Articles (Medicaid) « Medicaid

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Medicaid

• #CripTheVote Medicaid Stories 
  Earlier this year #CripTheVote, an online movement created by Gregg Beratan, Andrew Pulrang, and Alice Wong encouraging the political participation of disabled people, collected stories by disabled people on the impact of the current GOP healthcare bill (first known as the AHCA and now the BCRA in the Senate). Here are some stories that put a human face on issue.

• A Warning for Medicaid Beneficiaries Traveling Out of State (Sherabrams.com – 3/16/09) 
  Many Medicaid recipients don’t realize that their health insurance coverage may not provide a full set of benefits should they require care while out of state. Patti's Comment: This is an important warning…    
   
• Burden Is on Medicaid Applicant to Provide Verifying Bank Statements (Elder Law Answers)
  A New Jersey appeals court holds that the state was not required to assist a Medicaid applicant by obtaining debit card statements from her bank to verify her application. C.F.J. v. Division of Medical Assistance and Health Services (N.J. Super. Ct., App. Div., No. A-4385-16T4, Dec. 11, 2018).
   
• Can a Medicaid Recipient's House Be Transferred to a Caregiver Child After the Recipient's Death? (11/4/16) 
  A Q&A from Elder Law Answers about whether a Medicaid recipient's house can be transferred to a caregiver child after the recipient's Death.
   
• Deciphering State Medicaid Programs (Commonwealth Medicine – 1/8/19)
  State Medicaid programs vary substantially from one another.  For members, researchers, policymakers, and advocates trying to decipher a state’s Medicaid program, this variation can be a source of frustration, because the details of this variation can be hard to locate. 
   
• Elderly Medicare, Medicaid Patients Not Receiving Quality Care (Science Daily – Oct. 2007) 
  If the care received by vulnerable older people concurrently enrolled in Medicare and Medicaid was evaluated on a grading scale, it would squeak by with a barely passing mark, a new UCLA study has found.
• Exempt Medicaid Transfers (Thomas D. Begley, Jr., Esq.)
  Patti's Comment: This is a great summary of transfers which are exempt from Medicaid penalties – written by a talented attorney! 
   
• Go to the Back of the Bus! (One Dad's Opinion Blog – Sept. 2007) 
  Regulations Proposed to Eliminate Federal Medicaid Reimbursement to Schools – an opinion from a dad raising an autistic child.
   
• Health Care and Medicaid – Weathering the Recession (KFF – 3/26/09) 
  Many have sought public coverage from the states through Medicaid, but Medicaid's ability to fill the gap is becoming increasingly constrained, as state revenues decline and states turn to Washington for help in paying their share of the Medicaid bill.
   
• Health Advocate: Medicaid Managed Care: Modernized Federal Regulations are Long Overdue (National Health Law Program – 9/19/14) 
  In 1965, when the Medicaid program was created, American health care bore little resemblance to the complex system we have today. One of the most significant changes has been the expanding role of managed care. In its early years, Medicaid was almost exclusively a fee-for-service system in which providers were reimbursed directly by state Medicaid agencies for each service provided. Now, nearly three quarters of Medicaid beneficiaries receive services through some type of managed care arrangement. 
   
• HHS announces state health care innovation initiative (CMS.gov – 7/19/12) 
  Health and Human Services (HHS) Secretary Kathleen Sebelius today announced a new opportunity made possible by the Affordable Care Act to help states design and test improvements to their health care systems that would bolster health care quality and decrease costs.  
   
• Implications of the Expiration of Medicaid Long-Term Care Spousal Impoverishment Rules for Community Integration (KFF – 11/25/19)
  Section 2404 of the Affordable Care Act (ACA), which is set to expire on December 31, 2019, changed the spousal impoverishment rules to treat Medicaid HCBS and institutional care equally. Applying more stringent Medicaid financial eligibility rules to HCBS than to nursing homes could slow or begin to reverse states’ progress in expanding access to HCBS, while reauthorizing the rules would provide stability for enrollees and states. This issue brief answers key questions about the spousal impoverishment rules, presents 50-state data from a 2019 Kaiser Family Foundation survey about state policies and future plans, and considers the implications if Congress does not extend Section 2404.
   
• Improving Access to Home and Community-Based Services (Aging and Disability in America – 8/13/10) 
  Nearly five years ago, Congress amended Medicaid by adding Section 1915(i), intending to increase community-based services instead of institutional Medicaid services by permitting greater flexibility than Waivers permit. Unfortunately, only a few states took advantage of this. In enacting the Affordable Care Act in 2010, Congress made a number of additional changes which are extremely important to the disability community. However, unless your State opts to take advantage of these changes, they will not happen. These amendments take away many excuses the States have used in the past. 
   
•  Is it Medicare or Medicaid? (SSA – 11/16/17) 
  A lot of people have a difficult time understanding the difference between Medicare and Medicaid. Both programs begin with the letter “M.” They’re both health insurance programs run by the government. People often ask questions about what Medicare and Medicaid are, what services they cover, and who administers the programs. 

• Medicaid – An Overview of Medicaid Eligibility and Benefits (About.com – 1/28/10) 
  Medicaid is an insurance program for low-income and needy people that provides health-related coverage for children, many seniors, and/or people who are blind or have other disabilities. 
   
• Medicaid and Long-Term Services and Supports: A Primer (12/15/15) 
  Medicaid is the nation’s major publicly-financed health insurance program, covering the acute and long-term services and supports (LTSS) needs of millions of low-income Americans of all ages. Advances in assistive and medical technology that allow people with disabilities to be more independent and to live longer, together with the aging of the baby boomers, will likely result in increased need for LTSS over the coming decades. This primer describes LTSS delivery and financing in the U.S., highlighting covered services and supports, types of care providers and care settings, beneficiary subpopulations, costs and financing models, quality improvement efforts, and recent LTSS reform initiatives.
   
• Medicaid and National Health Care Reform (New England Journal of Medicine – 10/14/09) 
  Defined by a history of both achievement and controversy, Medicaid has once again become central to the U.S. health policy debate, this time figuring as a key to national health care reform. 
  Patti's Comments: This is a good summary of some of the issues.
   
• Medicaid Applying and Eligibility (Lift Chair Guide – May 2008) 
  While Medicaid is funded by both the federal government and the state government, it is, for the most part, in the hands of the states to provide the actual care. The federal government has a set of regulations that every state must follow.
   
• Medicaid Coverage Explained (NPR – 10/7/09) 
  Medicaid is a joint federal-state program that provides health care coverage for low-income people — primarily children, pregnant women, parents, the disabled and the elderly.
   
• Medicaid [and Medicare] Far More Cost-Efficient Than Private Insurance (Firedog Lake – 8/10/12) 
  The public debate has focused on transforming Medicare and Medicaid in the coming years, constraining cost in the very programs that are the most cost-efficient. If anything, the opposite should be true, and more and more of the system should be converted into public programs to increase the risk pool, allow for greater bargaining leverage on prices, and provide stability.
   
• Medicaid vs. Medicare – What's the Difference?  (Special Needs Answers – 7/5/12) 
  People with special needs may qualify for a variety of government benefits, including Medicaid and Medicare. It can be difficult to tell the two programs apart, especially because their names are so similar. However, Medicaid and Medicare, which account for the lions share of federal spending on health care, are dramatically different programs with different eligibility requirements and benefits. Here's how the two programs differ.
   
• Medicaid & Medicare (AGIS) 
  Discusses the differences between these complicated government programs.
   
• Medicaid Waivers (2/8/09) 
  A blog entry from a woman with a child with Down syndrome about Medicaid waivers to help with what insurance won't cover.
   
• Michigan Medicare Medicaid Assistance Program statewide service offers free counseling for the 2015 Medicare Plan changes and new enrollments (insurancenewsnet.com – 10/14/14)  
  During the Medicare Open Enrollment period, October 15th to December 7th, all Medicare beneficiaries have the option to change their plans for 2015. This includes anyone with Original Medicare, a Medicare Advantage Health Plan or a Part D prescription drug plan.   
   
• Money Follows the Person (medicaid.gov)
  The Money Follows the Person (MFP) Rebalancing Demonstration Grant helps states rebalance their Medicaid long-term care systems. Over 75,151 people with chronic conditions and disabilities have transitioned from institutions back into the community through MFP programs as of December 2016. The Affordable Care Act of 2010 strengthened and expanded the MFP program allowing more states to apply. There are currently forty-three states and the District of Columbia participating in the demonstration.

• Myths and Realities About Medicaid Planning (NAELA – 6/25/14) 
  Long-term care in the United States is overwhelmingly provided by unpaid caregivers; researchers estimate the value of this unpaid caregiving at well over $450 billion per year.1 By contrast, paid caregiving costs the public and private sectors about $219.9 billion,2 more than a quarter of which is paid out-of-pocket by individuals and their families. Nursing home care costs more than $81,000 per year on average, with 36% of that paid out-of-pocket by individuals and their families.3 It is in this context that families needing long-term care services engage in financial planning to pay for those services. The Medicaid aspect of that planning has given rise to a number of myths.

• Next Steps: Children can help mom best with advice of a lawyer (Post-Gazette – 11/25/08) 
  A good summary of Medicaid planning and the use of special needs trusts.
   
• Nursing Home Medicaid (Wall Street Journal – 5/18/08) 
  Medicaid is commonly called the government health-care program for the poor, but it pays for more than two-thirds of long-term nursing-home stays. That means many middle-income Americans with savings will come to rely on the program.

• Serving Low-Income Seniors Where They Live: Medicaid's Role in Providing Community-Based Long-Term Services and Supports (9/18/15) 
  Seniors managing chronic health conditions or experiencing an age-related decline in physical or cognitive functioning may need long-term services and supports (LTSS) to complete daily self-care or household activities. Medicare is the primary source of health insurance for nearly all seniors, but the program does not cover LTSS. Medicaid fills this gap by providing wraparound coverage for a range of services, including LTSS.

• Study Spotlights Growing Role of Medicare in Propping Up Nation's Medicaid Program – (EMaxHealth – 10/07) 
  New BDO Seidman study of the nation's Medicaid program draws much needed attention to a chronic and worsening problem: Medicare's cross-subsidization of increasingly inadequate Medicaid payments for nursing home care. 
  Patti's Comment: I could not agree more!

• These 2 Medicaid provisions prevent medical debts from ruining people’s lives (7/19/17)
  The Senate Republican plan to replace Obamacare would have eliminated two provisions, called presumptive eligibility and retroactive eligibility as part of a bigger drive to cut and cap spending on the program. The provisions are crucial to helping low-income people avoid massive medical bills, but they got little attention in the broader health care fight.

• Those Left Out Of Medicaid Expansion Won’t Have To Buy Insurance (Kaiser Health News – 6/24/13) 
  Low-income Americans who live in states that have decided not to expand Medicaid eligibility will not face penalties if they fail to buy insurance next year.  That’s according to a final rule on exemptions to the health law’s individual mandate – the law’s controversial requirement that most Americans have health coverage or pay a penalty in 2014. 
   
• Updates on Medicaid Cuts Litigation (Disability Law – 9/6/12) 
  Today's news brings two articles on key challenges to state Medicaid cuts.  One is from the New York Times, reporting on a preliminary injunction issued to block certain cuts to Medicaid personal care services in New York City and state.
   
• U.S. Ruling Backs Benefit Cut at 65 in Retiree Plans – (New York Times – Dec. 27, 2007) 
  The Equal Employment Opportunity Commission said that employers could reduce or eliminate health benefits for retirees when they turn 65 and become eligible for Medicare.   
   
• Watch out for the Medicaid Cliff! (11/19/18)
  Medicare does not pay for LTSS; it only covers short term stays after hospitalization in a skilled nursing facility and limited periods of skilled home health and hospice care. That means if you live a couple of years needing paid daily help, you will have to pay for that all out-of-pocket – or spend down to Medicaid. And that means you will forfeit essentially almost all of your assets and income.
   
• What is the Difference Between Medicaid and Medicare (Disabled World )
  Just like there's confusion over the difference between SSDI and SSI, there's confusion over the difference between Medicare and Medicaid. So, here in a nutshell, is the definition of each.
   
• With Medicaid, Long-Term Care of Elderly Looms as a Rising Cost (New York Times – 9/6/12) 
  With baby boomers and their parents living longer than ever, few families can count on their own money to go the distance. So while Medicare has drawn more attention in the election campaign, seniors and their families may have even more at stake in the future of Medicaid changes — those proposed, and others already under way.

For information on Medicaid Fraud, click here.