Medicaid Eligibility
(3/13/13)- Under the terms of the Patient Protect and Affordable Care Act of 2010 (PPACA) states have the option of expanding Medicaid coverage to low income adults, ages 19-64, with incomes below 133% of the federal poverty level (FPL). New federal match rates will provide 100% federal funding for the care of the newly eligible population for the first three years starting in 2014. Funding will be gradually reduced to 90% of the total spending by 2020.
To date, 24 states and D.C. have decided to expand coverage, while 14 have opted not to expand it. Of the remaining states, 4 are leaning towards expansion, 3 are leaning against it, and 5 are undecided.
For more info on the Patient Protect and Affordable Care Act of 2010, please see our article on this topic.
(11/12/12)- The Supreme Court ruling that upheld the constitutionality of the Patient Protect and Affordable Care Act of 2010 held that the states do not have to participate in the expansion of Medicaid coverage if they chose not to do so. For those who do, the federal government would pay the full cost of the expansion for the first 3 years starting in 2014.
The federal government would reduce that percentage of full payment to 90% in 2020 and beyond.
Medicaid now pays for people with incomes up to 133% of the poverty level. The federal government pays for about half the cost of Medicaid and the states pick up the other half of the cost.
(11/1/12)- Spending on Medicaid decreased sharply last year, according to a survey from the Kaiser Family Foundation. For the fiscal year that ended this past June, total spending on Medicaid grew by only 2%, which was sharply lower than the10% increase in 2011, and one of the lowest rates on record.
Enrollment growth slowed to 3.2% for the year ended June, as opposed to the 4.4% growth rate in 2011, and 7.2% in 2i010.
Spending cuts accounted for a large part of this decrease, with reimbursement rates being cut for hospitals, doctors' visits, and for optional benefits like dental, vision and drug coverage. Forty-five states cut or froze reimbursement rates last year, according to the report. Many of the states switched to managed care plans for Medicaid beneficiaries.
Ex-governor Mitt Romney is proposing to replace the current Medicaid program with one of block grants to the states, giving each state a fixed amount of federal funds, and letting them determine eligibility and benefit levels. The federal government currently sets minimum requirement, like covering all children under poverty levels, and providing unlimited matching funds.
(10/5/12)- Obama officials released their first definitive guidelines since the Supreme Court ruling in June respecting the expansion of Medicaid as an option that will be available to the 50 states.
Under the Supreme Court ruling the expansion is an option, not a requirement for the states to follow. Under the terms of the Affordable Care Act, Congress required states to expand Medicaid coverage for people under the age of 65 with income less than or equal to 133% of the federal poverty level (up to $25,900 for a family of three).
Under the guidelines, the federal government will pay the entire cost of Medicaid coverage for newly eligible beneficiaries for three years, from 2014 to 2016. That share will decline to 95% in 2017, 94% in 2018, 93% in 2019 and 90% in 2020 and later years.
Cindy Mann, the federal official in charge of Medicaid, said, "A state may choose whether and when to expand, and if a state covers the expansion group, it may decide later to drop the coverage."
(9/10/12)-There are 1.8 million nursing homes in this country. 31.5% of Medicaid's $400 billion in shared federal and state spending goes to long-term care for the elderly and the disabled.
To be eligible for Medicaid, a person typically can have no more than $14,800 in assets. New York has the biggest Medicaid budget of any state at $54 billion, and spends about 41% of it for long term care, almost half on nursing homes.
By 2015, New York will start requiring some 78,000 nursing home residents to choose one of several managed care plans or be enrolled randomly in one of them.
Children could be liable for Medicaid expenditures for their parents under pending new laws. A 2009 analysis by the Kaiser Foundation found that direct out-of-pocket sending by individuals and families accounts for 22% of the $178 billion spent on nursing homes.
(2/22/12)- Starting in 2014, people with family incomes up to 138% of the poverty level ($31,809 for a family of four and $15,415 for a single person in 2012) will be generally eligible for the Medicaid program. People buying coverage in the new state-based health insurance exchanges will be eligible for federal subsidies to subsidize the cost of insurance if their income is below four times the poverty level ($92,200 for a family of four and $44,680 for a single person in 2012).
(7/27/11)- As the states search for ways to reduce their budget deficits it is becoming quite clear that Medicaid is one of the prime areas that they are looking at as they seek to reduce their expenditures. Medicaid is paid for through federal and state contributions so it is a prime target to be cut on both the federal and state level.
Ten hospitals sued the state of New Hampshire in federal court over the state's payments to them for caring for Medicaid patients, claiming them to be inadequate. The lawsuit claims that the state is jeopardizing the poors access to health care under the federal Medicaid Act by providing insufficient payment to them and doctors to treat Medicaid patients.
(10/3/10)- An additional 3.7 million people joined the Medicaid program last year, the largest single-year increase since the early days of the government program, according to data from the annual survey of the Kaiser Family Foundation, an independent nonprofit group that conducts research on health policy matters.
Enrollment in the program grew by 8.2 percent from December 2008 to December 2009, the second largest rate of increase in the 10 years that Kaiser has conducted the survey.
There were 48.5 million people on Medicaid at the end of 2009, or about one in six Americans. Every state showed enrollment growth, with nine states above 15% and Nevada and Wisconsin above 20%.
Spending on Medicaid grew 8.8% in 2009, the largest percentage increase since 2002. The stimulus package of $781 billion included $87 billion in Medicaid relief for the states, and Congress extended the assistance, at a reduced level, through June 2011.
Under the new health-care law passed this year, starting in 2014, the program will become available to able-bodied adults with income up to 133% of the federal poverty level (currently 414, 404 for a single adult and $29,326 for a family of four.).
The government expects the Medicaid expansion to account for about half of the 32 million uninsured people who are projected to gain health-care coverage because of the new law.
Virtually every state made cuts to benefit levels or provider payments in order to help balance their budgets. 39 states cut or froze payment to providers, including 20 states that reduced rates for doctors.
As a condition or receiving stimulus money, states were prohibited from lowering eligibility thresholds, which they are allowed to set within federal parameters.
(2/8/09)- For 2009, federal guidelines allow couples to keep up to $2,739 a month in combined income and $109,560 in assets, not including a home or car and still have Medicaid cover nursing home costs. There is a five year look-back on assets that are gifted by a Medicaid or Medicare beneficiary.
(12/16/08)- Your state may help pay for Medicare expenses through the Medicare Savings Program if:
(10/24/06)- If you are a New York City resident there is now an online tool that allows residents to see if they are eligible for up to 21 government programs, including Medicaid, food stamps, child care, Head Start, and tax and rent exemptions.
In addition to English the tool is available in Spanish, Chinese, Korean, Russian, Arabic and Haitian Creole. The tool is available at nyc.gov and is intended to ease the application process and cut down on office visits and paperwork. Eventually, users will be able to submit their information to city caseworkers electronically.
The first phase of the project cost $8.5 million; the second phase, costing $14 million and incorporating more programs, is to be completed next year.
(9/29/06)- Kelly Greene in her September 26, 2006 column in the Wall St. Journal entitled "Ask Encore" points out that the federal law requires the state's Medicaid program that paid for the care of a Medicaid patient may be entitled to reimbursement for the expenditures. Medicaid is a program that is run jointly by the federal government and the state's Medicaid department.
The recovery rule varies from state to state, so you have to check with the state Medicaid department that covered the costs of the Medicaid beneficiary to see what the rules are pertaining to recoveries from any of the estate assets. Thus if a beneficiary had a home, the state and the federal government may be able to recover some of their expenditures by selling the home after the death of the Medicaid patient.
(1/8/06)- Congress recently enacted changes in Medicaid coverage for nursing home care so that a nursing home resident whose home equity exceeds $500,000 would not be eligible for Medicaid coverage. A provision in the rules would allow individual states to increase this limit to $750,000
The changes enacted allow states to charge higher premiums and higher co-payments for a wide range of Medicaid benefits, including prescription drugs, doctors' services and hospital care. Medicaid recipients can be charged 10% of the cost of any item or service if their family incomes were 100% to 150% of the federal poverty level, $12,830 to $19,245 for a family of two. Recipients above that can be required to pay 20% of the cost of any item or service.
Total co-payments for all people in a family cannot exceed 5% of family income. States would not have to provide a Medicaid recipient with all the services now required by federal low, but can off a more modest package of benefits resembling commercial insurance. States will be allowed to end Medicaid coverage for people who fail to pay premiums for 60 days or more. Pharmacists can refuse to fill prescriptions and doctors and hospitals can deny services for recipients who do not make required co-payments.
(9/18/05)- A new homestead exemption law went into effect in New York State on August 31 that allows a person to protect $50,000 of equity in an individuals home from creditors. Thus a husband and wife can protect up to $100,000 in equity in their home from their creditors. The previous level had been $20,000.
The homestead provision had been introduced in every legislative session since 1992, but had never been able to get past the Republican Senate. This year, Senator Vincent L. Leibell, a Putnam county Republican backed the measure and was instrumental in getting it passed.
The new federal bankruptcy law, which tightens up the law considerably, goes into effect on October 17th. That law will make it more difficult for people to claim bankruptcy and discharge their debts. Elizabeth Warren, a Harvard bankruptcy researcher, said the change in homestead protection would ultimately have greater impact in New York than the federal bankruptcy overhaul.
Some states like Texas allow homes to be withheld from creditors no matter what their value may be.
(4/19/05)-Medicaid is a program that pays for medical assistance for certain individuals and families with low incomes and resources. This program became law in 1965 and is jointly funded by the Federal and State governments (including the District of Columbia and the Territories) to assist States in providing medical long-term care assistance to people who meet certain eligibility. Medicaid is the largest source of funding for medical and health-related services for people with limited income.
For more information on Medicaid: www.cms.hhs.gov/medicaid
Medicaid Information for States and Territories- www.cms.hhs.gov/default.asp
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FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
Allan Rubin and Harold Rubin
updated March 13, 2013
http://www.therubins.com
To e-mail: hrubin12.@nyc.rr.com or allanrubin4@gmail.com