• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

Changes in Medicaid Long-Term Care Rules May Devour Life Savings of Seniors

Posted on: Thursday, 19 January 2006, 18:00 CST

By Diane C. Lade, South Florida Sun-Sentinel

Jan. 19--While seniors have spent recent weeks puzzling about the new Medicare drug benefit, congressional leaders have been pushing Medicaid changes that would make it far more difficult for seniors to qualify for government-subsidized nursing home care.

Tucked into the 750-page budget reconciliation act -- passed by the Senate and in line for a final House vote -- are new restrictive laws on who can qualify for Medicaid, the only government program that pays for long-term home care.

Supporters of the changes say they are designed to keep wealthy seniors from shifting assets so taxpayers have to pick up the costs of their nursing home stays. But senior advocates say the changes will hurt middle-income seniors.

Seniors who give family members financial gifts, such as money for college tuition or a home down payment, as much as five years before they require nursing home care, could find themselves disqualified from Medicaid reimbursements, under the new rules.

Also in the act are measures that could affect how much patients pay for home oxygen systems. Advocates also are concerned about the act's failure to extend an existing moratorium on reimbursement caps for speech, physical and occupational therapies.

The Senate has approved the measure, and all that is required is a second vote by the House of Representatives, anticipated in late January or early February, before it goes to President Bush, who is expected to sign it.

"We had a sense this wasn't getting much coverage," said David Certner, federal affairs director for AARP.

"It's incredibly punitive. What I see coming is that seniors will be forced to give away their money when they're young because they have no other choice," said lawyer Alice Reiter Feld, of Tamarac, president of the Academy of Florida Elder Law Attorneys.

One of her clients is Roslyn Golden, a retired postal employee whose husband, Nathan, owned a housewares store.

Every day, Golden drives from the North Lauderdale apartment she and Nathan once shared to the nursing home where he now lives, crippled by Parkinson's disease and spinal stenosis. Every month, she dips out of a dwindling pool of money she has for extras not covered by Medicaid, like his adult diapers, and to keep up their condo.

But under the new rules, seniors in Golden's situation would be forced to spend almost everything before Medicaid kicked in. Under such a scenario, Golden said: "I would be destitute by now."

Medicaid, created in 1965 to provide health care for the poor, is the only government program that reimburses for long-term care. The program's main policies are set at the federal level, but states and the federal government share the costs.

Over the past 10 years, Medicaid nursing home spending has doubled in Florida, with the state spending $2.1 billion on Medicaid nursing home care in the 2002-03 fiscal year, the latest year for which figures are available. Long-term care now comprises almost 30 percent of the state's Medicaid budget.

Congressional supporters of the changes said they would disqualify "millionaires on Medicaid" -- wealthy seniors who can afford to pay for their own nursing home care. In a November letter to his House of Representative colleagues, U.S. Rep. Joe Barton, R-Texas, said the new rules hammered out by the House Committee on Energy and Commerce he chairs would "eliminate fraud and abuse" by middle and upper-income seniors who transfer or hide assets "to appear impoverished."

But elder law attorneys insist most of their clients are average folks like the Goldens, whose life savings could quickly vanish with South Florida nursing homes charging about $7,000 a month. .

Research by the Kaiser Family Foundation found no more than 13 percent of patients had transferred assets four years prior to becoming eligible for Medicaid. And among those who did transfers, the amount was small, averaging $5,380.

Under the new rules, seniors who need Medicaid could disqualify themselves by having given their children money for college tuition or a home down payment up to five years earlier, as compared to the current three-year "lookback" period.

In addition to the proposed Medicaid changes, other provisions in the act might change the way Medicare will reimburse for home oxygen equipment and services.

Patients typically rent their oxygen systems from medical equipment companies, reimbursed by Medicare. The systems are returned to the provider when patients no longer need them. Under the new rule, the systems will belong to the patients after 36 months.

Medicare still will pay for repairs and filling the tanks. But Rob Brant, general manager of City Medical Services in North Miami Beach, said providers could start charging consumers as much as $400 extra a month for the best systems, such as the new lightweight liquid oxygen tanks, in order to recoup the reimbursements they'll lose.

Walter Hart Jr., a 95-year-old retired furniture store owner on 24-hour oxygen due to a pulmonary disorder, says he would pay it. But he worries about other residents at his Lauderhill assisted living center.

"This is not an optional thing for us. I can't go anywhere without oxygen," he said.

Advocates also are troubled by congressional leaders' failure to include in the act language that would continue a current moratorium prohibiting caps on Medicare reimbursements for speech, physical and occupational therapies.

Without the moratorium, Medicare will pay a maximum of $1,740 per person annually for speech and physical therapy combined, with another $1,740 maximum for occupational therapy.

-----

To see more of the South Florida Sun-Sentinel -- including its homes, jobs, cars and other classified listings -- or to subscribe to the newspaper, go to http://www.sun-sentinel.com.

Copyright (c) 2006, South Florida Sun-Sentinel

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail reprints@krtinfo.com.

Source: South Florida Sun-Sentinel

More News in this Category