Medicaid Applications Category Archives

WSJ on the “Re-Thinking” of New York Medicaid

Published on: August 9, 2013 | by Ettinger Law Firm

Drastic revisions to the New York Medicaid system have been well documented in recent years. Most attention relates to a crackdown on fraud and similar cost-cutting measures. The spur for the alternations, as with so many government program decisions, is the hope of reigning in costs and ensuring the program’s viability for many years to come.

There is an assumption that saving on costs can only be accomplished by taking away available services. But that is not always the case. Take, for example, the long-term care aspect of Medicaid. The annual cost of care in a skilled nursing facility is incredibly high. New York homes have some of the steepest price tags in the country. On top of that, many residents would rather not live in the restrictive facilities in the first place. Obviously some of the most ill seniors simply must have around-the-clock care. But others who may be able to live off less intensive support are forced to move into a facility for lack of options. In other words, it is a situation where the state is paying significantly for a service that many would rather not have anyway.

Fortunately, in recent months the state has worked to flip the model, saving money and providing more tailored service in the process. A Wall Street Journal story last week touched on some of the general themes of the change.

Back to the Basics: Understanding Medicaid Asset Protection Trusts in New York

Published on: July 18, 2013 | by Ettinger Law Firm

The tremendous benefit of planning ahead for possible long-term care needs cannot be explained enough. The typical New York family is understandably most concerned about paying monthly bills, attending birthday parties, fixing up the house, and the thousand other activities that fill the day. Taking the time to think about serious illness, death, and inheritance often falls quite low on the priority list.

The motto, “I’ll cross that bridge when I get there” may work well for issues that cannot be dealt with ahead of time, but that is certainly not the case when it comes to long-term care and similar elder issues. Planning makes all the difference, not just for the senior, but also their family. That is why it is critical to fight the inertia and be prudent about planning.

The MAPT

Comptroller Claims New York Medicaid Still Rife with Waste

Published on: July 16, 2013 | by Ettinger Law Firm

News about potential fraud and waste within the New York Medicaid system keeps on coming. It seems as if every week there is a new allegations of practices which unnecessarily cost the state money in unnecessary Medicaid payments. With Governor Cuomo’s continued focus on rooting out problems with the system, we can likely expect even more information to come out regarding these issues in the next few months.

In fact, just last week the Capitol Confidential published a story discussing how the New York Comptroller, Tom DiNapoli, recently released two new audits which suggest widespread waste in the system.

One of those audits suggests that the NY Department of Health paid out more money for certain procedures than is allowed under current Medicaid rules. The administrative rules for Medicaid set specific maximum rates for certain procedures. Care providers—from nursing homes to hospitals–know those set rates. Those facilities do not necessarily get to set their own price.

Battles Continue Over New Medicaid Eligibility for NY Home Health Programs

Published on: June 25, 2013 | by Ettinger Law Firm

In an effort to more efficiently use state funds, over the past few years the New York Medicaid program has been closely analyzed by state groups looking to root out fraud. Those investigations have returned hundreds of millions of dollars back into the programs following problematic practices at New York nursing homes, senior day care facilities, and many other settings.

While rooting out excess and fraud is a net positive, one must not forget the real lives that are affected any time that changes are demanded by program officials. Many New York seniors are in delicate situations, and any time that a nursing home, at-home provider, or other entity is no longer able to operate as a result of bad practices, many seniors struggle to deal with caregiving changes.

Finding Good Elderly Home Care in New York

NY Nursing Home Kickback Settlement – Reminder of Need to Make Careful Nursing Home Choices

Published on: June 19, 2013 | by Ettinger Law Firm

The New York Medicaid program has been making many headlines in recent months. Implementation of the Affordable Care Act and efforts to control state spending all have significant implications for the program. Interestingly, these developments have opposing outcomes. As the Affordable Care Act provisions are unrolled the program will be expanded, offering services to more New Yorkers. Conversely, the state’s push to control costs and root out fraud limits services in a few ways, sometimes impacting local seniors and their families.

Fraud Repayment From Estate

On the fraud issue, the NY Daily News reported last week on a settlement reached between the Attorney General and the estate of a former nursing home owner.

Audit of NY Office of Medicaid Inspector General

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

The latest developments with the NY Medicaid program relate to concerns about the performance of the state Office of Medicaid Inspector General (OMIG). The OMIG’s role is to ensure maximum efficiency of the program. Considering the constant chatter about possible program changes in order to save costs, the work of the OMIG is critical for all New York residents who rely on Medicaid assistance in any number of ways.

The OMIG identifies that its goal is “to enhance the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive, and wasteful practices within the Medicaid program and recovering improperly expended Medicaid funds while promoting high-quality patient care.”

However, many observers have grown worried that the office is not maximizing its capabilities, allowing unnecessary funds to go out, hurting the overall efficiency of the Medicaid program. Those concerns were likely amplified in recent weeks as information came out regarding the potential abuse of adult day care programs funded by Medicaid. In addition, a congressional panel recently issued sharp criticism of the NY Medicaid program. That panel noted that New York maintains the largest Medicaid program in the country ($56 billion), and that the ballooning costs may be related, in part, to poor investigation of Medicaid fraud and abuse. The federal government pays for a portion of all Medicaid services, and so federal decision-makers can play in role in state Medicaid policy,.

Landmark Medicaid Study on Effect of Program Expansion

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

The results of a comprehensive new research effort on Medicaid’s effects on low-income residents was just published in the New England Journal of Medicine. The full summary of the article can be found online here.

As discussed in the New York Times late last week, the project compared individuals who received Medicaid support over a period of two years with those in similar income brackets who were not enrolled in Medicaid. The idea was to compare these groups on a wide range of indicators–financial well-being, physical health, mental health, and more. As such, it provides the most comprehensive understanding yet of how wide-ranging Medicaid changes may impact various community members.

Counterintuitive Results?

NY Medicaid Supported Adult Day Care Suspended Following Fraud Concerns

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

Last week we shared information about the revelations in the New York Times that efforts to curb New York Medicaid costs have been less than successful–mostly because of expanded enrollment in certain programs, like senior day care centers. These assistance centers are locations where frail and sometimes vulnerable elderly community members can stay during the day, while other caregivers–usually adult children–are at work. The facilities offer a way for seniors to avoid being forced to move into a long-term care home.

While useful, concerns have mounted regarding the tactics used by the operators of these facilities to increase enrollment. Owners of the adult care facilities are paid based on the number of eligible New York Medicaid recipients who attend. Therefore, it is in the best interest of the operators financially to increase enrollment–and that is exactly what they have been doing. The increase has been so stark, that some worry that the cost-savings intended (by averting expensive nursing home stays) may be illusory.

Temporary Suspension

Managed-Care Medicaid in New York

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

A New York Times article this week took a look at the consequences of a Medicaid change engineered by Governor Cuomo in the hopes of saving money: switching to “managed-care” for NY Medicaid programs.

The basic idea is straightforward: switch from paying providers a “fee for service” and instead make a specific payment to provide proper care–whatever that care might be. The logic goes that when medical care providers receive a fee for specific actions performed, they are incentivized to provide more services, even if they aren’t needed. By switching to a set payment amount, those providers will be incentivized to simply provide the most efficient care possible. They will also be more competitive, trying to increase quality of care to attract more Medicaid participants.

The Reality

House GOP Proposal & Medicaid

Published on: March 14, 2013 | by Ettinger Law Firm

As most know, the March 1st “sequester” cut deadline came and went without much serious action by policymakers to avert the automatic cuts. This was not unexpected considering policymakers have been very far off on goals for a compromise and because the $85 billion in first year cuts will not necessarily take effect immediately. The real layoffs and consequences that might be felt by most community members will roll out slowly throughout the year, stalling the public outrage and pushing off the political pressure that might force an ultimate budget agreement.

It is important to clarify that while Medicaid cuts were not part of the sequester, potential changes to Medicaid are very much part of potential compromise that could be reached in the coming weeks and months. For that reason, it is important for all local families who rely in any way on New York Medicaid (or who expect to in the future) to understand how potential changes may alter their options.

Latest GOP Proposal