Medicaid Applications

Privately-Run Managed Elder Care – Advocates Worry About Neglect

Published on: March 7, 2014 | by Ettinger Law Firm

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.

Billions on the Line with New York Medicaid “Adjustments” from Federal Government

Published on: February 27, 2014 | by Ettinger Law Firm

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

New York Medicaid Program Recovers Record $851 Million in 2013

Published on: February 5, 2014 | by Ettinger Law Firm

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 Truth About Medicaid “Estate Recovery” Concerns

Published on: January 29, 2014 | by Ettinger Law Firm

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…”

Don’t Let Qualifying for Medicaid Force You Into Poverty

Published on: December 26, 2013 | by Ettinger Law Firm

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.

Update on Effort to Fix New York Medicaid System

Published on: November 29, 2013 | by Ettinger Law Firm

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”

Be Aware of Trust Fund Theft At Nursing Homes

Published on: November 20, 2013 | by Ettinger Law Firm

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.

Ineligible Patients Enrolled in Medicaid Program by Agency in NY

Published on: November 6, 2013 | by Ettinger Law Firm

The New York Medicaid system is the largest in the nation. As most know, Medicaid is a joint federal-state program, paid for by both entities. While federal parameters must be met, each state is free to decide upon various details of the program, including eligibility and extensiveness of support provided. New York has elected to open Medicaid to many residents with comparatively generous support.

Of course, the more expansive system comes with a high price tag. In order to ensure every dollar spent on the program is used efficiently, the state has engaged in a recent push to crack down on Medicaid fraud.

NY Visiting Nurse Service Problem

Financial Problems at NY Nursing Home, Says Comptroller’s Audit

Published on: November 5, 2013 | by Ettinger Law Firm

A common theme in recent years regarding long-term care in New York is the shuttering of county-owned public nursing homes. Historically, facilities to provide specialized care to seniors were built in different communities, with operation and ownership in the hands of local policymakers. But with financial pressures mounting, that format is changing quickly.

In the latest news on the same topic, WAMC reported earlier last month on the state audit which found that many county homes were in poor financial health. For example, the story point to the fiscal challenges faced by the facility in Saratoga County. The report notes that the county’s entire budget was in trouble because of the cost of subsidizing the home.

According to the New York State Comptroller’s audit, the county’s general fund balance was more than halved in the period from the beginning of 2010 to the end for 2012 (from nearly $25 million to just over $10 million). This massive loss of reserves was caused almost exclusively by the increased fiscal burden of the local nursing home–Maplewood Manor. In order to keep the long-term care facility in operation, the county was forced to put $13 million into the facility from reserves.

New York Medicaid & Obamacare Roll Out

Published on: October 30, 2013 | by Ettinger Law Firm

Anyone who has watched a nightly news broadcast or browsed a new website likely heard this month about the roll-out of Obamacare (the colloquial name for the large-scale healthcare overhaul known as the Affordable Care Act). In the past we discussed the way that the new law offers additional opportunities with expanded Medicaid services.

Most recent discussion relates to problems with the website created to allow consumers to purchase new insurance via health care exchanges. Luckily, New York essentially had its own separate sign-in system that was not plagued by the problems with the federal site which was used by those in states which had not set up their own programs.

Beyond the technical issue, how has everything worked out thus far in New York?