Medicaid Planning

County Run Nursing Home in New York Studying Future of Long-Term Care

Published on: February 4, 2014 | by Ettinger Law Firm

The future of providing necessary care and support for New York seniors is a hotly debated topic. The analysis is taking place everywhere, including at the local level. As frequently discussed, one of the primary battlegrounds is that of county-run nursing homes. Long a bastion of care for residents, these facilities are being shuttered by some and transferred to private owners.

But not all New York communities are giving up on the idea of publicly-owned long-term care facilities. One area taking a cautious approach is Genesee County which recently commissioned a committee to study various aspects of long-term care in the community to determine the best course of action with regard to the current county nursing home.

NY Elder Care – A Closer Look

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…”

AARP Comment on Upcoming State of the State Address

Published on: January 8, 2014 | by Ettinger Law Firm

Today, New York Governor Andrew Cuomo will deliver his 2014 “State of the State” address. Just like the more well-known “State of the Union” address that President Obama will deliver later this month,the purpose of the event is for the Governor to lay out his vision for the upcoming year. It is intended to be a starting point in policymaking, usually outlining the issues that the Governor will attempt to advance within the state legislature in the upcoming session.

Earlier this week, the New York State AARP Director, Beth Finkel released a statement sharing information about what the advocacy organization hoped to hear included within the address. In particular, the statement discusses the policy issues that are likely to affect older New Yorkers. Considering the critical role that state policy has on so many elder law issues, from New York Medicaid to nursing home quality, the issues to be addressed her should be on the radar of most New York families.

Relevant New York Policy Issues

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.

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

Five Members of Long-Term Care Commission Issue Separate Report

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

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

Final Report Issued by Federal Long-Term Care Commission

Published on: September 24, 2013 | by Ettinger Law Firm

You may remember that on New Year’s Day of this year, a large piece of legislation was passed by Congress and signed by President Obama. The bill was the one that (temporarily) avoided the fiscal cliff. It was the measure that seemed to permanently set the estate tax rates among other things.

At the same time, the legislation also called for the creation of a Long-Term Care Commission. Comprised of 15 members, selected by both Republican and Democratic leaders, the group was given six months to hold hearings, debate, discuss, and create a report on various issues regarding long-term care nationwide. More specifically, the entity’s specific charge was to “develop recommendations for the establishment, implementation, and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports for individuals who depend on this system to live full and healthy lives.”

The Recommendations

Home Health Care Workers to Receive Additional Worker Protections

Published on: September 17, 2013 | by Ettinger Law Firm

A growing number of New York seniors in need of caregiving support are opting to stay in their homes, instead of moving into nursing facilities. This is partially a result of Medicaid programs changing to accommodate more at-home caregiving, often saving money and better meeting elderly preferences at the same time.

As a result, more and more attention is being paid to home caregivers. In particular, some are voicing concern about potential negligent care. Obviously, caregivers can fall far short of standards no matter what the setting, from nursing homes to traveling support. One particular concern with home caregiving aides is that, unknown to many, they actually fall under an exempted category in the Fair Labor Standards Act–the federal law which includes issues like the minimum wage, overtime pay, and more.

At least that was the case. According to new rules released today by the U.S. Labor Department, the specific definition of the “companionship exemption” under which these caregivers previously fell will be narrowed. Beginning in 2015, home caregivers will no longer be exempt, leading to significant changes in their employment status and, some hope, the quality of their work.

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.

New York Nursing Homes & Poor Dental Care

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

Most horror stories about poor nursing home care include tales of grotesque “bed sores,” broken bones gone undiagnosed, and similar cases of obvious caregiving lapses. But the best way to measure the quality of long-term care facilities may not be to see how many of these “big” mistakes are made. Instead, it might be more appropriate to look into resident’s mouths.

As a New York Times article discussed last week, there is a chronic problem of poor (and virtually non-existent) dental care provided at far too many nursing homes. A facility’s attention to dental care may be a key indicator of their overall commitment to proper support.

For one thing, many seniors do not have dental insurance. Medicare usually does not cover basic dental care. Medicaid might, but many have reported problems finding local dentists who accept Medicaid coverage. Without private insurance, many seniors simply go without regular cleanings and preventative care. Following a medical setback, dementia, or other challenge, many of these seniors land in nursing homes already in poor dental health.