Graham-Cassidy Proposal Puts Medicaid Coverage at Risk

Senate Republicans continue to push for legislation to repeal and replace the Affordable Care Act. The Graham-Cassidy bill is sponsored by Senator Lindsey Graham, from South Carolina and Senator Bill Cassidy, from Louisiana. Although the bill is still lacking 50 votes needed, it is important to understand the effects it may have on health care. Continue reading “Graham-Cassidy Proposal Puts Medicaid Coverage at Risk”

Community Medicaid and Chronic Medicaid

To qualify for Community Medicaid an applicant may have no more than $14,850.00 in assets. Community Medicaid provides coverage for at home care. It does not have a look back period and allows an individual to be eligible for benefits within one month. In addition, the $14,850 does not include qualifying retirement accounts, where the individual is taking monthly required distributions. Continue reading “Community Medicaid and Chronic Medicaid”

New York Medicaid Personal Care Services

NY Medicaid personal care servicesMedicaid is a federal and state funded program that provides health coverage to those, including the elderly and disabled, who meet certain income and resource eligibility requirements. Personal care services (PCS), or home attendant services, are provided by a personal care aide to individuals who require nutritional and environmental support as well as assistance with personal care functions. Through New York Medicaid, eligible individuals can receive PCS to maintain their health and safety in their own homes. Continue reading “New York Medicaid Personal Care Services”

Common Long-Term Care Planning Misconceptions

Many people share common concerns as they reach retirement age: Will they have the ability to remain independent in their homes without intervention from others? Are they going to be able to maintain good health and receive adequate health care? Will they have enough money for everyday needs and not outlive their assets and income? Despite the fact that thousands of Americans are concerned with these aspects of aging, many have failed to develop adequate long-term care plans that specify which services they will need and how they will pay for them. Unfortunately, many Americans also share common misconceptions about long-term care planning that may be factors in why individuals fail to establish a properly executed long-term care plan prior to when they need the services. Continue reading “Common Long-Term Care Planning Misconceptions”

Geriatric Care Services Industry Projected to Exceed $1.1 Billion by 2023

As more baby boomers shift into retirement age, the emphasis on geriatric care services to meet the elder population’s growing needs becomes greater. According to a statement released by Global Market Insights, Inc., the geriatric care services market size is estimated to see revenues of $1,101,800,000 by 2023. The elder care industry reached $684 billion in 2015, and will steadily increase over the next couple of years due to the increase in the retirement-age population, in conjunction with growing disposable incomes.

The largest contributor in the geriatric care services market is Medicaid’s institutional care centers, which reached $279 billion in revenue in 2015. Medicaid is a federally funded program administered by the states that provides medical coverage and long-term care to middle-to low-income persons, including the disabled and the elderly.

Institutional care centers covered by Medicaid are residential facilities and around-the-clock, comprehensive elder care services. Medicaid coverage may include hospital and physician care, prescriptions, home care, nursing home care and other health-related expenses. Medicaid eligibility is based on income and resource restrictions and, although anyone may submit an application, an individual’s criteria must be reviewed and approved through the application process.

P&P Medicaid assists clients in the preparation of Medicaid applications for eligibility. Our company also provides a full range of geriatric care management services to help individuals and their families make decisions about and supervise their long-term care needs. Please contact P&P Medicaid Consulting, Inc. at (516) 541-4770 for more information.

New York Medicaid Expands its Services for Women’s Health

Effective June 1, 2016, New York State Medicaid fee-for-service (FFS) and Medicaid Managed Care (MMC) will begin covering breast ultrasonography following a patient’s diagnostic mammogram with an abnormal or suspicious finding. Additionally, those enrolled in New York Medicaid FFS and MMC with breast cancer diagnoses will receive their mastectomy and lumpectomy procedures at high-volume facilities. According to research, five-year survival rates increase for women who have their breast cancer surgeries performed at high-volume facilities and by high-volume surgeons.

Breast ultrasonography, also known as ultrasound, is an imaging method that uses sound waves to evaluate breast tissue. It is non-invasive and may aid in distinguishing normal findings like simple cysts or fat lobules from suspicious breast findings that may require a biopsy.

Once the New York Medicaid’s new program initiative comes into effect, breast ultrasonography following a diagnostic mammogram will no longer require an additional order from the primary provider when performed in a hospital setting. Instead, a note in the radiologist’s report will fulfill this requirement.

High-volume facilities that will be able to perform mastectomy and lumpectomy procedures associated with a breast cancer diagnosis for New York FFS and MMS patients are defined as averaging 30 or more all-payer surgeries annually over a three-year period.  Low-volume facilities will not be reimbursed for breast cancer surgeries provided to Medicaid beneficiaries. This policy is an ongoing effort to reform New York State Medicaid and to ensure the purchase of cost-effective, high-quality health care and better outcomes for its beneficiaries.

Medicaid is a federally funded program run by the state and the county which provides medical insurance and long-term care for middle- to low-income persons, including the elderly and disabled. P&P Medicaid Consulting Inc. specializes in preparing applications for Medicaid eligibility, guiding you through the document acquiring process and will appear on your behalf at all interviews with the Department of Social Services (Medicaid).

If you are interested in learning more about applying for Medicaid or any of our additional services, call (516) 541-4770 or visit www.ppmedicaid.com.

Long Island Veterans to Face More Difficulties Securing Long-Term Care Assistance

With the baby boomer generation in the heart of retirement age, private resources to support older Americans have begun to feel the strain. Among these is the Veteran’s Administration (VA), which faces impending regulations that will make nursing care benefits available to even fewer veterans.

The administration currently offers a pension called Aid and Attendance (A&A), an underused resource that supplies those who have served and are current nursing home residents or require geriatric home care assistance. For the first time, new regulations will limit the services ONLY to those whose asset levels qualify and will impose a look-back period, restrictions on gift or transfers of assets that will subjugate violators to penalties.

The current income and assets of a veteran and their spouse currently determines eligibility for these benefits. The proposed regulations will set the amount at a limit of $119,220, with only homeowner properties of two-acres or less will be excluded from this evaluation. While this was the previous limit set for veteran’s spouses, the limit will now extend to both beneficiaries.  Similar to Social Security benefits, these VA benefits will be indexed based on inflation.

An applicant who transfers assets to a non-beneficiary within three years of applying for A&A will face a penalty period of up to 10 years, double for spouses, unless clear and convincing evidence can be proven that the transfer was not in the interest of qualifying for the program’s benefits.

An alternative to A&A is Medicaid, a state and federally funded health insurance program that pays for the medical care of people who have low income and resource levels, or for the elderly. Although we caution applicants that there are still strict rules regarding transfers of assets and limits of income, Medicaid regulations are much less stringent than the A&A rules.

P & P Medicaid is available to assist retirement-age veterans and their families apply for Medicaid, Aid and Attendance and other programs or services. P & P Medicaid handles everything in the application and document-acquiring processes and will appear on behalf of the applicant at a governmental agency. The company can also provide guidance in selecting home healthcare or nursing home placement options, along with assistance in applying to the long-term care facilities.

For more information on how to begin the Medicaid application process, call (516) 541-4770 or visit www.ppmedicaid.com.

Is the Affordable Care Act the New Medicaid/Medicare?

Wilbur J. Cohen, U.S. Secretary of Health, Education and Welfare under President Lyndon B. Johnson, created the United States Medicare and Medicaid programs in the 1960s.  Inspired by the success New Deal at the end of the Great Depression, Cohen aimed to provide “relief, recovery and reform” to older and low-income Americans who could not afford coverage in the competitive commercial market.

It’s hard to believe President Johnson could have imagined such success for the Medicare and Medicaid programs when he signed them into law in July 1965. At that time, his main objective was simply to provide “the miracle of healing to the old and to the poor.”

While Medicaid is a federally funded program, it is controlled by local governments in each state and county. If one is eligible, based on age and disability, several applications and an evaluation of a person’s income and resource restrictions must be coordinated to determine to what degree Medicaid will to help pay for all medical expenses. Medicare offers many similar services as Medicaid, but it is available only to people over age 65, or younger if they are found to be certified disabled, who have worked and paid into the U.S. Social Security system.

Today, at the 50 year anniversary of the two programs, the nation still relies on that legislation. In fact, the Obama administration continues to make improvements to both platforms, in addition to using them as a basis for the Affordable Care Act, referred to by many as “Obamacare.” Like Medicare and Medicaid, the Affordable Care Act offers a combination of federal and private healthcare coverage. Unlike its predecessors, the program is open to all Americans, rather than just the elderly or those with limited incomes.

First enacted in March 2010, Obamacare’s original provisions led many insurers to forecast a decline in enrollment due to an increase in out-of-pocket expenses. Under pressure from the Obama administration’s Affordable Care Act, however, Congress reduced payments to Medicare Advantage. The legislation stated that beginning in 2014, Medicare Advantage plans could not spend more than 15 percent of Medicare payment on administrative or insurance costs. This could result in a reduction of individual member plan cost by up to $1,000 without reduction of benefits. Since this legislation was passed, member enrollment unexpectedly increased from 11 million in 2010 to 16.6 million in 2015.

Today, under Obamacare, more than half of the states’ governments have expanded Medicaid eligibility. Overall health insurance enrollment has soared thanks to government subsidies to private insurers who are now providing and coordinating almost 80 percent of new beneficiaries. Additionally, over 30 percent of the 55 million Medicare beneficiaries and more than half the 66 million Medicaid beneficiaries are now in privatized health care plans. White House officials are hopeful that Obama’s healthcare program will one day garner the standing and popularity of Medicare and Medicaid.