Posts filed under 'Medicare Coverage'
October 16th, 2012
Many individuals in need of home care assistance require care 24 hours per day, as they are totally unable to attend to their own needs. When receiving Medicaid home care services, a “split-shift” allows such an individual to have two aides per day, one working the first 12 hours of the day, and another working the remaining 12 hours. This ensures that the individual in need of care is never without assistance. If only one aide provided care for a 24 hour period (a “live-in” aide), the aide would need to sleep through the night. This leaves open the possibility that the aide would be asleep during a time when the individual needs help, leaving them without the care they need.
Recently, a group of New York City recipients of Medicaid home care services received notice that their services would be cut from split-shift care to one live-in aide per day. A class action lawsuit was filed challenging the city’s actions.
A federal court judge granted a preliminary injunction ordering the city to stop reducing or terminating split-shift care, unless there is a physician-certified improvement in the person’s medical condition, or there was a mistake when split-shift care was initially authorized.
The judge recognized that state and city budget cuts may be the reason for the actions taken by Medicaid, but stated that, nevertheless, “administrators –even when faced with major budget crises– may not deprive citizens of the care to which they are legally entitled.”
If you feel that your Medicaid home care hours have been unfairly reduced or terminated without justification, or if you are interested in obtaining Medicaid home care services, contact the Elder Law Attorneys at Lamson & Cutner, P.C. to discuss your situation.
March 12th, 2012
On March 9, 2012, The Wall Street Journal published a front-page story about the complexity of the Medicare and Medicaid laws, and how even judges are having difficulty in understanding them. The U.S. Supreme Court once characterized the Medicaid statute as “an aggravated assault on the English language.”
James Madison warned long ago in the Federalist Papers about laws “so voluminous that they cannot be read, or so incoherent that they cannot be understood.” His caution remains a timely one.
Judges from all over the country have written about the practically impossible complexity of the Medicare and Medicaid laws, often in a caustic or humorous fashion. These laws were initially enacted in 1965, and, after several amendments since then, now run hundreds of pages.
If you are having as much difficulty as these judges in understanding your rights under Medicare or Medicaid, you may want to call an Elder Law attorney at Lamson & Cutner. We work with these laws every day, and, while there are times when certain provisions seem beyond anyone’s understanding, in most situations we’ll be able to help you.
December 21st, 2011
We’ve been asked several times whether or not a Medicaid applicant can have a primary (and in many instances secondary) health insurance plan, and, if so, if he or she must give up such plans once accepted to the Medicaid program. People often believe that their medical insurance coverage precludes them from becoming Medicaid eligible, and are worried that they may lose their current benefits by becoming a Medicaid recipient.
Having medical insurance, either through Medicare or any other private plan (such as GHI or Blue Cross Blue Shield), does not prevent an individual from becoming Medicaid eligible. Additionally, if an individual is accepted to the Medicaid program, he or she will not be forced to give up any existing health insurance plans.
Since medical insurance does not pay for the catastrophic cost of long term care, it is often necessary for an individual to access Medicaid for assistance with paying for home care or nursing home care, even if he or she has ample health insurance.
When it comes to medical coverage, Medicaid is the “payor of last resort,” so a patient’s primary and secondary insurance policies will be accessed before Medicaid contributes. In fact, Medicaid advises that a Medicaid recipient maintain all insurance policies he or she currently has, and even offers incentives such as deducting the cost of the premiums from the recipient’s monthly income calculation or paying the premiums under certain situations. Also, it is advisable that current health insurance be maintained so that the Medicaid recipient can continue to see his or her doctors and specialists, even if they don’t accept Medicaid.
The fact that you have Medicare or a supplemental health insurance plan should not keep you from accessing Medicaid benefits if you need assistance with paying for long-term care. Elder law attorneys can advise you on how to get the most benefits available to you, without giving up any insurance you already have.
June 30th, 2010
Heavy financial pressures on the federal and state governments are being felt in the Medicare and Medicaid programs. Both of these programs are important safety nets for the millions of seniors and disabled persons in our country. However, as the costs of medical and long-term care continue to escalate, the financial impact of these programs on federal and state budgets is dramatic.
The federal government is increasing pressure on private insurers that sell Medicare Advantage plans by freezing payment rates to these insurers in 2011 and reducing them starting in 2012. Meanwhile, medical costs are increasing by at least 6% per year, and these private insurers are being warned not to increase premiums or co-pays to seniors. Inevitably, something has to give, and it’s likely to be a reduction in the scope and quality of services.
On the Medicaid front, many states are facing larger-than-expected budget deficits because assumed federal assistance for Medicaid is apparently not going to be awarded by Congress. New York may be forced to do without $1.1 billion in federal funds that had been penciled into the state budget.
Due to federal mandates regarding health care, the funding shortfalls will result in a reduction of other services, including education, the arts, and even police and fire. Layoffs of government workers are expected. Medicaid is likely to feel the pinch, as well.
As Elder Law attorneys, we are starting to see a change in attitude at some of the Medicaid offices in local counties, even though the governing laws and rules have not changed. Rather than being compassionate and helpful, many Medicaid workers, compelled by budgetary pressures, are looking for ways to delay or deny applications for medical assistance or to reduce the scope of services. Medicaid is also becoming more aggressive about enforcing spousal obligations of support, pursuing liens against real property, and seeking recovery from the estates of Medicaid recipients.
In these times, we believe that it is all the more important for seniors, the disabled, and their families to be aware of their rights to government benefits for medical and long-term care, which can be ruinous if paid from your own funds. For many, a consultation with an Elder Law attorney will be the best couple of hours you’ve spent in a long time.
November 24th, 2009
Medicare is a federal health insurance program available to individuals 65 and older. Since Medicare is fundamentally a health insurance program, it comes with the complex options and limitations of any other health insurance program, such as premiums, deductibles, copays and exclusions. Choosing the best coverage to suit your individual health care needs is no easy task, since Medicare has several components and offerings. Recipients have many important choices to make regarding their plan, such as whether to choose Medicare D drug coverage along with their traditional Medicare, or to opt for a Medicare Advantage plan, which is a private-carrier package that groups many benefits together. There are many Medicare Advantage plans currently available.
The annual Medicare enrollment period is from November 15 through December 31. Welecia Konrad of the New York Times has recently published two clarifying articles designed to help enrollees make the best decisions possible when choosing their health coverage. The article “Nearly 65? Time for the Medicare Maze” is for first-time enrollees. The article “Now Is the Time to Weigh Medicare Options” is for those already enrolled in Medicare, and explains whether making changes to your current plan may or may not be the best idea for your individual situation.
Be sure look into all of your options and to sign up for your new coverage before the Medicare enrollment period ends.