When you are preparing for retirement and beyond, considering how you will pay for long-term care should be an important part of your overall plan. Yet, too often people neglect to provide for long-term care and find themselves having to either self-insure or spend down their assets to qualify for Medicaid. This piece from NPR highlights some of the pitfalls. [Read more…]
Medicaid Patients Risk Eviction
Some residents of assisted living facilities who are covered by Medicaid are at risk of being evicted if they leave the facility for a period of time – even if they leave merely for a temporary hospitalization.
This is a significant problem that seniors should be aware of when they are planning for long-term care.
In general, Medicaid will pay nursing homes to hold a room for a Medicaid recipient who is temporarily absent due to a hospitalization. This entitles the resident to return to the first-available room.
However, most states don’t make similar “room-hold” payments to assisted living facilities. And there is no law requiring assisted living facilities to give priority to returning residents.
As a result, even if an assisted living resident leaves for only a short hospital stay, the facility could refuse to accept the resident once he or she is ready to return. The resident might end up having to find a nursing home instead.
Although the federal government has authorized state Medicaid programs to make “room-hold” payments to assisted living facilities, only a handful of states (including Georgia, Illinois, Montana, and Washington) have adopted such programs so far.
Should you have any questions about your Medicaid planning to avoid eviction, contact Attorney Kristina Vickstrom at 508-757-3800.
[photo credit: MyFutureDotCom]
Medicare Expands Coverage
In a major change, the federal government has agreed to provide seniors who have chronic illnesses and disabilities with Medicare coverage for many services … even if those services will simply maintain the person’s present health status and aren’t likely to improve their condition.
This is very important news for people who have diabetes, heart disease, Alzheimer’s disease, multiple sclerosis, Parkinson’s disease, Lou Gehrig’s disease, arthritis, or the effects of a stroke, among other medical conditions.
Soon, these seniors may be able to obtain Medicare coverage for care in a skilled nursing facility, as well as home health care and outpatient therapy.
For decades, Medicare had a “rule of thumb” that coverage for these services was available only if they were likely to lead to an improvement in the patient’s condition. This resulted in many people with chronic illnesses being unable to obtain coverage for treatments that were critical to maintaining their health, but that didn’t promise a cure or improvement.
According to the government, treatments that weren’t likely to lead to improvement were considered “custodial care,” which Medicare doesn’t cover.
But in January 2011, a group of seniors and some elder advocacy groups brought a nationwide class action lawsuit against the government. They argued that this policy violated their rights, because the “rule of thumb” against covering such services never actually appeared anywhere in the Medicare laws.
The government tried to have the case thrown out, but recently a federal judge rejected that request and allowed it to proceed. Shortly afterward, the government agreed to settle the case by expanding Medicare coverage.
The settlement is being reviewed by the court, and it’s still unclear exactly when the policy change will go into effect. It’s also unclear whether the change will apply just to future claims or to claims going all the way back to January 2011.
Under the terms of the settlement, patients who have “plateaued” in their treatment but still need the assistance of a skilled professional such as a nurse or therapist will be eligible for all of Medicare’s standard benefits. Seniors who are enrolled in Part A, which covers hospitalizations, will be eligible for up to 100 days in a skilled nursing facility (as long as it follows a three-day hospitalization), as well as up to 100 home visits following a hospitalization. Seniors who are enrolled in Part B, which covers doctor visits and other outpatient services, are eligible for potentially unlimited home visits.
It’s not completely clear to what extent the new policy will increase Medicare coverage for dementia. Many seniors with dementia simply need custodial care – unskilled help with routine activities of daily living such as eating, dressing, and bathing – and this kind of unskilled care wouldn’t be covered under the settlement.
However, if the services of a skilled professional might delay the progress of dementia, then those services might be covered. For example, Medicare might now cover occupational therapists who specialize in helping dementia sufferers.
In addition, Medicare might also begin covering speech therapists who teach stroke and Parkinson’s patients how to regain their communications skills. If you’d like to discuss all the ways Medicare is available to cover your or a loved one’s health issues, contact Attorney Kristina Vickstrom today at 508-757-3800.
[photo credit: Wikimedia.org]
