Articles Posted in Medicaid Planning

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

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 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

Yesterday we discussed the release of the federal Long-Term Care Commission’s final report. As mentioned, the major glaring issue with the report was its relative silence on financing solutions for this care. The Commission was made up of individuals with varying interests–from owners to residents–who have very different incentives. Issues regarding payment for long-term care services, particular Medicaid, is always a contentious topic. In that vein, it is perhaps not surprising that the report did not issue conclusive recommendations on that front.

Yet, that did not stop a subset of the Commission from issuing their own dissent which directly addressed the financing issue. A full version of that 17-page alternative report can be read online here.

Alternative Report