The Ethics of Medicaid Planning

Arranging your assets so that you will qualify for Medicaid, should you ever need to stay in a nursing home for long-term care is possible. However, many people question the ethics of doing so.

Medicaid often does not get a lot of attention, despite its importance. However, with some in Congress looking to make cuts to it as a way to reduce spending and taxes, Medicaid is back in the news on a regular basis.

One of the things the program does, is pay for long-term care in nursing homes for those elderly people who cannot afford their own care.

That part of the program is under fire because some people essentially hide their assets to make it look like they cannot afford their own nursing home bills, so that Medicaid will pick up the tab.

Recently, The New York Times looked at the debate over the ethics of doing that in “The Ethics of Adjusting Your Assets to Qualify for Medicaid.”

On one side of the debate are people who point out that those who can plan for Medicaid are wealthy enough to hire attorneys. Therefore, they should not hide assets to take advantage of a program designed to help the poor.

On the other side, people point out that nursing home care is extremely expensive. They believe that it is not fair for people to have to exhaust all of their assets, leaving nothing for their children to inherit, in order to have some of that care paid for by a program they fund with their taxes.

Whichever side you are on, it is important to know that if you do want to plan for Medicaid, then you need to see an elder law attorney about doing so and you need to do that long before you will ever need nursing home care.

Reference: New York Times (July 21, 2017) “The Ethics of Adjusting Your Assets to Qualify for Medicaid.”

Does the Senate Bill Cut Medicaid?

Even though a vote over the Senate’s bill to repeal Obamacare (Affordable Care Act) has been delayed, it is important to know whether or not it cuts Medicaid. The answer depends on how you look at it.

Very little in government is ever straightforward. One example is the Senate Republican plan to repeal and replace the Affordable Care Act.

A vote on the bill has been delayed. However, it is likely to still come at some point in the future. Therefore, what the bill proposes to do with Medicaid funding, is important for elderly people who rely on the program for their nursing home care.

On one side of the debate over the bill are Democrats, who claim that it will slash Medicaid spending. On the other side, are Republicans who claim that the bill will increase Medicaid funding, as Fox News reports in “Fact Check: Dem claims that Senate bill guts Medicaid ignore billions in new funding.”

Which side is right depends entirely on how you look at the issue. If the Senate bill passes and eventually becomes law, then Medicaid funding would increase by $71 billion by 2026. However, if the Senate bill does not become law and the current law remains in place, then Medicaid funding would increase by $231 billion during the same time period.

Under either scenario, Medicaid funding increases.

The argument is over how much it should increase and whether any increases are enough to meet future costs.

In the current highly partisan climate, it can be difficult to understand what is going on, as politicians and the media discuss policy changes. For that reason, it is important to look carefully at the facts to determine what the real question is.

For Medicaid that question is this: are politicians making sure the program can continue to do what it was designed to do without the country going broke?

Reference: Fox News (June 27, 2017) “Fact Check: Dem claims that Senate bill guts Medicaid ignore billions in new funding.”

Medicaid Facts

Repeal of the Affordable Care Act has been one the biggest news items in recent weeks. Changes to Medicaid in Republican proposals have received a lot of attention, but many people do not know exactly what Medicaid does.

You probably know that Medicaid is the federal government program that provides health care coverage to poor Americans. However, in the debate about the repeal of Obamacare (Affordable Care Act) and possible reductions to Medicaid in various appeal proposals, what often gets lost is exactly what that federal government program for the poor does.

Facts about the program get lost in the media noise.

It is important to know the facts, because only then can you really decide if you are for or against any changes.

NPR recently published a list of some lesser known facts about Medicaid in “From Birth To Death, Medicaid Affects The Lives of Millions,” including:

•It is very expensive. Medicaid currently takes up approximately 10% of the federal budget. State governments contribute even more on top of that to the costs of the program.

•Half of all births in the U.S. are covered by Medicaid. The program has been expanded multiple times to include more and more pregnant women.

•Some 62% of nursing home residents have their care through Medicaid.

•Disabled people and the people who take care of them are often eligible to receive their care through Medicaid.

•Medicaid is a major source of funding for the fight against opioid addiction.

Reference: NPR (June 27, 2017) “From Birth To Death, Medicaid Affects The Lives of Millions.”

ACA Repeal Vote Could Come Soon

Senate Republicans are planning to hold a vote on their version of repealing Obamacare by the end of June. No one knows yet what their bill contains.

Republicans in Congress are moving forward with their plans to repeal the Affordable Care Act.

The House of Representatives previously passed a bill that would do just that. It would have cut funding for Medicaid and increased health insurance costs dramatically for many seniors who have not yet reached retirement age.

A Senate version is expected soon, as Politico reports in “Senate GOP prepares for Obamacare repeal vote next week.”

The biggest problem with the Senate bill from an elder law perspective, is that no one knows what the problems are.

Since President Trump is reported to have told Republican Senators in private that the House bill is “mean,” it is expected that the Senate version will contain some softer provisions.

However, the negotiations over the Senate bill are being conducted behind closed doors. It is also expected that no hearings or debate will be held on the bill before it is called for a vote.

That makes it difficult for elder law advocates to determine whether the bill is supportable or not.

When details of the bill are released, it will need to be quickly and thoroughly scrutinized from an elder law perspective.

Reference: Politico (June 20, 2017) “Senate GOP prepares for Obamacare repeal vote next week.”

Medicare Penalty Waived for Some

People who are eligible for Medicare and who do not sign up on time can face stiff penalties. Some of them have been granted a small window to have those penalties waived.

The federal government has always been particular about Medicare. Eligible people either sign up at the right time or they face stiff penalties, if they attempt to sign up later.

Elder law advocates have always thought that this was a harsh way to penalize many people who simply made honest mistakes and were not aware of those penalties.

Advocates’ complaints have typically fallen on deaf ears, since the government was more concerned about cost controls. However, an important victory has been won for some who would otherwise face penalties for not signing up for Medicare on time.

NPR reports on this latest development in “Feds to Waive Penalties for Some Who Signed up Late for Medicare.”

People who purchased their health insurance through the Affordable Care Act’s marketplaces were not made aware that they needed to sign up for Medicare, when they became eligible.

When looking at the marketplace website, it appeared they were doing everything properly as long as they continued to purchase insurance on the marketplace. They have been granted a waiver of the penalties.

People affected will need to apply for the waiver. They only have until Sept. 30, 2017 to do so.

This waiver is only being granted to those who continued to purchase insurance through the Affordable Care Act, but it is an important step for many elderly people.

Reference: NPR (June 6, 2017) “Feds to Waive Penalties for Some Who Signed up Late for Medicare.”

Massive Medicare Fraud Alleged

Every few years it seems the federal government needs to do something to fix Medicare or risk running out of available funds for the program. One attempt to fix Medicare was undertaken in the early 2000s. It is now known as Medicare Advantage.

The program privatized parts of Medicare by turning things over to insurance companies. The idea was that insurers would do a better job of controlling costs in the program than the government.

Instead of doing that, however, a whistle-blower alleges that insurers have used the program to make billions of dollars from Medicare they are not entitled to, as The New York Times reports in “A Whistle-Blower Tells of Health Insurers Bilking Medicare.”

The alleged fraud is a relatively simple one.

Insurers are said to have used the medical coding system to make patients look sicker than they really are. As a result, the insurers easily collect more money from the government than they actually should.

The government has already announced plans to sue one insurer based on these allegations and more lawsuits against other companies are expected.

It is important for the government to stop this fraud, if true, and any other Medicare fraud.
The Medicare system is yet again close to running out of funds and in need of a fix. The government cannot afford to lose billions to fraud.

Reference: New York Times (May 15, 2017) “A Whistle-Blower Tells of Health Insurers Bilking Medicare.”

Forced to Pay for Your Parents

It is well-known and accepted that parents are required to provide care and support for their minor children. What is less well-known, is that in over half the states, adult children can be required to provide care and support for their elderly parents.

There are many laws on the books that receive very little attention because they are very rarely used. If few ever bother to attempt to enforce a law, then there is usually no reason for people to bring it up.

However, sometimes those laws do eventually become important, because of a general change in circumstances that sees those laws starting to be used more frequently.

An example of this is filial-responsibility laws.

These are laws that have been passed in 28 states that require adult children to provide financial support for their elderly parents, if the parents are unable to pay their own bills, as the Wills, Trusts & Estates Prof Blog discusses in “Filial-Responsibility Laws Could Cost You.”

These laws were not used much in the past because government programs for the elderly such as Social Security, Medicare and Medicaid provide financial support for the elderly.

Today, with people saving less and living longer, many elderly people are not able to afford the costs of their own care, which is increasing.

Nursing homes in states with filial-responsibility laws are increasingly looking to enforce them against children with parents who do not pay their bills.

This is yet another reason to make sure that you plan for your retirement and estate. If you do not, your children might be required to pay for you.

Reference: Wills, Trusts & Estates Prof Blog (May 3, 2017) “Filial-Responsibility Laws Could Cost You.”

Counting on Medicaid

People who plan to rely on Medicaid, if they ever need long-term care in a nursing home, often make a very big mistake.

Nursing home care is one of the most expensive things facing elderly people. It costs a lot of money to get long-term care in a nursing home.

Many older people do not have the money for it and do not have a realistic way of getting that money.

As a result, they look to the government to pay for that care. The government will step up through Medicaid, but only if the elderly person, who is in need of nursing home care, has no assets.

When seeking to qualify for Medicaid, however, many people make a big, big mistake.

This mistake is discussed in the Pauls Valley Daily Democrat article titled “Misunderstandings create traps in planning.”

The mistake is a simple one to explain, but it is important to make sure you understand it so you will not make it. You cannot give your assets to your children, just before you go into a nursing home, at Medicaid’s expense.

Unfortunately, that is just what many people are planning to do and it will not work.

What is the problem?

Medicaid has a five-year lookback window, which means that the program will look at any asset transfers the applicant (or anyone on his or her behalf) made within five years of needing long-term care.

If those transfers were not made at market value, then Medicaid will not pay for care until the expenses start to exceed the value of the transferred assets. There is a formula to calculate the “penalty period” that will be applied.

This simple mistake is a big source of problems for the elderly. Make sure that you understand it and ask an elder law attorney, if you have any questions about it.

Reference: Pauls Valley Daily Democrat (March 8, 2017) “Misunderstandings create traps in planning.”

Millennials Should Pay Attention to Elder Law

The Millennial generation might still have a long way to go before they reach retirement age, but they should be paying attention to elder law issues that will affect them in the future.

People of all generations tend to pay the most attention to the issues that affect them directly and immediately.

Most senior citizens do not think a lot about the cost of a college education and the availability of entry level jobs. Conversely, younger people do not think much about Social Security and Medicare. Each group has more pressing concerns that hold their attention.

However, the younger Millennial generation should pay attention to Social Security and Medicare.

Some people believe that stock markets will be bearish in the next few years. As a result, Millennials should save 25% of their current income to make sure that their retirement nest eggs grow at the appropriate rate, according to Wealth Management in “Should Millennials Double Retirement Savings Rates?”

Many Millennials will quickly point out that due to other economic factors beyond their control, they cannot afford to save 25% of their incomes, or even the traditional 10-15%.

As a result, people in that age group will be reliant to some extent on Social Security and Medicare when they retire. Since both of those programs face impending financial problems, Millennials need to pay attention to how these programs might change.

They should not consider it just an issue for older people. It will be their issue one day.

Reference: Wealth Management (Jan. 11, 2017) “Ken Thompson’s mother says she was cut out of will by late Brooklyn DA’s wife.”

The Future of Medicare

President-elect Donald Trump’s nominee to be Secretary of Health and Human Services has many worried that Medicare could undergo severe changes and cuts. However, there might be some opportunity for positive changes as well.

It is no secret that U.S. Rep. Tom Price is not a fan of Medicare or any form of federal government health coverage. Since he has been in Congress, the legislator has sought to make drastic changes to Medicare and to reduce its funding. This has many seniors and elder law advocates rightfully worried.

If he is confirmed as the next Secretary of Health and Human Services, the future of Medicare is in doubt, as Price would be in charge of overseeing the program.

However, as recently argued in “Make lemonade out of possible Medicare lemon,” there might be an opportunity for positive changes to the program.

One thing Price might do as secretary is to end Medicare at the federal level and instead give each state a block grant to administer its own replacement program. That could leave open the possibility that individual states could seek to negotiate prescription drug prices with manufacturers, which the federal government is currently prohibited from doing.

While negotiating at the state level would not be as effective at lowering prices as it would be at the federal level, it would still be helpful and Medicare patients could see their drug prices reduced.

Reference: (Dec. 26, 2016) “Make lemonade out of possible Medicare lemon.”