Articles Posted in Medicaid Applications

The face of New York nursing home care has been changing in recent years. The traditional model of individual counties throughout the state owning and operating facilities to provide care to ailing seniors is being phased out in may places. Instead, the counties are selling the homes to private companies to operate. The moves are spurred in almost all cases by financial realities–the facilities are too expensive for the county to operate.

Understandably, elder advocates worry about the effect of the change on senior care. In the past, some analyses have suggested that privately-run nursing homes, on average, show more “deficiencies” than their public counterparts. The assumption is that private homes are motivated by profit and more willing to cut resources to residents and refuse to pay wages for the best caregivers in order to boost their bottom line.

But is is important to remember that no two homes are identical, and “averages” do not mean that all privately run homes are rampant with neglect and need to be avoided. Early reports out of Ulster County, for example, offer a hopeful reminder that quality decreases may not automatically follow private nursing homes sales.

We are in the midst of significant changes to the New York Medicaid system. The critical state-federal program serves as a lifeline for many residents–including those in nursing homes. As part of President Obama’s healthcare overhaul, Medicaid is expanding, opening opportunities to more residents than ever before. New York has been cited as a model for that expansion, as our state has the most robust system in the country.

At the same time, however, with expansion comes increased scrutiny on exactly how each Medicaid dollar is spent. Both state officials and federal regulators are focusing on cutting out fraud and otherwise maximizing the value of funds. While this may seem like only a concern of policymakers, these changes will also trickle down and directly affect New York residents who rely on the system. As oversight changes, there may be alterations to the Medicaid application process and new rules about what benefits a resident can receive as part of the system.

More Overpayments

Late March is best known for many as the time of year that they fervently fill out their “March Madness” college basketball bracket in hopes of winning the office pool or family competition. For others, however, this marks the time when the procrastination ends and you finally get around to filing your taxes. With less than a month left before the classic April 15th deadline, if you have not done so already, it is time to start gathering paperwork and getting the task out of the way.

Elder Care & Taxes

Tax issues are notoriously complex and confusing. And considering the thousands of pages that make up the Tax Code, New York residents can be forgiven for not committing the details to memory or spending their free-time analyzing the issues. Yet, one general tip that most are aware of is the need to claim all possible deductions in order to lower your overall tax burden.In that regard it is important not to forget the way that elder care intersects with your taxes.

The elder care “problem” with which many policymakers in New York and federally are grappling is rooted around one issue: finances. In other words, there are many great models for providing high-quality care to seniors, but there is far less understanding of how to pay for that care. As a result, a balancing act is being performed within the New York Medicaid system as administrators determine what model provides the best care based on the amount of funds that the public can provide.

Is Managed Care the Answer?

The most popular recent trend nationwide, including in New York, involves using “managed care” programs for elder care. The idea is relatively simple: pay private companies to provide senior care at a set-price, with the compensation not tied explicitly to the exact services rendered. The pay-for-service model is often plagued with fraud and perverse incentives.

New York State has the largest Medicaid system in the country. As most know, Medicaid is a joint state-federal program that provides healthcare to low-income residents. Unlike Medicare (which is a program exclusively for seniors based on their age), Medicaid is for all those who do not have enough assets to pay for the insurance they need out-of-pocket.

Medicaid provides general health care to residents of all ages. In addition it acts as the primary public provider of support for seniors in need of a nursing home stays or other elder care. Considering that each kind of support comes from the same pool of Medicaid money, it is useful for those reliant on the Medicaid system to keep up with all matters that affect the overall budget. In other words, any NY Medicaid budget issues may eventually affect elder care and support options.

Federal Government Adjustment

Earlier this week new figures were released by the Medicaid Inspector General’s office which highlight the expanding crackdown on misuse of New York Medicaid funds.

As discussed in a NY Daily News story, last year state investigators recouped $851 million in allegedly misspent Medicaid funds. This marks nearly double the previous record, from 2012, of $468 million in savings. However, the sizeable figure for 2013 is due in large part to the recovery of nearly $496 million as part of a settlement with federal officials regarding billing for home health services.

These tallies represent a commitment by a growing number of state officials and lawmakers to ensure billing practices with Medicaid are above board and every taxpayer dollar is spent as efficiently as possible. Even with this “record setting” year, some officials, particularly fiscal conservatives, argue that more needs to be done to root out fraud and lower overall Medicaid spending.

The New York Medicaid system is the primary source of funding for many seniors in need of long-term care at nursing homes. Medicare does not cover these extensive stays, and the out-of-pocket costs are tremendous. As a result, many seniors enroll in the program to pay for their care.

Payments for long-term care make up a sizeable part of the entire Medicaid budget. As a result, policymakers are often looking at ways of cutting expenses or funnelling more money into the program to pay for those in need. One way that Medicaid law has accounted for ths is via a Medicaid estate recovery program. The basic idea is that the state can re-coup portions of the funds spent on an individual under Medicaid after that person’s passing. This takes the form of the state receiving a portion of the decedent’s assets.

The laws regarding Medicaid estate recovery are quite complex, with exceptions depending on surviving spouses, dependent children and similar details. But, under current rules,recovery may be made on “assets passing under the terms of a valid will or by intestacy, and any other real and personal property and other assets in which the decedent had any legal title or interest at the time of death…”

If a New York senior is in immediate need of close, skilled, long-term care and lacks the resources to pay the (quite high) fees for such care are out of pocket, then the only recourse is usually the New York Medicaid system.

But far too many residents fail to appreciate the basic details of this system until they are confronted with the reality head-on. Most notably, Medicaid, unlike Medicare, is based on need–not age. Therefore, the only way to qualify is to have a set asset level that falls below a certain threshold. Many families who have spent a lifetime saving and investing in their home have assets above that threshold. Therefore they are forced to spend down their resources in order to qualify for needed Medicaid support.

A New York Times story from last month discussed how many elderly couples in the past were essentially forced into poverty in order to receive Medicaid help. One story from the 1980s is shared involving a couple who were married for 45 years before divorcing in the mid-1980s. The divorce was not pursued because the couple had fallen out of love, but because it was the only way to avoid the healthier partner from being forced into poverty to ensure the couple qualified for Medicaid.

The New York Medicaid system is unique in the country for its size. The state serves more people (as a percentage) and provides more extensive benefits than any other state in the nation–by far. Of course, this all means that our program costs billions more per year than any other. Financial pressures are constantly threatening to alter the scope of support available to program participants, including New Yorkers who used Medicaid for elder care.

For this reason, all state residents have an interest in recent efforts to streamline the state program, crack down on fraud, and ensure all money spent is used properly and efficiently.

NY Medicaid’s Move Away from “Fee For Service”

Most fears about moving into a nursing home concern abuse and neglect. After living independent lives on one’s own, it is easy to understand why seniors may wish to avoid moving into a facility where they will rely on others (strangers) for day to day aid. Unfortunately, beyond the physical, emotional, and sexual mistreatment that can occur at these facilities, there is another risk–financial theft.

Wide Scope

As the USA Today reported recently, far too many nursing home workers use their position of control to enrich themselves at the expense of the residents in their care. One of the most common crimes is stealing discreetly from nursing home controlled trust accounts. When moving into a home, many seniors have their personal savings moved into trust funds managed by the facility. Yet, without properly oversight, those funds can be raided for personal gain without anyone ever discovering the problem. Even when it is discovered, it is sometimes too late for the senior to get any money returned. According to some advocates, this is a problem that has flown under the radar too long.

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