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”

Social Security Disability Insurance vs. Supplemental Security Income

Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are both supplemental income programs that are used to help the disabled, elderly, and blind. The main difference between SSDI and SSI is that SSI is a means-based program, whereas SSDI is an entitlement program. SSDI is only available to people who have worked long enough to accumulate work credits. SSI is available to people who have not earned enough work credits and can show that they financially need the support. Both SSI and SSDI are administered by the Social Security Administration, but they have entirely different financial requirements. Continue reading “Social Security Disability Insurance vs. Supplemental Security Income”

Medicaid Financials At A Glimpse

New York Medicaid eligibility

Medicaid is a program that entitles individuals who meet certain income and asset criteria to benefits for Chronic Medicaid or Community Medicaid. Chronic Medicaid is care that is provided in a skilled nursing facility, whereas Community Medicaid is care that is provided in an individual’s home by a home health aide. In 2017, Medicaid applicants may have up to $14,850.00 in resources to qualify for Chronic Medicaid. A Medicaid applicant may also have retirement accounts, such as IRAs, as long as the applicant is taking the minimum monthly distributions. In addition, a pre-paid burial account is an exempt asset. Continue reading “Medicaid Financials At A Glimpse”

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”

What to Consider Before Choosing a Nursing Home

Today, as many as 1.3 million Americans live in nursing homes. Choosing a nursing home for a loved one can be difficult and there are many factors that need to be taken into consideration before making a decision. Although every elder’s needs are unique, there are common criteria that may serve as a guide when choosing the best nursing home for a loved one’s needs. These important factors include method of payment, location, quality, and specialized services. Continue reading “What to Consider Before Choosing a Nursing Home”

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”

What is Managed Long-Term Care and What are My Available Options?

Managed long-term care is an option utilized by those who are disabled or chronically ill and need assistance with activities of daily living (ADL), but wish to remain within their homes and communities. Managed long-term care can be provided through the Program of All-Inclusive Care for the Elderly (PACE) and managed long-term care plans.

PACE is a little-known Medicaid and Medicare program that provides comprehensive health care services to eligible members 55 years and older who are otherwise eligible to be admitted to a nursing home. PACE is available through 110 programs in the United States, eight of which are located in New York State.

According to AARP, PACE provides coverage of in-home care, checkups, doctor and dental services, hospital and nursing home stays, as well as prescription medication and some transportation. PACE is open to those enrolled in Medicaid and/or Medicare; some may need to pay a monthly premium based on coverage. All applicants are screened by a team of doctors, therapists and nurses who will determine whether an individual’s level of health and disability requires the level of care typically provided in a nursing home.

Managed long-term care plans provide long-term care services, such as home health care, nursing home care, ancillary and ambulatory services and are funded through Medicaid. Medicaid members can use their Medicaid and/or Medicare cards to pay for services rendered by their primary physicians. To be eligible for a managed long-term care plan, the individual must qualify for nursing home admission. Most enrollees must be 65 years or older to qualify for a managed long-term care plan; however, there are several plans in New York State that will accept younger applicants.

P&P Medicaid provides assistance to those who are seeking a home care program to meet their needs or the needs of their loved ones. We offer a comprehensive in-home assessment conducted by our case manager, who, with the assistance of a nurse, can help determine program eligibility. Together, the case manager, the client and their family caregivers can develop a comprehensive long-term care strategy that is reassessed on a regular basis.

For those seeking qualification for Medicaid, P&P Medicaid will handle the entire application and document acquiring process and appear on the applicant’s behalf for all interviews with the Department of Social Services (Medicaid). For more information about home care evaluation, Medicaid application or any of our other services, please call us at (516) 541-4770 for a consultation.

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.

The American Geriatrics Society Focuses on the Future of Elder Care

With an estimated 20 percent of the United States population accounting for those 65 and older by 2030, the American Geriatrics Society (AGS) is focusing on how to improve medical care in the geriatric community. One concern is the low number of doctors specializing in geriatric care. U.S. News and World Report-Health estimates that approximately 17,000 geriatricians are necessary to care for the growing elderly population, but that there is currently only about 7,500 or more certified in America.

One goal of AGC is to find additional funding to support medical students studying to be a geriatrician. One of the reasons why many graduating medical students choose other medical specialties is that private insurance has higher payouts. When it comes to Medicare and Medicaid, the reimbursement rates are lower. With high debt upon graduation, going into geriatrics may not be an option for new doctors. With more educational funding, the number of doctors entering the geriatric field is apt to increase.

Additionally, there is a focus on other skilled professional fields which care for the elderly. This includes occupational therapists, physical therapists, nurses, social workers, and home health care aids. Often these health care providers must work together to support an elderly individual who suffers from multiple chronic issues. With the elderly, often a more holistic approach is better because much of the medical care will focus on daily functionality, such as getting dressed and eating.

Understanding the options for an elderly loved one can be challenging. Applying for Medicaid and making sure necessary needs are covered can be a complex process. P&P Medicaid provides Medicaid application services. The 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.