Climate Change Bill Brings a Bright Spot of Good News for Americans

We welcome any good news in a dismal news cycle, but the healthcare provisions built into the “Inflation Reduction Act” are worth a special mention.

The New York Times calls it “the most substantial changes to health policy since the passage of Obamacare in 2010.”

Passed by the U.S. Senate on August 8 and expected to pass in the House of Representatives on August 12, President Biden says he is looking forward to signing the bill into law. Here’s what we are looking forward to:

What seniors have needed for decades: giving Medicare the power to negotiate directly with pharmaceutical companies to reduce the astronomical costs charged for many drugs seniors need to stay alive and healthy.

The bill, beginning in 2025, sets a cap of $2,000 yearly for how much seniors pay for drugs. After reaching the cap, funds will come from the federal government, private insurers, and drug companies.

Federal subsidies for people who buy private health insurance through the Obama exchanges will be extended for three additional years, as they were during the coronavirus pandemic. For example, someone who pays about $80 in premiums will continue to pay that amount. These costs would double in 2023 without the bill.

Adult vaccines will be free starting in 2023 for seniors and people on Medicaid.

The bill uses federal subsidies to reduce the cost of health insurance and prescription drugs, insidious economic difficulties suffered by middle class and senior Americans.

Many benefits of this bill may not be evident to the people they help, as they are not visible directly. For instance, people won’t see large medical bills and may not be fully aware of free vaccines. But for the millions of Americans, particularly seniors, who struggle to pay for their prescription medications, the bill will be life-changing.

By design, the legislation will pay for itself and reduce the federal deficit over time while cutting prescription drug costs for the elderly and tightening enforcement on taxes for corporations and the wealthy.

It sounds like good news to us.

SCOTUS Rules State Medicaid Programs Can Recoup a Larger Share of Personal Injury Settlements

Suppose you were injured due to another person’s negligence and your medical expenses were paid in whole or part by Medicaid. In that case, the state has a legal right to recover the funds it spends on your care from a personal injury settlement or award. In a case involving a Florida teen catastrophically injured more than a decade ago, the United States Supreme Court has ruled that state Medicaid programs can recover the amounts paid from settlement funds reserved for future medical expenses.

In 2008, a truck struck 13-year-old Gianinna Gallardo, leaving her in a persistent vegetative state. The state’s Medicaid agency provided $862,688.77 in medical payments on Gallardo’s behalf. Her parents sued the parties responsible, and the case eventually settled for $800,000, of which about $35,000 represented payment for past medical expenses. The settlement also included funds for Gallardo’s future medical expenses, lost wages, and other damages.

The state Medicaid agency claimed it was entitled to more than $300,000 in medical payments from this settlement, including money specifically allocated for Gianinna’s future medical expenses.

Gianinna’s parents then sued the agency in federal court, arguing that Florida should be able to recover monies only from that portion of the settlement allocated for past medical expenses in accord with a prior Supreme Court ruling.

A U.S. District Court ruled for Gianinna, and the Medicaid agency appealed. The Court of Appeals reversed the lower court’s decision. Ultimately, the Supreme Court agreed to hear the case

In a 7-2 decision, the Supreme Court agreed that Florida could recover from the proceeds allocated to Gianinna’s past and future medical care. Justice Clarence Thomas, who wrote the majority opinion, noted that Medicaid law “distinguishes only between medical and non-medical care, not between past (paid) medical care payments and future (un-paid) medical care payments.”

Justices Sonia Sotomayor and Stephen Breyer dissented. They argued that accepting Medicaid shouldn’t leave a beneficiary indebted to the state for future care that may or may not be necessary.

If you or a family member are receiving care through Medicaid and expect a settlement, it would be wise to contact our office and learn if Medicaid will zero in on you or your estate for past, present, and future medical expenses.

ELDER LAW UPDATE: Medicaid Community Based Care Look Back Period Extended to April 2021

 As a result of the continued pandemic, the Secretary of Health and Human Services has continued to renew the declaration that a public health emergency exists. The most recent renewal extends the PHE through until late April, 2021. Due to the requirement for states to maintain Medicaid benefits through the Public Health Emergency, no changes to Medicaid benefits can go into effect until July 1, 2021.

For New York State residents and families contemplating a Medicaid application for community home care, this is welcome news. The lookback requirements were to have changed to require applicants to submit to a 30 month financial lookback to ensure eligibility for Medicaid community home care.

As a result of this additional renewal of the PHE, there is additional time for seniors and family members to conduct Medicaid planning for community home care. It is now possible to make gifts, transfer assets and utilize other planning techniques, but only if your Medicaid Application is filed before July 1, 2021.

This is a unique opportunity and one that should be taken advantage of if at all possible.

For decades, Medicaid community home care applicants did not have to worry about any kind of lookback period. This changed in 2020, but the Covid-19 pandemic has created a window of opportunity.

We encourage you to contact our office at 516-307-1236 if you or a loved one anticipates filing for community Medicaid or Medicaid home care.

 

 

How Do the New Rules for Community Medicaid for Home Care Work?

While October 1, 2020 may feel like it’s a long way off, it will be here before you know it. October 1 is the date when a host of new rules go into effect regarding Medicaid home care and all community based long term care services. It is essential to plan now if this is on the event horizon for you or a member of your family.

Perhaps the most significant change is the 30 month look-back for Community Medicaid. It provides care for people at home and other benefits for people living in the community. After October 1, 2020, anyone who wants to receive Community Medicaid benefits must submit financial statements for the past 30 months, or 2.5 years, when applying for benefits. Any funds transferred by the applicant or a spouse may create a period when the person will not be eligible for Medicaid benefits. That starts on October 1, 2020.

Until October 1, 2020, there is no look-back period and no penalties for transfers, so now is the time to talk with our office so we can create a plan.

Next, there are changes to the CDPAP – Consumer Directed Personal Assistance Program (CDPAP) and PCS (Personal Care Services) program. The CDPAP allows recipients to hire a non-licensed person to provide services in the home, instead of through a home healthcare agency. The person can be a family member, friend, or someone the family knows to provide caregiving, and Medicaid pays for that care.

The New York State Department of Health is creating a new assessment tool to determine how much care a person will receive through Medicaid.

And instead of your treating doctor giving you the go-ahead, after October 1, 2020, the plan of care will need to be determined by an independent physician approved by the Department of Health.

The PCS program allows Medicaid recipients to receive care services through home healthcare agencies who have contracts with the local department of social services.

Changes that also begin on October 1, 2020:

Eligibility requirements change – you must require help with three (3) ADLs (Activities of Daily Living). It is an increase from the previous requirement of needing help with two (2) ADLs, meaning people will require more care to be eligible for Community Medicaid. Those diagnosed with dementia, including Alzheimer’s, need require only help with one (1) ADL. The Activities of Daily Living include bathing, dressing, grooming, toileting, walking, turning, positioning, and feeding.

For those who believe they will need help, an application for Medicaid must be completed and submitted soon. Many people will likely wait until September, but that’s a mistake. Wait too long, and you or a loved one may not get the services needed.

If you have questions about Medicaid and these changes, please call our office at 516-307-1236. We are open and able to serve you through phone, email, and videoconferencing.