Medicaid disparities: children with public insurance wait longer, denied more frequently

It is hard to imagine sick children could be seriously implicated and affected by public insurance disparities...federal law, after all, prohibits discirminatory treatment between patients who receive public vs. private insurance. But what about acceptance into such facilities, before they are patients? 

A new study examining facilities in Illinois claims "Sick children covered by Medicaid or the Children's Health Insurance Program (CHIP) must wait twice as long as youngsters with private insurance to get an appointment with a specialist." (Reuters Health).

According to one of the authors, "this [study] is the first to take a comprehensive look at specialty care in children."

The study tracked actors – female callers posing as mothers – who called specialty clinics for serious conditions afflicting their children.

These “callers” even went so far as to list specific conditions that their children were suffering from, like seizures and diabetes, which presumably these clinics had no reason to doubt the legitimacy of.

Two-thirds (66%) were denied appointments when the caller indicated the child was covered by Medicaid.  On the other hand, the clinics denied about one-tenth (11%) of callers claiming to have private insurance.

It doesn’t end there.  Children supposedly receiving Medicaid-CHIP insurance received a 22 day extra waiting period, on average,  as opposed to when these clinics *thought* the caller had private insurance.  MSNBC reported that the disparity was seen across numerous fields: "The trend was seen across all seven specialties tested -- orthopedics, psychiatry, asthma, neurology, endocrinology, otolaryngology and dermatology."

We've reported on the growing number of young people in nursing homes and the problems that can arise. We noted in our January 10 post, "[that]more than 200,000 people living in such facilities under the age of 65."  Let's hope this study serves as a wake-up call. 

New Property Tax Exemption for Disabled Veterans

Good news for veterans!

On April 6, 2011 a new statute was made Virginia law, awarding a real property tax exemption for permanently service-related disabled veterans and their surviving spouses. Originally approved by voters in November 2010, this statute will positively affect an estimated 7,350 disabled veterans living in the state of Virginia, according to the U.S. Department of Veterans Affairs. The exemption applies to the sole dwelling and land (not more than one acre) of the veteran, but not to any vacation homes or rental properties. For most people living in the city or suburbs this will be a sufficient and appreciated break. However, if your locality exempts more than one acre under its tax relief program for the elderly, then veterans will receive this new property tax exemption for the same number of acres as allowed for the elderly.

The application is a fairly simple one-time process that does not need to be re-submitted annually, unless you move or have another change in circumstance. First, you must obtain the required disability documentation from the VA by submitting VA Form 21-4138. Second, after you have received the appropriate paperwork that proves your 100% service-related disability, download the "Disabled Veteran Exemption Application" from your county website and submit to your county’s Department of Tax Administration along with your VA documentation for approval. Lastly, once approved, make sure to alert your mortgage company (if applicable) so that they may adjust your monthly mortgage payment according to this property tax break.

The Farr Law Firm and the Elder Law Institute for Training and Education appreciates the military service of our veterans and are proud to offer a 15% discount on our Level 1 and 2 packages to all active duty, reserve and retired military members. Our Level 1 and 2 packages include incapacity protection planning documents and living trusts, as well as optional add-ons like wills and child protection plans. This is a substantial savings of up to $1000! If you’re a veteran in need of estate planning services, please contact us at 703-691-1888 to see how we can help.

Photo by Maggie Smith.

$2.9 billion vaporized by elder financial abuse in 2009.

On-Board with Elder Justice?

What is the Elder Justice Act? “The act authorizes federal funding for adult protective services in each state, demonstration projects, forensic centers and training for long-term care providers,” according to the ABA. Unlike Child Protective Services, Adult Protect Services is not federally mandated.

The Elder Abuse Act (EAA) was introduced this year by the Senate Special Committee on Aging, and would support the formation of specially selected elder justice positions in local jurisdictions. The EAA calls for the creation of an office of Elder Justice within the Justice Department itself.

The EJA mandates direct reporting to law enforcement for crimes occurring in long-term care facilities, and would impose civil penalties for failure to report.

MetLife Study: "Crimes of Occasion, Desperation, and Predation Against America's Elders," a follow-up to a study in 2009 named "Broken Trust: Elders, Family, and Finances." This new study broadens the scope of the preceding study to match the growing problem of fiscal abuse against the elderly.

The annual financial loss by victims of elder financial abuse is estimated to be at least $2.9 billion dollars, a 12% increase from 2008. Evan H. Farr on Google +

What the American Middle Class Needs to Know: How to Protect the Family Home From Medicaid Recovery

Because the home is the largest asset a couple can keep while still qualifying for Medicaid, it is also usually the main target of estate recovery.



Meet Sidney and Rachel

Sidney and Rachel had lived in their home since it was new. They built it just after Sidney got a promotion to regional sales manager for a shoe distributor. Through the years, the house was remodeled twice and expanded to add a loft bedroom. Even when their children were grown with families of their own, they all remained close, with frequent family gatherings for holidays and birthdays.

Sidney and Rachel had paid off the mortgage and two second mortgages before Sidney retired. So in addition to being the center of family life, the house had also become the couple's biggest asset.

Rachel always hoped the house would remain in the family when she and Sidney were gone. She often talked about leaving it to their oldest son, Mark, who promised that he and his wife would continue the tradition of hosting the family for holidays and birthday dinners. However, as Sidney's Alzheimer's disease progressed, Rachel worried that Sidney would need to move into a nursing home. With the high cost of long-term care, Rachel knew their savings wouldn't last long. Sidney would eventually need to qualify for Medicaid to pay the bills.  

Side note:

If you or a loved one is struggling with Alzheimer’s, you may find this story to be inspirational.  “[The] true life story of an Alzheimer’s sufferer and his contribution towards understanding and dealing with [the disease].” You may find this program, Seven Second Memory, to prove beneficial. 

Rachel’s biggest question was, "Will I lose my home?"

For a great many people who need Medicaid benefits for long term care, the home makes up most of their life savings.  Often, it's all a couple has to pass on to their children.

You may not know that the home is an exempt asset according to Medicaid. It continues to be exempt as long as the community spouse lives there.  However, after both the ill spouse and the healthy spouse pass away, the property may no longer be protected.

What Is Estate Recovery?

According to the Omnibus Budget Reconciliation Act of 1993 (OBRA-93), the state has the right to take back whatever it paid for the care of a Medicaid applicant. And because you have to be "broke" to qualify for Medicaid, usually the only property of substantial value that a person on Medicaid is likely to own when they die is their own home. When OBRA-93 was passed, each state established an Estate Recovery Unit (ERU) to go out and find what assets they can take back from those that received Medicaid benefits!
Because the home is the largest asset a couple can keep (while still qualifying for Medicaid), in most states it is also the main target of estate recovery.

After both the community spouse and the ill spouse die, the state's estate recovery unit has the authority to take just about any property that the Medicaid recipient had their name on.  In most cases, that means going back to the house.

For example, if Sidney dies before Rachel after living in a nursing home for two years and Medicaid has paid the nursing home $3,000 per month, the state will have paid $72,000 for Sidney's care ($3,000 per month times 24 months). If the family home where Rachel lives is worth $100,000, the state would have a claim for the first $72,000 that comes from the sale of the house.

So, the house is protected while Rachel is alive. However, when she passes, the state may force the sale of the house. Whatever's left over after Medicaid is paid back ($100,000 minus the $72,000 taken out to repay Medicaid) would go to their children.

A Married Couple Strategy For Protecting The Family Home From Recovery

According to federal law, a married Medicaid applicant is allowed to transfer the home to his or her spouse - without any penalty. Once the transfer is made (meaning the ill spouse no longer has any interest in the house), the community spouse may be able to make some changes to that asset. In some states the community spouse can even give the house away!

That sort of gift, of course, would create a period of Medicaid ineligibility if the community spouse needs nursing home care within the five-year look-back period.  

The family home remains one of the most difficult assets to protect because of timing, but there are proven strategies that make it possible to protect the home from Medicaid Recovery.

The Society of Medicaid Planners offers a free download of their report “Medicaid Secrets Revealed by Dan Stemen. The report offers information on qualifying for Nursing Home Medicaid without losing the family home to recovery or spending down your life savings. 

Healthy couples may be interested in protecting their assets by using an income-only, self-settled asset protection trust.  Visit LivingTrustPlus.com to locate an attorney.  For attorneys who want to offer this form of asset protection, click here.

The National Care Planning Council provides a resource for long term care planning with educational information and lists of professional elder care service providers.

Image: dan / FreeDigitalPhotos.net

Evan H. Farr on Google +

What Costs Billions per Year and is the Leading Cause of Traumatic Brain Injury?

Falls.

Each year, one in every three adults age 65 and older falls, according to Centers for Disease Control (CDC).  These falls can cause devastating consequences; falls are the most common cause of Traumatic Brain Injuries, according to a study cited by the CDC.  The cost of falls exceeded $19 billion in 2000, and with a growing Senior citizen population, this number is expected to rise.  

How can you prevent a catastrophic fall?

Exercise is important, but need not be rigorous.   Interestingly, the CDC lists “Tai Chi” as an optimal exercise.  Tai Chi is known for its calm and relaxing methods, as opposed to more traditional, rigorous exercise.  If you are interested in learning more about Tai Chi, you should checkout this program by James Pang, Tai Chi expert.  

If you or a loved-one has experienced a fall, ask your doctor whether it is possible medication has played a role.  Not only can medications cause dizziness but they can also affect mood, which can in turn lead to a different pattern of mannerisms and behaviors.  

Declining vision can lead to catastrophic falls.  Your first resource should be your doctor who can assess your eyesight, prescription lenses, and balance.  Natural vision correction solutions do exist and have gained popularity in recent years, but there is no substitute for an in-person evaluation.

Image: Ambro / FreeDigitalPhotos.net

Evan H. Farr on Google +

Handicap Remodeling or Relocating

Robert and Anne purchased the family home thirty years ago, and their plan was to live there through retirement. They had furnished their home with restored antiques acquired from their many trips together. It was one of their cherished antique coffee tables that Robert tumbled over, breaking his hip.  Now with his return from the hospital in a wheelchair, Anne faced the overwhelming task of making their home both accessible and safe.

Remodeling for wheelchair entrances, organizing household furnishings and daily living items or downsizing and moving to a smaller living area are colossal tasks that are many times thrust on senior home owners.  Sometimes the need to do this is brought on by injury or age related illness. Home and yard maintenance can become a daunting chore for even the healthiest of seniors, calling for a decision whether to downsize.

There is a large and growing industry of specialists who understand these challenges of elderly homeowners and are ready and willing to help with remodeling, organizing or the sale of the home and with the move to a new location.

A professional organizer provides skills in making the home safe and manageable. Relocating furniture, removing hazards such as electrical cords, throw rugs, heavy objects on shelves that might fall are some of the ways they make a home more senior friendly.  They specialize in helping seniors part with items that clutter or have no valued use, so to make rooms less crowded or to make ready for a move to a smaller living space.

Handicap remodeling services and senior safety services offer help in adding wheelchair ramps and widening doorways. Bathrooms are made more accessible and safe, with hand rails, walk-in bath facilities and easier access to toilets.

If moving to a smaller retirement home or care facility is the best solution there is another senior specialty provider to call on called a Seniors Real Estate Specialist.

The Senior Real Estate Specialist concentrates more on a complete service package for the sale of the property and/or the purchase of a new living arrangement. The specialist also arranges for the services of a relocation specialist or Senior Move Manager to provide a complete, stress-free package for the elderly homeowner.

A move often requires downsizing and getting rid of a tremendous number of acquired possessions. The relocation specialist or Senior Move Manager, as they are often called, will typically provide a turnkey operation that includes assessing and identifying items to keep, arranging for auction or other disposal, cleaning the home, moving the belongings and setting up the new residence. The manager may also work closely with a real estate agent to arrange for the sale of the home and may also be involved in the financial transactions necessary to move into a new living arrangement.

All the help available to seniors may in itself be overwhelming.  How do seniors choose the right service provider for their needs?  How do they know they will hire someone qualified, responsible and honest?  Area Agencies on Aging and State Better Business Bureaus are good resources to check out available service providers.

Family, friends and religious leaders can be valuable resources to seniors in referring service providers and helping to manage the hiring and supervision.

The National Care Planning Council’s website www.longtermcarelink.net provides educational articles and information on eldercare providers throughout the nation.  Other resources you may be interested in, include
this Aging at Home guide and recipes for Senior citizens.

Image: FreeDigitalPhotos.net Evan H. Farr on Google +

New Veteran Bill Would Increase Pension Benefits for Some Couples

The Honoring All Veterans Act of 2011 – introduced yesterday by Senator Richard Blumenthal (D-CT) –seeks to improve health care, education, employment, and housing for veterans.  “Our military men and women have kept their promises to our country, and now we must keep faith with them, not only in words but in deeds,” said Blumenthal.

The Aid and Attendance Pension Benefit Rates for 2011:

• Up to $1,644 per month for a single veteran
• Up to $1,949 per month for a married veteran or a veteran with one dependent
• Up to $1,057 per month for an un-remarried widowed surviving spouse

For some couples, aid and attendance benefits may increase.  The Bill passed the House May 23^rd and will need to pass the Senate next.   The legislation seems to be on the fast track to becoming law.  GovTrack reports, “the vote was held under a suspension of the rules to cut debate short and pass the bill, needing a two-thirds majority . . . [usually reserved] . . . for non-controversial legislation. The totals were 380 Ayes, 0 Nays.”

• The aid and attendance benefit would be increased for disabled veterans who are married to one another.
   
• The Department of Veterans Affairs would gain a new source of key medical personnel through the Uniformed Services University of the Health Sciences (USU). 
• Who can argue with this provision? "USU has a worldwide reputation as a center of excellence for military and public health professions education and research."  
 
• The Veterans Administration would seek to remedy substance abuse by using data from state prescription drug monitoring programs (PDMP).
• This provision may be criticized by privacy groups. According to DeaDiversion, the National Alliance for Model State Drug Laws (NAMSDL), a PDMP is a statewide electronic database which collects designated data on substances dispensed in the state."

• An Independent Board would review DOD/VA transition problems including benefits.

“Our nation must keep faith with men and women who serve and sacrifice for our freedom. Unfortunately and unconscionably, America is still failing them and their families by tolerating unemployment, homelessness and inadequate health care,” said Blumenthal.

“This legislation comes from listening to and working with veterans and their families. While the Honoring All Veterans Act addresses many critical needs, it is only an opening salvo in a sustained, unceasing campaign to ensure that no veteran is left behind. It is a down payment on a larger debt,” said Blumenthal, according to politicalnews.me. “Our military men and women have kept their promises to our country, and now we must keep faith with them, not only in words but in deeds.”

For more on this Bill, see Blumenthal Introduces Bill to Improve Benefits for Veterans

Evan H. Farr on Google +