New York Elder Law Attorney Blog

The Center for Medicaid Services recently issued a notable statement requesting that parties conform with the duties and obligation of third-parties found in existing law. The Center recently reviewed each state’s Medicaid plan to make sure that states complied with recent statute changes. The Center for Medicaid decided that many states are yet to revise their guidelines to meet regulations found in the Bipartisan Budget Act as well as the Medicaid Services Investment and Accountability Act. Regulations found in the Bipartisan Act include statements that impact regulations connected to the treatment of some kinds of care. 

The Background of These Changes

Medicaid often disperses funds only as a “last resort”, which means that Medicaid issues payment for treatment and services only when it is assessed that no other payment sources exist. The Social Security Act’s Section 1902 requires all 50 states to take measures deemed reasonable when deciding on third-party payer liability.  The Act also specifies what the term “third-party payer” means. The definition of “third-party payer” encompasses various entities including health insurers, qualified health plans, and any other entity that are classified as legally responsible for certain medical treatment. The Bipartisan Act revised section 1902 to require all 50 states to utilize standard cost avoidance methods rather than paying the total amount allowed under the appropriate payment schedule then seeking third-party reimbursement. 

Deciding how to best care for elderly parents is never easy, particularly when they face difficulties in performing daily living activities for themselves. In an effort to resolve your responsibilities as well as meet your parents’ needs, you can unexpectedly end up facing various challenges, particularly if your loved one resides in a nursing home. Data currently suggests that only 4.5 percent of older adults or 1.5 million people live in nursing homes.

 At the end of the day, you likely desire for your parents to reside in a facility which may very well be a nursing home where they will be able to thrive as well make the most of their remaining time. With these issues in mind, it’s a good idea to review and plan around all aspects of nursing home life. 

Adapting to a Schedule

A study conducted by researchers at Cornell and the University of Toronto recently found that over 1 in 10 older adults in the state of New York is at risk of becoming the victims of elder abuse over the next decades. Poor health has been determined to be a major risk factor in abuse. Black elderly individuals are also reported to be at a greater risk of financial abuse. 

The study, Estimated Incidence and Factors Associated with Risk of Elder Mistreatment in New York State,  tracked abuse over time among hundreds of older adults who had not previously been abused. The study subsequently determined that elder abuse is widespread. The research followed elderly adults over a 10 year period. 

While the study only examined New York state, the researchers who performed the study have commented that the results are likely to be indicative of the conditions that exist in the rest of the country. 

President Biden as well as progressive Democrats have proposed lowering Medicare’s eligibility age to 60 to help older individuals obtain affordable coverage. A new study, however, has found that Medicare is more expensive than other options for individuals with modest assets. Two reasons exist why Medicare is more expensive: traditional Medicare contains gaps in what it covers which often necessitates purchasing supplemental insurance.  Additionally, premiums for the Affordable Care Act have dropped substantially due to President Biden’s COVID relief measure and as a result, the act has become more attractive. This article reviews some critical details that you should remember if you’re helping a loved one consider whether Medicare is the best option for them. 

# 1 – Long Term Care Insurance

Provided that you’re capable of being insured and can pay for the premiums, long-term care might be the best option that you need to satisfy your needs. Coverage, however, varies based on the insurance company you utilize as well as what plan you end up choosing. Assisted living costs continue to climb, though. If you can pursue long-term care insurance as an option, you should make sure to start planning early. The more a person ages, the more difficult a time an individual has getting covered by an insurance carrier.