Keep Your Medicaid Eligibility Intact

Add comment September 28th, 2009

In New York, Medicaid requires recertification once per year to continue your benefits. In order to maintain access to medical and health services without any lapse, it’s critical to prepare and submit the proper recertification documentation. Home or nursing facility care, doctor visits, prescriptions and other vital coverage all depend on it.

A recent New York Times article highlighted the importance of keeping your Medicaid status current. It referenced a study of patients who experienced lapses in their coverage and the effects on them. The five-year inquiry found that people with intermittent coverage had three times the incidence of hospitalization as those who received continuous benefits. Many instances of illness and disability that could have been handled at a physician’s office degenerated into conditions requiring hospital care. The reason was individuals didn’t seek care sooner due to the absence of benefits.

Chronic health conditions posed the greatest dangers for these patients, with many having been being hospitalized within three months of losing Medicaid benefits.

Attempting to process your own recertification documents can be problematic. If you handle your own recertification, you may be exposed to a greater risk of denial of benefits than if you have the professional assistance of a competent Elder Law attorney. Your Medicaid lawyer deals with recertification issues on a routine basis and is in the best position to give you the proper advice. Experienced lawyers also help make the entire process as smooth and hassle-free as possible.

The study concluded that with continuous Medicaid coverage and uninterrupted access to primary care services, many hospitalizations could be avoided. It’s a mistake not to get the medical care you need until there are serious health consequences. By taking these simple steps to keep your eligibility for Medicaid intact, you won’t lose access to your benefits and can protect your health, well-being and quality-of-life.

If you have been denied Medicaid benefits you once had, you can get information on reestablishing your coverage at Denial Of Medicaid.

Seniors who are considering a change of residence should consider the cost of medical insurance and the availability of Medicaid benefits.

Add comment November 13th, 2007

Seniors who are considering a change of residence should consider the cost of medical insurance and the availability of Medicaid benefits.

For many seniors and retirees living in New York (and other northern states), the warm climates of, for example, Florida, Arizona or other southern states, may be appealing. Real estate developers have created numerous retirement communities to fulfill the needs and desires of these “snow birds.”

When considering the feasibility of changing their residence to another state, seniors and retirees are well advised to investigate the cost of medical insurance and the availability of Medicaid home care services.

Insurance premiums can vary widely from state to state. For some people with pre-existing conditions, coverage may not be available at all, or only in a state’s “high risk pool” at very high rates.

In a few states – including New York – coverage cannot be denied and insurance companies must establish premiums without regard to age, gender, or health of the applicant. Also, New York has very generous Medicaid home care benefits that are unmatched by any other state.

Even though insurance premiums or the availability of Medicaid benefits may not be the controlling factors involved in their decision regarding whether to move to another state, seniors and retirees on a budget will want to be informed in advance about these considerations.

Medicaid Available for Breast and Cervical Cancer Patients even if they don’t meet Eligibility Requirements

Add comment October 22nd, 2007

Medicaid Available for Breast and Cervical Cancer Patients even if they don’t meet Eligibility Requirements.

Women who have breast or cervical cancer—in addition to enduring the pain and suffering of a terrible disease—must also confront the logistical and financial nightmare of obtaining proper medical treatment. For thousands of women who have no medical insurance, the problems must seem overwhelming.

In 2000, however, Congress enacted The Breast and Cervical Cancer Prevention and Treatment Act, which makes Medicaid benefits available to such women, even if they would not otherwise be eligible for Medicaid.

This Act provides another example of where the laudable aims of a public policy are frustrated by the fact that few people are aware of the availability of these benefits and even fewer know how to obtain them. Some states—not including New York—will deny benefits unless the woman is diagnosed at a clinic funded by a federal cancer detection program.

If you, or a loved one, have breast or cervical cancer, you may be well advised to consult an attorney who is familiar with public benefits law and Medicaid.

Medicaid Planning & Protecting an Individual

Add comment April 26th, 2006

On February 8, 2006, President Bush signed into law the Deficit Reduction Act of 2005 (“DRA”). This new law makes profound changes in the rules affecting eligibility for Medicaid. As a result, individuals who want to hold onto at least some savings or property need to plan sooner and plan better than ever before.

Today’s article will discuss one of the main obstacles to protecting savings or property: the “penalty period” during which an individual is not eligible for Medicaid. A penalty period arises when an individual seeking Medicaid benefits for nursing home or other institutional care has transferred money or property to another person or to a trust. Generally, the penalty period of ineligibility is calculated by dividing the amount transferred by the regional cost of nursing home care (the actual cost of a particular home may be higher). For example, if Mrs. Jones, who lives alone in New York City (where the regional cost of nursing home care is currently $9,132 per month) transfers $91,320 to her daughter or to a trust during the “look back period” (see below), she will not be eligible for Medicaid for nursing home care for ten months.

The DRA has changed the rules regarding which transfers must be considered, and when the penalty period begins. Under the old law, Medicaid “looked back” three years for transfers to other persons, and five years for transfers to a trust. Now, under the DRA, Medicaid “looks back” at all transfers for five years. This means that, in order to apply for Medicaid, an individual must produce a full five years worth of financial records, no matter who received the transferred assets.

Even more significant in the change regarding when the penalty period begins. Under the old law, the penalty period began on the first day of the month following the transfer. In many cases under the old law, the penalty period expired before the individual needed nursing home care. Thus, the individual’s assets were saved without incurring an actual financial penalty. In many cases, even if an individual’s assets were transferred immediately prior to going into a nursing home, at least half of such assets could be saved.

Under the DRA, the penalty period begins when (1) the individual applies for Medicaid, and (2) the individual is receiving institutional care such as in a nursing home, and (3) the individual is eligible for Medicaid but for the penalty period (meaning that the individual has less than $4,150 in non-exempt assets). It is easy to see that some people may find themselves in a situation where they need nursing care but have no ability to pay for it. For example, if Mrs. Jones who lives alone in New York City, transferred $91,320 to her daughter on February 28, 2006, and she entered a nursing home on December 31, 2006, and applied for Medicaid, she would not be Medicaid eligible until November 1, 2007, even if she had less than $4,150 in assets on the date she entered the nursing home. Under the old law, the penalty period would have expired prior to the time that Mrs. Jones went into the nursing home.

The DRA makes other important changes regarding Medicaid which will be discussed in future articles in The Best Elder Law Blog.

Medicaid planning has become more difficult and more complicated than ever before. Nevertheless, solutions and best courses of action are available. Seniors and their families will want to consult a qualified elder law attorney before taking any action that may compromise their rights, or their ability to obtain benefits to which they are entitled.

Deficit Reduction Act of 2005

Add comment January 26th, 2006

The Federal Deficit Reduction Act of 2005 (“DRA”), if enacted, will dramatically change the legal landscape of Medicaid. The DRA seems to be headed for enactment in early February 2006 by an extremely narrow margin in both the Senate and the House, unless industry groups and constituents are able to persuade a few representatives to change their votes.

The main features of the DRA are designed to tighten Medicaid eligibility rules. First, the “look back period” on transfers of assets that must be considered on an application for Medicaid will be increased to 60 months for all transfers. Under current law, the look back period on outright transfers is 36 months, and on certain trusts is 60 months.

Second, the penalty period (for transfers of assets) during which an applicant is ineligible for Medicaid would commence only when he or she is in a nursing home (or receiving an institutional level of care), and when his or her application for Medicaid would have been approved but for the penalty period.

Third, if a Medicaid applicant has equity in her home in excess of $500,000 (or $750,000 at the state’s option), such excess must be counted on her application for Medicaid. (This rule will not apply when the spouse or minor, blind, or disabled child lives in the home.)

The net result of these and other changes in the DRA is that planning and paying for long-term care will become even more difficult. In addition, the quality of care at nursing homes may deteriorate with declining revenues as a consequence of the DRA.

o learn more, visit our New York Elder Attorney Information Site.

New York’s Facilitated Enrollment Program

Add comment December 10th, 2005

New York’s Facilitated Enrollment Program - Set To Expire Unless Bush Administration Acts

Under federal law, “facilitated enrollment” for Medicaid is not permitted. However, for a number of years, New York residents have enjoyed a waiver of this prohibition, granted under the Clinton administration. As a result, New York has been the only state in the country where community groups, clinics, and HMO’s have been permitted to assist people in filling out their applications for Medicaid. Unfortunately, this waiver is due to expire on April 1, 2006. New York has asked the federal government to extend the waiver, but it is unclear whether this request will be granted.

Some politicians have argued that facilitated enrollment has increased cheating on Medicaid applications, for example, it has been alleged that HMO employees have counseled people to conceal income in order to qualify for Medicaid. Others argue that cheating is minimal, and that the benefits of the program far outweigh any disadvantages.

Despite criticisms, it is clear that facilitated enrollment in New York helps a great many qualified individuals obtain needed assistance from Medicaid. For many people – even health care professionals – the task of filling out a Medicaid application is daunting. Without facilitated enrollment programs to provide assistance, a large number of New York residents will fail to obtain, or lose, Medicaid assistance to which they are entitled.

For general information about Medicaid and other programs, readers may wish to consult this website: NYC Department for the Aging.

Health Insurance Information Counseling Assistance Program (HICAP)

Cutner & Associates, P.C., assists its clients with Medicaid applications, and many other issues confronted by the elderly or disabled. See our Medicaid Benefits Planning website.