Articles Posted in Medicaid Applications

When Medicare was expanded in 2003, the expansion that established prescription drug coverage was called a “promise, a solemn promise, to America’s seniors.” Part D Medicare officially took effect in 2006, but still some seniors were afraid of falling into the infamous “doughnut-hole” coverage gap.

Initial Benefits of Part D

In Part D’s first few years, national data has shown that the program had helped seniors make progress with their prescription drugs. Overall, out of pocket costs decreased for medication, seniors took their medication more regularly, and were less likely to forego basics like food or heat in order to afford for their prescriptions.

The New York Medicaid system is the primary means of providing long-term care to many seniors in the state. However, the system’s popularity led to financial strains, and public officials have worked for years to address rising costs and budget challenges. The most popular large-scale change to the program pushed by reform advocates is referred to as “managed care.”

The idea of managed care is to move away from paying service providers per specific task provided and instead compensate them a flat fee for each resident–regardless of what care the resident needs. The idea is to eliminate the company’s incentive to provide care that is not needed simply to increase their reimbursement. By providing a flat fee per resident, caregivers are incentivized to provide efficient, quality care.

Purging “Unprofitable” Clients?

Uncertainty reigned over the last few months regarding the budget situation for the New York Medicaid system. Fortunately, an agreement has been reached which should provide more long-term stability and the ease the minds of both policymakers and NY residents alike.

The underlying problem was claims by the federal government that over a period of years New York engaged in improper billing practices. The mistakes led to billions of dollars being paid to the state that should not have been paid. After discovering the problem, federal officials initially claimed that the money needed to be re-paid. All told, this would amount to nearly $15 billion being drained from state coffers that otherwise would provide support to local residents. No matter which way you slice it, losing those funds would hurt New York Medicaid participants, including seniors.

Settlement Agreement

As the first wave of healthcare insurance enrollment ends as part of the Affordable Care Act, observers are quick to comment on the changes enacted by the law. In addition to millions who took advantage of insurance sold in private marketplace exchanges, there has also been a significant increase in Medicaid participants–both in New York and nationwide.

According to a New York Times report last week, across the country there are now over 62 million Americans receiving some Medicaid support. The increase is more targeted in states like New York that specifically took advantage of options in the Affordable Care Act that allow for expansion of the program.

Importantly, much of the discussion about healthcare exchanges and Medicaid expansion refer to general health insurance coverage–not necessarily care that includes long-term support for the elderly.

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.

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