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December 2018 – When A Qualified Income Trust Is All You Need

Month: December 2018

Medicaid Bill Would Prevent Spousal Impoverishment as Route to Home Care Coverage

medicaid planning lawyer and elder law attorney in jacksonville, floridaMembers of the U.S. House house of representatives have taken a step toward extending some of the financial protections provided to seniors receiving long-term care in home or community settings. They have the support of more than a dozen health care organizations.

To financially qualify for Medicaid long-term care and support (LTSS), an individual must meet certain low-income and minimal asset limitations. Marriage often complicates those eligibility requirements. In some cases, one spouse can be put in the position where it is necessary to “spend down” or bankrupt themselves to secure Medicaid benefits to pay for long term-care support for their partner.

Medicaid, as the payer of last resort, is currently the primary payer for long-term care services and support in the U.S. health care system. According to federal Medicaid data,  as of August 2018, more than 66 million individuals combined were enrolled in Medicaid.

To prevent self-induced bankruptcy for the purpose of continuing a spouse’s Medicaid eligibility, Congress created spousal impoverishment rules in the late 1980s.  Originally, the rules required states to protect a portion of a married couple’s income and assets to provide for the “community spouse’s” living expenses when determining nursing home financial eligibility, according to the Kaiser Family Foundation. States, though, were also given the option to apply the rules to home and community-based services (HCBS) waivers, which most states, including Florida have done.

Section 2404 of the Affordable Care Act (ACA) changed that stipulation, mandating that the spousal impoverishment rules treat Medicaid HCBS and institutional care equally. The institutional care program is the Medicaid program that provides benefits for skilled nursing facilities so that those elderly people who need long term care, but cannot afford it, can receive that care through the Medicaid program. The ACA provision is set to expire at the end of December 2018, meaning individual states would once again have the authority to make program coverage decisions when it comes to spousal impoverishment in the home care setting.

In 2018, all 50 states were applying the spousal impoverishment rules to HCBS waivers, according to Kaiser Family Foundation. Five states — Arkansas, Illinois, Maine, Minnesota and New Hampshire — plan to stop applying the spousal impoverishment rules to some or all of their HCBS waivers if Section 2404 expires at the end of 2018.

With support from LeadingAge, the National PACE Association, the National Council on Aging and several other groups, U.S. Reps. Debbie Dingell (D-Mich.) and Fred Upton (R-Mich.) on Friday introduced the Protecting Married Seniors from Impoverishment Act.

If passed, the legislation would permanently extend spousal impoverishment protections for Medicaid beneficiaries receiving long-term care in a home or community care setting. “Our long-term care system is broken,” Rep. Dingell said in a statement. “Seniors and their families already face too many challenges when navigating long-term care, and they should not have to get divorced or go broke just to be eligible for the care they need.”

At this time it is unclear how much Congressional support the Protecting Married Seniors from Impoverishment Act will ultimately draw. Perhaps, the fact that most states plan to continue protections on a voluntary basis is encouraging. Anyone who may be impacted by this proposed legislation should contact their representative and express their support for the legislation.

LeadingAge, a Washington, D.C. based association representing more than 6,000 not-for-profit senior care providers supports the proposed federal law establishing protections against spousal impoverishment. The National Academy of Elder Law Attorneys, Inc., the National Association for Home Care & Hospice and AARP are other  groups that have supported issues involving “spousal impoverishment” in the past two years.

If you or a member of your family needs to establish eligibility for Medicaid benefits to pay for long term care, without the necessity of spousal impoverishment, we can help you accomplish that objective. Please call us to schedule a consultation.



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Trump Administration Strengthens Nursing Home Oversight and Safety to Ensure Adequate Staffing

The following message was released on November 30, 2018, by the Centers for Medicare & Medicaid Services (CMS), a division of the Department of Health and Human Services, announced actions that will bolster nursing home oversight and improve transparency in order to ensure that facilities are staffed adequately to provide high-quality long term care. These actions include sharing data with states when potential issues arise regarding staffing levels and the availability of onsite registered nurses; clarifying how nursing home facilities should report hours and deduct time for staff meal breaks; and providing long term care facilities with new tools to help ensure their resident census is accurate.

“CMS takes very seriously our responsibility to protect the safety and quality of care for our beneficiaries,” said CMS Administrator Seema Verma. “Today CMS is taking important steps to protect nursing home residents based on potential risks revealed by new payroll-based staffing data that our Administration released. We’re deeply concerned about potential inadequacies in staffing, such as low weekend staffing levels or times when registered nurses are not onsite, and the impact that this can have on patient care. The actions announced today strengthen our oversight of resident health and safety, and help ensure accurate public reporting.”

Research shows the ratio of nurses to residents impacts quality of care and health outcomes. For example, facilities with higher nurse staffing levels tend to have fewer resident hospitalizations.  In general, the new payroll-based staffing data shows most facilities have somewhat fewer staff on weekends, but some facilities have significantly lower weekend staffing. Additionally, some facilities have reported days with no registered nurse onsite, although nursing homes are generally required by law to have a registered nurse onsite eight hours a day, seven days a week.

To help address these risks, CMS will use frequently-updated payroll-based data to identify and provide state survey agencies with a list of nursing homes that have a significant drop in staffing levels on weekends, or that have several days in a quarter without a registered nurse onsite.  State survey agencies will then be required to conduct surveys on some weekends based on this list.  If surveyors identify insufficient nurse staffing levels, the facility will be cited for noncompliance and required to implement a plan of correction.

These oversight initiatives are part of broader efforts CMS has underway to strengthen safety and health outcomes for nursing home residents. For example, the Nursing Home Compare website and facility Star Ratings are key resources CMS provides to increase transparency into nursing home quality and help consumers and their caregivers make informed decisions.

CMS also operates the National Partnership to Improve Dementia Care in Nursing Homes, which is helping to reduce the inappropriate prescribing of antipsychotic drugs among nursing home residents, and the recently-launched Civil Money Penalty Reinvestment Program, a three-year initiative to improve residents’ quality of life by equipping nursing home staff, management and stakeholders with practical tools, education, and assistance to enhance care.

Medicaid is the primary source of payment for residents of skilled nursing homes. This action by the Federal government will help nursing home residents, and their families, have more confidence that there will be adequate nurses to provide quality care for the residents of such long term care facilities.

We can help you achieve eligibility for Medicaid benefits to pay for long term care in a skilled nursing facility. If you, or a family member, need the services of a skilled nursing facility, but need Medicaid to pay for that care, please call to schedule an appointment so we can help your family member get Medicaid eligible.