this is a welcome development. The author notes that in the past "Medicaid, which pays for most long-term care, was spending way too much on care in the places nobody wanted to be--nursing homes--and very little on care in the places almost everyone preferred--their homes." The shift has been steady. In 1999, roughly 75% of Medicaid spending in this area went to institutional care. However, ten years later that spending level was down to 55%, with 45% going to home and community based services. The shift will likely accelerate even more as President Obama's "Money Follows the Person" program continues to take effect. It is helpful to note that this reallocation of resources still requires local residents to conduct New York Medicaid planning to shield assets from the going to pay for the program participation.

Along with the federal government, many more states are devoting Medicaid dollars to at-home care. Yet, New York seems to be lagging behind the pack. Along with Mississippi, New York is the only other state that has not seen any change in nursing home occupancy levels in the past six years. Some are concerned that part of the problem is the nursing home resistance to the proposal, because, as one advocate pointed out, "they make money keeping you in."

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All those with an eye toward New York Medicaid planning have been closely following the actions of the federal "Super Committee." This unique federal, bipartisan committee was charged with coming up with a long-term federal deficit reduction plan totaling $1.2 trillion over 10 years. Failure to reach an agreement on any plan will trigger automatic and deep cuts to a variety of federal funding areas, including Medicaid. Considering that New York Medicaid programs are funded jointly by the federal government and state government (including local governing bodies), the Super Committee's decision (or lack of decision) may ultimately have significant impact on local program participants.

We now know that the Super Committee has reportedly not reached an agreement. This means that the triggered cuts will likely take effect, so long as national leaders don't reach some other agreement. This presents a troublesome situation for all those who rely on these programs for basic services; though it remains unknown exactly what effect the potential cuts will have on local residents. In a pre-emptive move, New York Governor Andrew Cuomo sent a letter to the state's congressional delegation last week urging them to do everything in their power to prevent blanket cuts that may do much more long-term fiscal harm than good.

In the letter, reprinted in the Times Union, the Governor reminded our state's federal delegation that the Super Committee's actions or the resulting automatic cuts will "have a direct and significant impact on the finances and economy of the state of New York." Recognizing the long-term viability problems caused by our current federal debt, the Governor argued that progress can be made on the debt front without taking an axe to New York Medicaid and other programs that local citizens have come to rely on.

State Medicaid changes have made local news recently as proposals have been brought forward to save costs and shift the local government burden entirely onto the state. However, the state has thus far managed to avoid any major changes to reimbursements or qualification levels. Yet, the program may still be changed in ways beyond the Governor's control because of these federal issues. In his letter Cuomo explained how dramatic changes in Medicaid reimbursement rates may have a "catastrophic impact on New Yorkers and our economy." Proposed cuts in Medicaid and Medicare to the state may total $2.4 billion. Governor Cuomo noted that the result of such cuts would be "closure of fiscally fragile health care institutions, impact individual access to services, and displace thousands of heath care employees."

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The New York Times reported this week on a settlement reached by New York City officials which may have implications for all local seniors who rely on New York Medicaid services to stay in their homes. The problem began when New York City officials agreed to pay $70 million to settle a claim alleging Medicaid fraud. The case stemmed from federal accusations that the city approved Medicaid expenses for in-home care when cheaper nursing home care was available. The federal government pays for half of Medicaid expenses and so federal officials can bring suit if they believe that cities or states are not following Medicaid rules resulting in payment increases.

While the settlement ends the specific legal matter, our New York Medicaid attorneys know that there may be other repercussions as a result of the agreement. Medicaid rules can be complex, and cities and states are loath to make costly violations of those rules. As a result of this latest settlement, many observers have noted that city officials are taking protective measures to ensure better compliance with those sometimes harsh rules. Those measures may involve cutting at-home services to seniors who currently rely on them to stay living on their own.

Specifically, advocates explain that the city has now told at least a hundred elderly residents that it will reduce and in some cases discontinue currently available 24-hour at-home services. Much of this assistance--like bathing and toileting--is the only thing that is keeping residents in their own homes and out of nursing homes. There is a real fear that cut-backs in this care will ultimately force residents out of their homes. Dozens of disabled advocacy groups voiced that very concern in a letter to federal officials this week. The plea stated that "denials or reduction of services are the default position of an agency fearful of sanctions and audits."

For their part city officials acknowledge that they are becoming more vigilant about violating Medicaid rules. However, those rules are most often set by state officials, and any complaints about the requirements should be directed at the statehouse. Speculation remains rampant about changes that state officials may make in the coming months to the Medicaid system. The policies that they set with relation to the program dictate who qualifies for care and what care they can receive. Local residents should be sure to pay close attention to these developments to better understand how it might apply in their own case. However, at the end of the day, local residents are always best served by taking their long-term care plans into their own hands. Our New York elder law attorneys know that the earlier families plan, the better. When at-home care is desired--and it almost always is--the only surefire way to make it available is visiting with professionals well before the actual care is needed and arranging financial affairs to ensure the resources will be there at the right time.

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For years the New York Medicaid attorneys at our firm have helped local families navigate the Medicaid program's complexities. We guide families as they sort through the application process, protect property through use of New York Medicaid Asset Protection Trusts, and engage in similar planning strategies. Millions of families throughout our state depend on the program to receive the care that they need to get by each day. However, the popularity of the service has also threatened its long-term stability. That is why many observers have been closely watching lawmakers as they propose various programmatic changes that may affect individuals currently using the program as well as those who will likely apply in the future.

Yet, for all the "doom and gloom" discussion that seems to perpetuate, the state has actually received praise for its ability to save money without drastically altering the services available to residents. The Ithaca Journal commented this week on a Kaiser Family Foundation report which found that the New York Medicaid system was outperforming other states in efforts to keep spending in check. The report found that nationwide Medicaid spending increased 28.4 percent this year. New York, however, actually spent slightly less money on these services. The state has been able to avoid the significant increase in spending, say some experts, because of their increased use of managed care. In addition, New York eliminated a separate prescription drug plan for Medicaid receipts; the plan was folded into the managed care service. Other states may follow our lead. The article explains that the state's "redesigning the program appears to be the leading edge of a national trend."

Not only has the redesign saved state money, it may also have improved the actual services provided to residents. For example, the state's spokesman for the Division of the Budget claims that the restructuring has led to a major expansion in patient-centered medical homes and better care management for those with complex medical needs. The state has also added substance abuse screening procedures, expanded smoking cessation counseling services, and now requires hospitals to provide patient-centered palliative care.

The program expansion coupled with spending cuts is even more impressive considering that program participation has swelled. Since the onset of the recession in late 2007, Medicaid participants have risen by a million, now totaling nearly five million. This increase was expected as economic troubles nationwide typically lead to an increased reliance on Medicaid services.

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Syracuse News reported this week on public concern over changes that are about to take effect within the New York Medicaid system. Per the planned alterations, many local residents with developmental disabilities will lose their caseworkers as that task is soon to be outsourced to non-profit agencies in the state. Currently, many of these residents receive assistance from a group of public employees known as Medicaid service coordinators. However, these residents have been instructed that by the end of this week they must select a non-profit to take over this function.

Many community members are concerned about the effect the changes will have on their vulnerable family members with disabilities who have grown familiar with their personal caseworkers over many years. The service coordinators function as advocates for program participants, developing relationships with the clients and helping their family find the services that they need. Many coordinators have helped families find appropriate educational opportunities, arrange for respite care, and have linked participants with employment programs. Our New York Medicaid attorneys are aware of the complications that are intrinsic in working through the Medicaid system, as we also devote our time helping local residents work within the system to protect their assets while receiving the resources that they need to get by each day.

Cost-cutting is the state's motivation for changing the way the services are provided. The state spokesman for the Office for People with Developmental Disabilities reported that non-profit agencies already handle roughly eighty percent of Medicaid service coordination in the state. Nonprofit agencies explain that they are prepared to handle their expanded role. However, they also report that it may be difficult to complete the transition in a month--which is the goal of the administration. Even if the changes go through, there is a chance that families may be able to remain with the same service coordinator if that coordinator is hired by a nonprofit after leaving the state payroll. The program shift will allow the state to cut 300 service coordinators who had previously served about 10,000 local residents. Current service coordinators may try to approve an amended contract and submit it to the state in an effort to halt the layoffs. However, there is no guarantee that the privatization effort will be halted.

These latest New York Medicaid changes are part of a wide range of alterations that will likely take place over the coming years in an effort to help the state absorb the program's growing costs. Other proposed changes may affect the way that seniors and other program participants use the service to receive the extra care they need. Our New York Medicaid lawyers urge all local residents to visit with professionals to plan ahead for all long-terms health and financial concerns.

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The Wall Street Journal reported this week on an approaching milestone as the New York Medicaid program expects to enroll its five millionth member in the coming days. Enrollment totals were last released in August, at which point there were 4,963,000 people participating in the healthcare program. Membership has only increased as of late, and experts predict that the total will actually top six million by the end of Governor Cuomo's first term in office. The increasing popularity of the program has placed a strain on state and local budgets--it remains the single biggest spending area for the state government.

As it now stands roughly 26% of all state residents utilize New York Medicaid services in some form. That rate is 10% higher than the national average. Many government officials predict that changes are going to have to be made to account for the increased use of Medicaid. The head of the state's Association of Counties explained, "It's an unsustainable trend. The revenues from all levels of government just aren't there to sustain this growth."

However, members of Governor's Cuomo's team were more optimistic about the state's ability to handle the program's finances. The chief executive announced earlier this year a plan to cap state-funded Medicaid spending growth at 4% a year. The Governor's spokesman explained this week that the Medicaid Redesign Team had already been able to enact dramatic changes, and the program spending is running below the current cap. Unlike political leaders in many other states, the Governor has yet to enact any changes to Medicaid benefits or eligibility rules. Instead, Governor Cuomo has tried to account for the costs by lowering rates and shifting certain patients to managed care instead of fee-for-service coverage.

Program advocates explain that the ongoing recession, high unemployment rate, and decrease in employer coverage has made the program more important than ever for many local residents. Our New York elder law attorneys know that the staggering cost of long-term care makes it impossible for many middle-class seniors to receive the care they need outside of the Medicaid system. The program is a lifeline for many vulnerable elderly residents. However, it is the increase in seniors on Medicaid that is causing observers to fear for the program long-term fiscal stability. Seniors are more expensive to treat than nonelderly adults. Yet, over the next two decades demographic trends predict that there will be a 36% increase in the number of residents over 85 years old, likely adding to the overall cost of the program.

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