Medicaid Planning Category Archives

What Does Elder Law Even Mean?

Published on: January 23, 2013 | by Ettinger Law Firm

The legal professionals at our firm provide elder law and estate planning services. Many community members are familiar with the basics of estate planning. Tasks like designing wills, creating trusts, and putting inheritance plans into place are understood by most when thinking about “later in life” legal issues. However, elder law is a bit less clear. What does it actually mean?

While there are many definitions, a good one was put forward on a recent story on the issue published in Wealth Management. Essentially, the authors of the material suggested that elder law can be reconsidered as “quality of life planning” to maximize the value the last two to three decades of one’s life.

In general this focuses on long-term care. Securing the proper care is critical for seniors to thrive in their golden years. But even though seventy percent of Americans will need long-term care at some point in their lives, the process of obtaining it can be incredibly confusing, complex, and, in some cases, downright impossible. An elder law attorney is responsible for assisting at these times by either putting plans in place early on so that the long-term care is available in the future or working when “on the nursing home doorstep” to protect assets while ensuring the necessary care is available.

Consumer Voice Updates on Filial Responsibility Laws

Published on: December 17, 2012 | by Ettinger Law Firm

Few seniors have the resources to pay for long-term skilled nursing home stays. As we have previously discussed, New York maintains one of the highest average cost per day rates at these facilities. For most families, those costs are far more than they are able to pay from their own income and savings. That is one reason why the elder law attorneys at our firm urge consideration of long-term care insurance (LTCI). However, LTCI premiums remain too high for many, and so Medicaid is generally used to provide for necessary care.

Some facilities are actually resorting to another option to ensure they are paid for providing care–getting adult children to foot the bill. Recently, the Consumer Voice–one of the nation’s leading nursing home resident advocacy groups–published information on the use of filial responsibility laws. While enforcement of rules based on these statutes remains relatively rare, some argue that more and more facilities will take a look at pursuing adult children to increase payments.

Local residents should know that New York currently does not have a filial responsibility law on the books. Some neighboring states do have these rules however, including New Jersey, Pennsylvania, Massachusetts, and others. Those with loved ones in facilities in one of those states need to be aware of the possibility of a facility filing suit against an adult child for unpaid nursing home bills.

Modernization to New York Medicaid Coming As Part of Affordable Care Act?

Published on: November 29, 2012 | by Ettinger Law Firm

Speculation was rampant over the past year regarding exactly how full implementation of the Affordable Care Act (ACA) (Obamacare) would actually affect the current healthcare programs, like Medicare and Medicaid. Now, with President Obama’s re-election in place and the long-term security of the ACA secure, we are beginning to see some possible ways that the program is going to alter current state practices. For one thing, it may act as a spur to modernize the interaction between various state agencies, including Medicaid.

For example, as discussed in a recent Albany Times Union editorial, the federal Centers for Medicare and Medicaid (CMS) is making a one-time offer to states of 90% matching funds for “modernization” efforts. What does this mean? States will have a significant incentive to spend some resources to improve the efficiency of its programs, including Medicaid. This increased matching fund effort was spurred by the “health exchange” components of the ACA.

In general, CMS pays 50% of Medicaid costs, and the state pays the remaining 50%. That is why Medicaid is deemed a joint state and federal program. However, as part of this new push to improve certain aspects of the program, when a state wants to work on a modernization project, instead of paying for half of the cost of the project, they would only have to pay 10%, with federal coffers taking care of the remaining 90%.

Medicare Funding & Nursing Home Overbilling

Published on: November 20, 2012 | by Ettinger Law Firm

One question many New York seniors (and their loved ones) considered during the presidential campaign was how each candidate’s election might affect programs like Medicare and Medicaid. While it is hard to say with certainty what changes, if any, will be made to these areas, much of the discussion between candidates centered around general approaches to tackling financial problems as they relate to Medicare and Medicaid.

In general, Governor Romney’s approach was more far-reaching, favoring structural changes to the programs, including shifting more responsibility to the states. It was claimed that this would result in more flexibility on top of cost savings. Conversely, President Obama was more inclined to focus on attacking “waste” within the system as well as fully implementing Obamacare to lower healthcare costs overall by better insuring all Americans.

Of course, with the President’s re-election, Obamacare is preserved and the approach championed by his opponents is less likely to become law. In fact, a new report out last week from the U.S. Department of Health and Human Services suggests that the administration may be going strong with its attempts to root out overbilling, waste, and fraud in the system.

Ensuring LTCI Fairness

Published on: October 30, 2012 | by Ettinger Law Firm

Elder law attorneys and senior care advocates frequently remind community members of the value of long-term care insurance (LTCI). The New York legal professionals at our firm advise those who we are assisting with elder law estate planning of the immense value of having this insurance in place so that family assets are not decimated in the event (often likely) that skilled nursing home or at-home care is needed down the road. There are ways to save some assets without LTCI when Medicaid is used, but the best approach is always to have the necessary insurance.

When deciding on LTCI, however, it is critical that you understand the details of the policy and act to ensure it will work as desired when necessary. In fact, with the importance of this insurance increasing, many state are getting more invovled, offering more regulations and guidelines so that community members are protected from unfair practices where LTCI is at issue. A story last week by NY Now discussed the ways that some states are hoping to iron out some “kinks” in the system.

The main concern is ensuring that policyholders actually receive full and timely payments from the providers. Of course, having an insurance claim denied or not paid quickly can lead to serious repurcussions, because familes are forced to scramble to find alternative arrangements for necessary long-term care. Even if they are eventually vindicated, the delay in insurance coverage can cause significant financial (and emotional) damage that cannot be fully recuperated. To avoid that situation, some states are implementing more streamlined appeals processes, so that those who have claims denied or delayed can press for their rights more efficiently.

Editorial on Presidential Medicaid Proposals

Published on: October 26, 2012 | by Ettinger Law Firm

In the back-and-forth of the presidential debates and the obviously skewed TV ads, it is hard for local seniors to make heads or tails of the different proposals that candidates have on the Medicare and Medicaid system. Millions of New Yorkers rely on the programs for their healthcare and long-term care needs. Nearly one in five New York seniors participates in the Medicaid program, as it funds 70% of all nursing home stays. It is natural for residents to be confused and downright worried about what changes may or may not be coming to the program.

Most concern focuses on potential changes that the challenger, Governor Mitt Romney, might make in the event that he is elected. Those concerns are likely amplified by Governor Romney’s choice of Congressman Paul Ryan as a running mate. Congressman Ryan previously focused much of his attention while in the U.S. House of Representatives on various sweeping financial changes, including alterations to the Medicare and Medicaid programs.

What are those possible changes and how will they affect local seniors? A recent editorial in City and State New York took a look at the Romney proposals and offered a critique of the long-term impact of the program proposals. It is critical to note that this particular editorial was crafted by a current Democratic Congressman who previously worked with President Obama. It remains important to collect as many perspectives as possible to get an idea of the real impact of these possible changes. However, the editorial does offer a helpful discussion of one perspective.

Elder Caregiving By Family Members

Published on: October 12, 2012 | by Ettinger Law Firm

The acting commissioner of the Dutchess County Department of Services for Aging, Veterans and Youth penned an article this week on the toll that elder caregiving takes on family members throughout the state. The purpose of the piece was two-fold: to recognize the amazing work done by so many local residents and to remind community members of the immense benefit of planning for the elder care they will likely need down the road.

The article, published in the Poughkeepsie Journal this week, refers to the recent AARP study which found that a staggering 42% of working-age U.S. citizens provided some form of unpaid elder care, with half of all citizens expecting to do that in the coming five years. In other words, this is not an isolated concern that affects “other people.” All of us, at one time or another, will have to deal with this situation.

Sadly, as noted in the AARP Report, the effect of providing this care (averaging 20 hours per week) is often more far-reaching than many suspect. It is not uncommon for elder caregivers to face limited work flexibility, denied leave, or even termination from their own paid job as a result of the care they are providing to their senior friend or family member. All of this is on top of data which suggests that senior caregivers has negative health consequences of their own. A MET Life study on the issue found that poor health was more common among those helping senior in poor health themselves.

Bronx Nursing Home Offers One-of-a-Kind Dementia Care

Published on: October 2, 2012 | by Ettinger Law Firm

In recent years there has been a push to alter care for seniors with dementia. Most arguments about superior elder care focus on limiting medication-only treatment options. These “chemical restraints” are still overused, with seniors in many nursing homes lulled into a near-stupor as a result of antipsychotic medication. In overcrowded or understaffed long-term care facilities, these drugs are often the only way that caregivers feel that they can handle the challenges that come with dementia and Alzheimer’s care.

However, just because medication is the most common way to deal with a resident with dementia does not mean that it is the best way. In fact, many elder care advocates argue that the best care steers clear of overuse of medication and provides tailored care that focuses on the individual senior and not the cognitive disease.

What does that individual care look like? One Bronx nursing home is receiving national plaudits for its work on the issue.

Proposed New York Medicaid “Personal Care” Cuts Halted By Court

Published on: September 13, 2012 | by Ettinger Law Firm

Not long ago a few residents received some disturbing news–the New York Medicaid support that they counted on to survive was being cut back. Many of these community members had severe disabilities, needing help with every aspect of their life, from dressing and bathing to eating and traveling. Many seniors and those with disabilities receive help from at-home care workers around the clock so that they are able function in the least invasive setting possible despite their challenges.

Yet, in an apparent effort to recoup funds given back to federal officials following an overbilling case that settled in November, the New York City Human Resources Administration decided to alter the way some personal care was provided to residents. In particular “split-shift” at home care was curtailed. This care is provided to those who need help 24 hours a day, with two different care workers each taking a 12 hours shift. In it’s place, the city wanted to provide just a single care worker who lived with the Medicaid recipient.

New York City Medicaid Lawsuit

Massive Medicaid Fraud and Texas’ O.I.G Dollar Recovery Strategy

Published on: July 31, 2012 | by Ettinger Law Firm

Medicaid and Medicare frauds have been weighing heavily on states’ financial resources in the past years and New York is not an exception.

In the midst of solutions to this inter-state problem, eyes are focused on the Office of Inspector General at Health and Human Services Commission (O.I.G) – charged with investigating fraud among health care providers in Texas- who has revolutionized its method of dealing with frauds. Our New York Medcaid attorneys are intimately familiar with the important role the program plays in the lives of so many local residents.

The O.I.G’s strategy: A Fair Solution to Medicaid Fraud?