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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.

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…

For starters, Medicare requires that a patient spend three midnights in the hospital before being admitted to a skilled nursing facility. With the push to get people in and out of hospitals, some doctors may be reluctant to keep the patient this long, so be prepared to play hardball.

State-mandated budget cuts mean no more funding for massage therapy for those with disabilities.

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.

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.

After the Patient Protection and Affordable Care Act (PPACA) became law, a state-based system of health benefit exchanges was established. This system will allow individuals to purchase coverage, with financial support for those between 133–400 percent of the federal poverty level, and expanding Medicaid eligibility to those with income below that level.

Patti's Comment: This is a great summary of transfers which are exempt from Medicaid penalties – written by a talented attorney! 

Elder Law Attorney Helps Family Navigate Complicated and Confusing Medicaid Regulations

New regulations for the Medicaid program, Targeted Case Management.

Under current Medicaid policy, disabled or elderly people who require assistance with daily activities are entitled to such services only if they reside in nursing homes.

Regulations Proposed to Eliminate Federal Medicaid Reimbursement to Schools – an opinion from a dad raising an autistic child.

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.

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. 

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.

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.

Recap of changes in law and policy that vastly affect basic health care, catastrophic medical, rehabilitation and long-term care for elders and persons with disabilities.

Medicaid is a health insurance program that serves low-income Americans, including children, seniors, and people with disabilities. It is jointly funded by states and the federal government. 
This fact sheet (PDF) explains that: 

  • Medicaid’s funding structure protects states and allows them to develop innovative program designs. 
  • States have the flexibility to design Medicaid programs that work for their particular residents. 
  • Medicaid is critical to state budgets. 
  • Medicaid dollars are spent efficiently.

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 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.

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.

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 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.

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 managed care for persons who needed acute care, doctors, prescriptions, etc. has been around for years. In the past, States carved out persons with disabilities for, at least, long-term services and supports, i.e., nursing home institutions and community-based waivers, personal care options and home health. Recently, the AARP and National Assn. of States United for Aging and Disabilities issued a report entitled "On the Verge: The Transformation of Long-Term Services and Supports."  In this Information Bulletin, we try to highlight some important points raised in this report.  

Overview of the Medicaid program.

Medicaid continued to be the largest source of funding for nursing and residential care facilities in 2007 at $59 billion, according to the U.S. Census Bureau.
Patti's Comment: Medicaid is certainly NOT just a health insurance program.

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.

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.
Patti's Comment: If you have someone in the family with a disability of any age and your attorney cannot answer this question, get a new attorney!

Discusses the differences between these complicated government programs.

The fight to protect health care entitlement is driving the Obamacare repeal struggle in the Senate.

A blog entry from a woman with a child with Down syndrome about Medicaid waivers to help with what insurance won't cover.

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.

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.

A good summary of Medicaid planning and the use of special needs trusts.

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.

A fair amount of attention was given recently to projections made by the Chief Actuary of the Centers for Medicare and Medicaid Services (CMS) about the new health reform law, and how they compare to previous estimates by the Congressional Budget Office (CBO). No doubt the various projections will be grist for claims made in the upcoming political season, so it is important to be clear about the differences between the two estimates and to keep in mind what this kind of statistical modeling does and does not do.

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.

As the economy heads into a recession, states are finding themselves in the difficult position of trying to make up for deficits in the current fiscal year. Also see Medicaid State Spending and Your State's Economy.

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!

The basics are described in this article. After reading through each program description, you will see how different and important Medicaid and Medicare are.

Latest issue in the Faces of Medicaid series. Each iteration has brought warranted attention to the complexity of Medicaid's high-need, high-cost populations and the challenges inherent in designing cost-effective systems of care for them. 

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.

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. 

When it comes to Medicaid eligibility, former lower-wage workers are sometimes treated worse than those who never worked.

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.

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.

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.

Qualifying Gramps for Medicaid eligibility means being able to show that Gramps is practically broke, without appreciable assets and very little income.

Medicaid is a lifeline for 9 million Americans with disabilities. Although only 15 percent of Medicaid beneficiaries are people with disabilities, they consume 43 percent of overall Medicaid spending. For these individuals, Medicaid is the primary public source of funding for long-term services and supports, whether provided in nursing or intermediate care facilities, as home and community-based services or as home health and personal care. Disability advocates must therefore remain vigilant in opposing efforts that would reduce Medicaid funding, benefits and eligibility, especially at a time when more Americans are experiencing heightened financial challenges and coverage loss in the face of our nation’s economic plight.


    For information on Medicaid Fraud, click here.