NYT: In Effort to Pare Medicaid Rolls, Long-Term Care Is the Focus

[DeepModem Mom]

In Effort to Pare Medicaid Rolls, Long-Term Care Is the Focus
By JANE GROSS
Published: June 27, 2005


Congress is holding hearings. The governors have a plan. The Bush administration has named a commission. Insurance companies have weighed in, and so have lawyers and the AARP.

The idea is to restrain the explosive growth in the taxpayers' contribution to the cost of long-term care for middle-class Americans in frail old age by making it harder to qualify for government benefits and shifting costs to individuals and private insurers.

Lawmakers, health policy experts and stakeholders in the long-term-care industry are rushing forward with proposals to remove from the Medicaid rolls people who are not poor by standard definitions, but who rather have exhausted a lifetime of resources or used legal strategies to give their money away.

There is plenty of argument about which proposals are best, but the broad consensus is that none, alone or in combination, will do much to cut government spending or provide older Americans an affordable and ethical way to pay for long-term care. And the need for a solution is critical; Medicaid, a government program created for the poor, is straining to cover two-thirds of the nation's 1.6 million nursing home residents, many of them real estate rich but cash poor.

Experts agree that many of the proposals are likely to be enacted in the coming year. "The governors are screaming bloody murder," said Keith D. Lind, a senior policy adviser at the AARP Public Policy Institute. "There is a consensus that something has to be done that will significantly change the program."...


http://www.nytimes.com/2005/06/27/politics/27medicaid.html?

[daleo]

1. Not poor by standard definitions?

"but who rather have exhausted a lifetime of resources".

This seems like a pretty standard definition of poor to me.

"And the need for a solution is critical; Medicaid, a government program created for the poor, is straining to cover two-thirds of the nation's 1.6 million nursing home residents, many of them real estate rich but cash poor."

In other words, you don't get covered for a nursing home until you have sold off all of the family's assets. Worse than the so-called "death tax". And if the special Shiavo laws are taken seriously, you have to hang around on a feeding tube until all family wealth is used up. Then the hospital or nursing home will pull the plug, post-haste.

[ninkasi]

5. Well, God forbid that Paris Hilton should have to be

burdened with the so-called "death tax", but what occurs to me is that if Grandpa is in a nursing home, and Grandma is still living in the home they paid for by frugal living years before, Medicaid won't kick in until Grandma sells the home, uses all of that money, and then is forced to...what?

She has to live somewhere; she might prefer to remain in the home she helped pay for, rather than burdening her grown children, if she has any. If she is forced to sell her home, affordable housing is practically non-existent.

I hope that some of the better off twits who care so much about chasing money realize that eventually, Republican policies will have an impact on them, too. What if they are forced to step forward and care for elderly relatives, because the government is more concerned with using tax money for more and more breaks for the wealthy, or endless wars?

The ultra wealthy, of course, won't have to worry. The ones who will feel it are those who have had the luxury of making money, and not having to be burdened with caring for Grandpa, because of Medicare and Medicaid. They are the ones who will scream the loudest, too.

[SoCalDem]

6. This actually plays into their philosophy..

Who takes care of the ill, the elderly, the infirm? Usually it's the WOMEN.. This "brave new world" will force women OUT of the workplace, if they have to daiper Granny every few hours, and there's no more money left since the home was sold to pay for Grandpa's care.

Home healthcare aides are expensive, so the burden will fall back on the women.

They have had a generation of "relative freedom", and now will end up back where THEIR mothers were....taking acre of the house and the frail elders, and the grandkids and the "man of the house".

[cap]

20. that's already happened... women are being marched out of the workforce

the biggest targets of the layoffs of the Bush administration have been middle aged professional women.

[DeepModem Mom]

24. Very interesting, and, I think, perceptive post, SoCalDem. nt

[MountainLaurel]

28. The 'Sandwich Generation'

Is a term often used: For families who are not only trying to raise children but must also take care of elderly parents or other family members.

[SoCalDem]

29. Yep.. That's us Boomers..

Our parents were the first generation to really benefit from "modern medicine" and are living a lot longer. My mother had lost both parents by the time she was 32.

There were some people who had great genes and lived a long time, but most people died much younger than they do now.

[October]

35. I'm one of them

My mom is young...she's more the boomer I guess at 62.

By all accounts, she died on the operating table after suffering a stroke post-surgery. Elective surgery "to improve her quality of life." Surgeons and modern medicine kept her alive.

Now...she's half paralyzed (right side) and has lost her ability to read/write. She is aware enough to know she's lost her home, possessions...and any hope of independence. It's purgatory, if not hell. And for me....GUILT with every visit, plus the overwhelming task of filing for Medicaid, etc., etc., which I won't bore you with.

I cannot possibly accommodate her enormous "needs" (24/7 supervision is required, as she can never be left alone.) Her siblings are in such denial, and constantly look to me to "do something." They see their own fate staring back at them through the eyes of their younger sister. And for whatever reason, they cannot understand that I have to put my children first. My mother's progress has plateaued...she's where she'll be according to 5 different hospital experts. <sigh>

My mother was very much overweight, and a smoker who for some reasons actually thought she just didn't have the "bad genes" that give you Cancer, strokes, etc.

[SoCalDem]

36. Awww, honey

:hug:.. I feel for you....When it comes to a stroke, I think death would be preferable.:(

My husband's mother lingered for almost 8 years after her stroke.. couldn't talk, walk, bathe herself, read, write.. We wanted to bring her here, since I didn't work, I was willing to care for her, but she made it known to us that she did not want to live with us.. I was a bit insulted at first, but our kids were little at the time, and had she been with us, it would have definetely taken time from them,., Her friends were all there, and they did faithfully visit her, so n the end she made the right choice.

[DeepModem Mom]

37. I'm so sorry, October --

Please, with all you're going through, and I would plead with others here going through similar, try not to add guilt to your burden. (My mother died recently after years in the "purgatory" of Alzheimer's.) You visit, you help, but your children must come first. And your own needs are important also -- please try and take care of yourself.

[progressivebydesign]

7. Well that kinda makes sense...

.. in some way. I mean why are the working poor and middle class expected to pay for the long term (terminal) care for someone who has money? So they can leave an inheritance? The rich do not pay for the long term care for these people.. they write everything off or shelter their money in tax schemes. It's the people earning 20k to 60k that pay for the rich who have sold off or passed assets off to kids. I really am conflicted on this.

[daleo]

8. Well, the working poor and middle class are the targets of this

So, in order to not have to help pay for their neighbors' care, they will have to lose their own houses. It is basically a case where a collective solution makes more sense for everybody.

The actual article said (if I recall) that implementing this would only save about 1% of the money spent on the program anyway.

[ninkasi]

15. Exactly, Daleo

This is a case where the pukes play on people's knee-jerk reactions, appealing to their sense of greed, and I've got mine, you get yours attitude. The suckers they prey on only think they are being helped; they are not. Rather than pay an extra dime in taxes to help society as a whole, they will willingly march to their own doom, when that extra dime might have enabled their own parents, or them, living out their lives in dignity, in the homes they worked for all of their lives.

Eventually, the ones who are counting on a nice, fat inheritance when the old folks go to their final resting place, will have, instead, a stack of bills, no house to sell and reap the profits from, and their own children facing increasing college costs. Too many comfortable upper middle class Americans like to count themselves as among the rich.

They are not, and the right-wing cares no more for them than for the rest of us. By the time they realize this, it might well be too late. If we can work together and stem the tide of fascism that is threatening us, will they thank us? No, I don't think so either.

[patcox2]

32. Fuck the heirs.

You have no right to anything you didn't earn.

Heirs are never, ever responsible for the bills of the deceased, by the way. Ever. They may not get that house they really really want to get, because, after all, everyone likes free money that you get just for being born. But not getting that free money just for being born is no tragedy, its just too fucking bad. If your parents had bills, then your parents money should be used ot pay their bills. Not my money. Maybe the selfish shits would care for their own parents instead of carting them off to a nursing home, this way.

Making people pay for the own care until they truly qualify for wlefare, instead of letting them give away everything to their kids, hurts noone. The kids, fuck them. They can be like the vast majority of people on this earth who don't inherit squat.

My tax dollars should not be sued to preserve the inheritance of anyone. Fuck that shit.

[MountainLaurel]

27. Got it in one

My friend's father had to do exactly that -- sell his home and his wheelchair-accessible van -- in order to have Medicare pay for his stay in a long-term care facility. (He's in the final stages of MS.) What's ironic is that the reason he had to go to this facility was that the doctor wouldn't release him from the hospital until he could show that he'd have full-time care from a health professional; my friend's father couldn't afford that and SS disability wouldn't pay for it. (He kept going in and out of the hospital because the 19-year-old he could afford kept forgetting about him for a couple days, and since he can't move on his own, he would develop pneumonia and kidney infections from not being able to eat, drink, or empty his waste bag.) Yet, he was apparently too wealthy by government standards.

:eyes:

[patcox2]

30. Its "planned poverty."

They don't make it clear, but the target is the elderly who use various legal tricks to "spend-down" until they do meet the income and asset tests for medicaid. So, we are talking about people with say $300,000 in assets, who give away their house (to the kids) and hide a lot of the rest in exempt assets, and otherwise purposely impoverish themselves so they can qualify for medicaid.

[iamjoy]

45. It Is Worse Than The Death Tax

Because it primarily affects lower middle class. More affluent people are more likely to have long term care insurance and the very fortunate have made arrangements for something better than medicaid nursing homes.

If it is a married couple and one of them must be in a nursing home, does the other get to keep the house?

[MichiganVote]

2. Gee..here's a thought, raise taxes on the wealthy for these

retired or disabled workers who probably worked for--the wealthy!

[bettyellen]

3. " exhausted a lifetime of resources" ... how is that different from being

poor? just asking.

[SoCalDem]

25. Here's how..

Society has always been expected to take care of the indigent poor. The perpetually jobless, skill-less, "renting" poor.

THIS is a shot across the bow to "the rest of us".....the ones who live paycheck to paycheck to pay for that home we bought. After a lifetime of paying on a home a COUPLE can be MADE poor if ONE of them gets desperately ill (which WILL MOST ALWAYS happen)..It's rare for two people to follow a tandem march to the end of life. One usually is left behind to carry on. This is the prime reason that so many middle class people have worked so hard to pay off a home...so that the one left behind has a place to live. If the HOME is sold or signed over to pay the outrageous costs of ONE, the surviving spouse is now POOR...and homeless.. What a grand payoff for a life of frugality..

Remember.. we are talking about ORDINARY people who have needed EVERY penny they earned ...just to LIVE.. They did not have "extra" money to set aside in trust funds, and IRAs, and stock portfolios.. These are the people whose homes will be happily snatched up by speculators who will spiff up Granny's house and re-sell it for 50 times what she paid for it. (Granted, her own kids would probably do the same, but THAT'S why Granny & Gramps held onto that home...so they could live out their days and then leave it to their family...as they will do for their kids too.. Private home ownership is the "legacy" that middle class people hand on tho their heirs.

The SCOTUS ruling and laws like these are meant to strip away the ONE thing of value that middle-classers , and hand them up the ladder to their "rightful owners"..the moneyed class.:puke:

[TahitiNut]

4. If you want ot be scared to death about getting old ...

... just take a tour of a Medicaid long-term care nursing home some day. I figure fellating a loaded shotgun is a better alternative. The quality of care in such facilities is about as frightening as anything I've ever seen.

Anyone can take a tour. Just tell 'em your looking for something for a needy older relative.

[Doremus]

9. Like everything else, there are the good and the bad

Not all nursing homes are horrible. Some are, no question. But there are good ones out there. Typically, the wealthy won't ever see inside any of them -- people with money hire live-ins to take care of them in their last days. If only we all had that luxury.

Ohio has required seniors to spend themselves down to $1500 before Medicaid kicks in for some time now. If there's a spouse involved, half of the assets are exempt from that rule, and the sell-off of the house doesn't need to occur until after the spouse has died, at which point the state takes their portion.

There are many ways to shelter assets, assuming one has planned ahead, including trusts etc. As long as title to property and other assets has changed hands 3 years or more before nursing home care is required, there's no problem.

[cap]

40. yeah... but you dont always get enough time to sort out a situation

we had one week to get my mom into a home. Of course, the really crappy ones were open and the really nice ones had a waiting list...

Read the article, they are extending the look back period from 3 to 5 years.

[Erika]

10. I have worked hard to own my own home, mortgage free

and plan to leave it to my kids. I will end my life voluntarily rather than giving my house up to the medical field. Let them be damned. Let the government system who would force those who have acted responsibly all their lives, to turn their assets over to a medical field which is based on profit greed. I won't do it.

[SoCalDem]

11. See a lawyer and transfer/sell your home to your kids NOW..before you

get old and infirm. If you do not OWN anything, how can you be forced to sell it:).

The other alternative is to be taken suddenly ill and have to sign over all you own.. That prospect leaves your kids NOTHING..and assuming you recover, you have nowhere to live:(

[SoCalDem]

12. I wonder if you can "gift" 11K of equity to kids every year..

Check with a lawyer.

[Erika]

14. Thanks, I will look into it

Again, it will be a cold day in Hell before I allow my life's work to be turned over to the medical industry vs my family.

[Erika]

13. I am not that old

I think all will be fine for a few years. If I am taken suddenly ill, I will refuse treatment before I sign over all that I have worked hard for in a lifetime to the medical industry. Somewhere in life, we have to stand for a principle.

Thanks to the help of Old Leftie Lawyer, I have the papers necessary to keep the government from extending my life. I will just say no.

[SoCalDem]

17. The problem with "signing over"

There is usually a time limit.. 4 years comes to mind..It's to prevent granny getting bad news at the doctor's office and THEN signing away her assets..
That's why it's important to do it while you are healthy and young:)

[Gormy Cuss]

26. The problem with signing over is that you are fueling the problem

Medicaid is for the poor, not those wily enough to have sheltered all their assets. By turning over your assets to your children in an effort to qualify, you're abusing the system. Having said that, spouses should be granted an exception from selling their primary residence or draining all assets in order to pay for long term care.

On the other hand,if you choose to off yourself rather than spend your assets on long term care, that's your business.

[wmills551]

38. Great point

Medicaid is for the poor. None of the proposals listed in the article or currently in place across the country ever force anyone to sell their home. They put a lien on the home that pays for Medicaid nursing home expenses before the home is sold by the children. Money for medical treatment for the poor should not be used so that children can keep money for their parents house. It should be used for the poor.

[cap]

41. the nursing homes make you do this...

also, you dont know every family's personal situation.

If my nephew can not overcome his autism, he will need my sister's house passed on to her so that he can have some assets to take care of himself. Each family is different.

[Gormy Cuss]

44. You're right, I don't know every situation.

If your nephew needs aid because he can't overcome a medical condition, there should be ways for him to receive it through government assistance. Even with his mother's house as an asset he may eventually need government assistance too. There is a pride issue involved, with living from your own family's assets perceived as better than living off government assistance, but the bottom line is you're describing a family that would probably need government assistance either way. That's very different from the families who are trying to make the government pay just so the children can pocket more money from the estate.

[cap]

46. government assistance only provides the bare minimum

it is not generous... anything else you got to pay for and that can make a big difference in a person's longevity. They are cutting welfare and Social Security for the Disabled. We cant count on the government these days, unfortunately.

Nobody can write a law to account for the worthy vs the unworthy. There is no way for the government to know which families are deserving of inheriting their families estate.

I dont think the issue is making the government pay just so kids can pocket more money from the estate. I think the issue is one of social insurance for everyone. Nobody knows what the future will bring.

[Gormy Cuss]

47. Social insurance would be great, and we agree it isn't there now.

The rules say your house (when there's no spouse) is an asset available first for your care before Medicaid picks up the tab, then any unspent remainder is available for inheritance. Hiding assets is willfully cheating no matter what your motivation. There are many very low income seniors with no assets to hide. When Medicaid is cut, there is no way for them or their families to pick up the slack. Believe me, I don't like it that there is insufficient support available for those who need it but until we have comprehensive supports is it right to expect the poorest of our citizens to suffer because others have moved assets? Medicaid is the primary health insurance for nonelderly low income families too, so children suffer with cuts in Medicaid. Again, should kids be denied services because someone hid assets? That is the level we are at with Medicaid now.

I truly hope that by the time your family faces this dilemma we have social insurance for everyone. It isn't right that families feel that cheating is necessary to protect loved ones. Until we can get more liberals and progressives elected, this underfunded system is what we're stuck with. Let's hope for success in '06.

[Iowa]

16. Caring for our elderly

is a moral obligation. Raise taxes if that's what it takes!! But that won't happen because republicans are greedy, self-centered, cold-hearted bastards who respect life only if it pertains to them and theirs, and only if it doesn't inconvenience or cost them in any way. And that's the primary difference between us and them, isn't it? Democrats are honorable people who will step up and pay the tab for a decent society, even if there's no money in it for them. Republicans are lightweights who are always scheming to find a way to skip out on the tab (although they'll trample you to get to the trough if there's government money to be had). Republicans are essentially freeloaders. It all comes down to a matter of character. This is what separates us from them and we should make that the core of our message. This would be a simple, true, and effective message.

[anitar1]

18. I am thankful I live in Oregon. But they will try again to

void our Right To Die law, I am sure.

[cap]

19. what's so darn wrong with raising taxes to cover Medicaid?

cheap, cheap, cheap ...

Nobody knows what the future will bring. Why not just make a commitment that everyone will be covered?

I dont think that taking people's houses away is going to sit to well with the electorate. I hope the Republicans try to do this. I hope they do. Their ugly program is coming home to roost.

[Princess Turandot]

21. In one of Pataki's earlier state budgets, he proposed massive slashing of

Medicaid, including long term care, which I believe consumes more than 25% of the NYS Medicaid budget these days.We have a Medicaid paid in-home long term care program here in addition to nursing home coverage.

The union for Health & Hospital workers ran a series of TV ads showing families with their infirm relative, some with Alzheimers, now living with them. Brutal to be sure, but it absolutely did the trick.

[Vinca]

22. If they didn't require servants and lawn maintenance.

they'd line the poor and middle class along the side of an open pit and let loose. How disgusting this is. Our elders should be cared for no matter how they became poor.

[patcox2]

31. No, you are wrong; if they purposely gave away their assets to qualify.

Sorry, but thats not right. They are talking about the practice of "medicaid planning" whereby elaborate legal tricks are used to get everything out of the name of the elderly person to make them "poor" so they can qualify for welfare. You do know that medicaid is tied to welfare, right? Its a welfare program. Under current rules, they are able to funnel hundreds of thousands of dollars to their kids, and then go on the public dole for their nursing home care.

I say fuck the kids, fuck heirs. My tax dollars should go to caring for the elderly, not to preserving the inheritance of the kids of the elderly. Maybe if the rules were changed, the kids would have more of an incentive to keep them with them and care for them, instead of dumping them in a warehouse for old people. On the public dime.

[preciousdove]

34. How about those billions that went to Iraq?

They have made it almost impossible to shelter assets already so this is like the welfare queens with the cadillac and the kids who misbehave to get Social Security. It was a couple people in a millions who did this. They want to hook more distant relatives with the bills and care of the elderly and disabled.

They will get around to you eventually. When they are dumped on you door are you going to feel the same way or are you going to wish you had thought this through a little better?

[wmills551]

39. That is a great post!!!

Medicaid is for the poor.

[cap]

42. also, if you are a 40 year old who got laid off and are living at home

you would not be so keen on leaving your family home and giving it to the nursing home.

Also, I would want the additional assets to cover things that Medicare/Medicaid wont cover.

[Coastie for Truth]

23. Unless and until Bush-Frist-Rove face up to universal health insurance

any talk of fiddling with the carefully crafted integrated system of Long Term Care Insurance integrated with Medicaid shows Bush to be neither Compassionate, nor Conservative, nor Christian.

[Lars39]

33. "who rather have exhausted a lifetime of resources"

They're looking to step up the rationing, gotta get rid of the old and infirm at a quicker pace.:sarcasm:
This reminds me of Dianne Odell, who has been in an iron lung for 50-something years.
The government has cut her benefits down to almost nothing, so folks
in Jackson TN periodically have a fundraiser to keep her alive.
Communities will bankrupt themselves trying to step in and help everybody.

[ihelpu2see]

43. Umm, I'm sorry Mr. Cheney but before we can empty your bed pan

and spoon you your puree of peaches you must sign over your monthly proceeds from your Haliburton stipend.....

That, I don't have a problem with. I have been doing nursing home care as an eye doctor for 8 years and Medicaid has not increased my reimbursement rate for exam or refraction in 8 years.... but my fuel cost (not billable) has doubled and other expenses as well.... I don't know if I could fix the problem but I know if it stays the same, I will have to stop going to nursing homes or stop paying my Federal Student Loans????? But I can only hope that the solution is NOT Privatization (they don't pay at all) or a large state run home for the elderly (just a scary thought)... Lets see 7-8 Billion $$ was lost by the Iraq Provisional Gov. just poof lost.... Hmmm that would be a start to fixing our problem but nope we need to control the Middle East!!!

(sorry for the rant)