Saturday, June 26, 2004

More entertainment courtesy of Georgia Medicaid. First look at this from the Atlanta Journal-Constitution:
Families denounce plans for Medicaid

Ruby Fair, 91, resides in a Louisville nursing home, with her care paid for since 2001 by the state's Medicaid program for the poor and disabled.

The 162 acres she inherited in Louisville, in east Georgia, is the only thing she owns of value. But that former farmland — in her family for decades — may go to the state under a new program that seeks to recover the state's costs for delivering long-term care. Fair's son Roy and her daughter Pat Lamb were among family members and advocates for the elderly who testified Thursday at a state Department of Community Health public hearing on Georgia's plan to go after the homes and other assets of people receiving long-term care under Medicaid. The program starts in August.

"Are they going to bear down this hard on our elderly population and go for the jugular vein?'' Lamb said.

The General Assembly approved "estate recovery," part of Gov. Sonny Perdue's budget plan for the upcoming fiscal year. State officials have said that a tight budget forced them to take the action, which is required by federal law. Georgia is one of the last states in the nation to recover Medicaid costs this way.

"This is theft . . . hard-core theft,'' said William Morris, whose wife's uncle is in a Fairburn nursing home. "Something needs to be done about this.''

Many were angry that those already receiving long-term care would not be exempted from the rule change. The state plans to seek costs dating back to August 2001.

Seeking repayment for services provided before the rule was changed "is unconstitutional,'' said Joy Shirley of Newnan, whose father died in a nursing home earlier this year. She said the family was told during his stay it wouldn't have to repay the costs. "We were misled,'' Shirley said.

The state also plans to eliminate a program that helps pay for nursing home care for about 1,700 people considered "medically needy'' — making too much income to qualify for Medicaid, but not enough to afford private nursing home rates.

Under estate recovery, Georgia will seek repayment of Medicaid benefits received by people 55 and older, as well as younger recipients who lived in a nursing home or other institutions for at least six months.

Georgia officials say they expect to collect $5 million the first year from the estates of Medicaid recipients.

About 39,000 Georgians age 55 and older in a year receive nursing home coverage through Medicaid, which covers 1.4 million low-income residents in the state. The changes will also affect an additional 15,000 Georgians in that age group who receive other types of Medicaid long-term care — community or home-based services.

William Pinkney's parents both receive Medicaid-funded community services.

Pinkney said his mother, 85, has Alzheimer's disease, and his father, 92, has congestive heart failure. They need the state's assistance, he said, to remain in their Atlanta home — and out of a nursing home, which would cost the state much more.

"I've been serving,'' said Pinkney, referring to his 27-year career in the military, now with Air National Guard. "It's about time the state started to serve me.''

He said it was his father's dream to leave his property for his children and grandchildren. "Unfortunately with this proposal, their American dream just went away.''

I can't imagine what the hue and cry would be if Georgia was the first state to try and do this. I could point out the selfishness of those quoted above but Neal Boortz gave a no-holds barred rant on his site yesterday.

Oh man ... you should hear the wailing and gnashing of teeth going on over this plan. Ruby's children asked if state officials were "going to bear down this hard on our elderly population and go for the jugular vein?" Hey, kids. The taxpayers have been forking over big bucks for a few years not to take care of your mother. Where were you then? Were you whining about the state using its police power to seize money from people you don't even know to pay for your mother's nursing home care? Does it occur to you that these people had something else they could be spending that money for? Maybe they had medical expenses in their own family that needed to be covered. Maybe they were behind on their mortgage, or needed repairs to their car. Did that bother you? No, you just stood by and watched the state use its police power to seize money from complete strangers to care for your mother. I sure would be interested to find out just how much you two were willing to dip into your savings to pay for your mother's medical care. But hell, why should you? Why even bother when the state will take care of it all for you!....We all know what the deal here is, don't we? Ruby Fair's kids will get those 162 acres once she gets tucked in for that eternal celestial dirt nap. Now the state is threatening to take that land, sell it, and reimburse the people who have been taking care of Ruby Fair while her children dreamed of inheritances.....Then we have William Morris. He's quoted in the article also. His wife's uncle is in a Fairburn nursing home at state expense. Evidently the wife's uncle has some assets that the state is eyeing. William Morris says "this is theft ... hard-core theft." Pray tell, Mr. Morris, what is it when the government takes money away from me to pay for your relative's nursing home stay? Let me see if I get this straight: You take money from me to pay for your wife's uncle's medical care, no problem. You make your uncle pay the costs of his own care and that's theft......The run isn't over. We also have William Pinkney. His parents are both in a taxpayer-funded community health services program. Pinkney says that it was his father's dream to leave his property to his children and grandchildren. "Unfortunately with this proposal, their American dream just went away." OK .. now let me get this straight. Your version of the American dream is to use the police power of government to force other people to pay medical bills for your parents so that their estate will remain intact for you to inherit when they die. Fascinating.

The regulations may be found here. Some highlights:
(2) Recovery will be pursued from Medicaid members:
(a) Who at the time of death was any age and an inpatient in a nursing facility, intermediate care facility for the mentally retarded, or other mental institution if the individual is required, as a condition of receiving services in the facility under the state plan, to spend for costs of medical care all but a minimal amount of the person’s income required for personal needs; or
(b) Who at the time of death were fifty-five (55) years of age or older when the individual received medical assistance, but only for medical services consisting of nursing facility services, personal care services, home and community based services, and hospital and prescription drug services provided to individuals in nursing facilities or receiving home and community based services.

So it doesn't seem that when you die your heirs will be hit with a bill for all of your Medicaid charges, only some of them. And there are some limitations:
(7) The debt created in this section shall not be enforced if the member is survived by:
(a) A spouse;
(b) A child or children under twenty-one (21) years of age; or
(c) A child or children who are blind or permanently and totally disabled pursuant to the eligibility requirements of Title XIX of the Social Security Act.

The state may also place a lien on your property:
(2) The state may place a lien on the member’s home when there is not a reasonable
expectation that the member will return home and when none of the following persons
are living in the home:
(a) The member’s spouse;
(b) A child under twenty-one (21) years of age;
(c) A disabled child of any age; or
(d) A sibling with an equity interest in the home who has lived in the home for at least one (1) year before the member entered the nursing home.

But they may not be enforceable:
(9) The state may not enforce a lien under any of the following circumstances:
(a) The member’s spouse is alive, even if not living in the home;
(b) The member’s child under twenty-one (21) years of age is alive, even if not living in the home;
(c) The member’s blind or disabled child of any age is alive, even if not living in the home;
(d) An adult child of the member is living in the home, if that child lived in the home for at least two (2) years prior to the member’s admission to the nursing home and provided care that kept the member from entering a nursing home.
(e) The member’s brother or sister is living in the home, if he or she lived in the home for at least two (2) years prior to the member’s admission to a nursing home.

There are even hardship provisions:
(4) Recovery will be waived of any estate recovery when the requesting party is able to show,through clear and convincing evidence, that the state’s pursuit of estate recovery subjects them to undue hardship. In determining whether an undue hardship exists, the following criteria will be used:
(a) The asset to be recovered is a income producing farm of one or more of the heirs and the annual gross income is limited to $25,000 or less; or
(b) The recovery of assets would result in the applicant becoming eligible for governmental public assistance based on need and/or medical assistance programs.
(5) Undue hardship does not exist when:
(a) The adjustment or recovery of the client’s cost of assistance would merely cause the client’s family members inconvenience or restrict the family’s lifestyle;
(b) The heir divests assets to qualify under the hardship provision.

None of the family members quoted above are threatened with the loss of their own homes or businesses because of this. The question may be asked, should these families lose their assets, acquired over a lifetime of hard work, to pay for their medical care? There are plenty of people who do not own homes or large tracts of land who pay the taxes that fund the Medicaid program. Is it fair for them to have subsidized their medical care while the heirs enjoy the inheritance? If the eligibility criteria for Medicaid used assets instead of income, the system would be fairer. Now this could lead to property or other assets being sold to heirs for pennies on the dollar, but "Medicaid Planning" is nothing new.
This is a very controversial issue, and will probably grow in scope as healthcare funding becomes more scarce. Let the debate begin.
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