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Monday, December 26, 2005
Last Updated: 12/24/2005
The Bush administration has given its blessing to provisions in the House budget reconciliation bill (H.R. 4241) that would make it far more difficult for the middle-class elderly to gain Medicaid coverage of nursing home care, according to McKnight's Long-Term Care News. Such support, says McKnight's, "increases the likelihood these provisions will remain in the final budget."
McNight's source is a Nov. 23 Bureau of National Affairs article stating that "The Bush administration has announced support for most of the key Medicaid elements in the House fiscal year 2006 reconciliation bill (H.R. 4241), particularly the provisions to tighten rules regarding asset transfers and to give states greater flexibility to administer Medicaid programs."
The House measure would extend Medicaid's "lookback" period for all asset transfers from three to five years and change the start of the penalty period for transferred assets from the date of transfer to the date of Medicaid application. The bill also would make any individual with home equity above $750,000 ineligible for Medicaid nursing home care.
Speaking to the National Association of State Medicaid Directors on Nov. 8, Centers for Medicaid & Medicare Services Administrator Mark McClellan said that as the bill goes to conference committee with a Senate budget bill (S. 1932) that makes only modest changes in the asset transfer rules, the administration will continue to work closely with legislators. Congress is expected to begin work on resolving the starkly different proposals in early December.
Meanwhile, the Washington Post is reporting that while Democratic lawmakers in Washington are united in their opposition to the Medicaid cutbacks in the House bill, "Democratic governors are quietly supporting the provisions and questioning the party's reflexive denunciations." The Congressional Research Service (CRS), the public policy research arm of Congress, has produced a 192-page side-by-side comparison of the Medicaid and Medicare provisions of S. 1932 and H.R. 4241. Although the CRS does not distribute its reports to the public, the National Senior Citizens Law Center says the report is or will be available on its Web site. Go tohttp://www.nsclc.org/
Monday, December 19, 2005
Last Updated: 11/21/2005
By the narrowest of margins, the House has voted to approve a budget plan that cuts about $12 billion from Medicaid, including imposing harsh new restrictions on the ability of the elderly to transfer assets before qualifying for Medicaid coverage of nursing home care.
The Deficit Reduction Act of 2005 (HR 4241) was approved by a 217 to 215 vote in the early hours of Friday, November 18. The bill maintains provisions aimed at making it even more difficult for the middle-class elderly to receive long-term care coverage. The measure would extend Medicaid's "lookback" period for all asset transfers from three to five years and change the start of the penalty period for transferred assets from the date of transfer to the date of Medicaid application. The bill also would make any individual with home equity above a certain limit ineligible for Medicaid nursing home care, although in a concession to Republican moderates that limit was raised from $500,000 to $750,000. The final measure retains a provision imposing co-payment increases on Medicaid beneficiaries with incomes above the federal poverty level.
The bill now must be reconciled in conference committee with aSenate budget bill that makes only modest changes in the asset transfer rules. (For an ElderLawAnswers article explaining the effects on America's elderly of the two competing proposals,click here.)
Last week, Republican leaders were forced to pull the bill from the floor because of a lack of support. In the final vote, after some of the bill's cuts had been softened, 14 House Republicans and all House Democrats opposed the bill. (For a tally of votes on the bill, click here.) The Center on Budget and Policy Priorities estimates that the eleventh-hour changes only eased the cuts aimed at the poor by 2 percent from the original version.
The House bill would also:
Codify the income-first rule.
Establish new rules for the treatment of annuities, including a requirement that the state be named as the remainder beneficiary.
Require Medicaid applicants to provide "full information . . . concerning any transaction involving the transfer or disposal of assets during the previous period of 60 months, if the transaction exceeded $100,000, without regard to whether the transfer or disposal was for fair market value."
Allow Continuing Care Retirement Communities (CCRCs) to require residents to spend down their declared resources before applying for medical assistance. Set forth rules under which an individual's CCRC entrance fee is considered an available resource. Extend long-term care partnership programs to any state.
The Associated Press predicts that the upcoming conference committee negotiations with the Senate will be "arduous." The negotiations, writes the Los Angeles Times, "are likely to test [President] Bush's ability to work his will in Congress when his approval ratings are at an all-time low." The conference committee has not yet been named and no timetable for its deliberations has been set.
The final version of HR 4241 is still unavailable. For a version of the bill that does not reflect last-minute changes (such as the shift from $500,000 to $750,000 in home equity), click here. Scroll down to Title III, Chapter 2 for the asset transfer rule changes. Meanwhile, a survey for the National Academy of Social Insurance finds that 7 in 10 Americans age 40 and over think the federal government should do more to help people meet the cost of long-term care.
Monday, December 12, 2005
Sustained state cost-containment actions and a stronger economy have improved the outlook for Medicaid and SCHIP, but factors contributing to Medicaid's cost growth continue to present long-term challenges, according to a new state surveys released Wednesday by the Kaiser Commission on Medicaid and the Uninsured. According to the survey, state Medicaid officials say that rising health costs, declining employer-based coverage, demographic trends and other factors raise concerns about future Medicaid cost growth.
Budget In a survey of state officials, KCMU and Health Management Associates found that growth in Medicaid spending slowed to an average of 7.5% in fiscal year 2005, the third year of decreased growth. The survey indicates that a decline in enrollment growth in fiscal year 2005 to 4% combined with spending reduction measures taken at the state level contributed to the slowdown in spending growth. Enrollment growth is expected to slow for the fourth consecutive year to 3.1% in fiscal year 2006 (KCMU release, 10/19). The gap between Medicaid spending increases and state tax revenue growth fell to 2.6%, the lowest level since 1999. According to the survey, despite the improved fiscal outlook, states are planning new cost-control measures, such as provider rate reductions or freezes, the Washington Post reports (Washington Post, 10/20).
In addition, many states are expanding coverage (CQ HealthBeat, 10/19).
Enrollment Procedures KCMU and the Center on Budget and Policy Priorities conducted a survey that focuses on state actions regarding Medicaid and SCHIP eligibility, enrollment and renewal procedures, as well as cost-sharing requirements for low-income families (KCMU release, 10/19). According to the survey, Missouri and Tennessee have made large cuts in eligibility. The survey also found that 20 states reported taking actions expand coverage by simplifying procedures and requirements for beneficiaries, expanding eligibility or reducing premiums for children's coverage (CQ HealthBeat, 10/19). However, 10 states either increased premiums or lowered the level at which they begin charging premiums for children's coverage, according to the survey.
Reaction Diane Rowland, executive director of KCMU and executive vice president of the Kaiser Family Foundation, said, "These studies affirm the basic countercyclical nature of Medicaid. Its costs increase most rapidly when it is most in demand -- in a sluggish economy," adding, "While the fiscal crisis has subsided, state budget pressure remains because the nation relies on Medicaid to forgive the failures of our larger health system." (KCMU release, 10/19). Alan Weil, executive director of the National Academy for State Health Policy, said, "We are at a turning point in how much with think of (Medicaid) as a national program," adding, "There is tension between state and federal government, ... we need to think about who the burden is going to fall upon" (CQ HealthBeat, 10/19).
Monday, December 05, 2005
Last Updated: 11/25/2005
Topic: Nursing Home Issues
In December, the National Senior Citizens Law Center (NSCLC) will publish a new guide to nursing home laws, entitled 20 Common Nursing Home Problems, and How to Resolve Them. The guide is an adaptation and expansion of NSCLC attorney Eric Carlsons Fifteen Falsehoods presentation.
1. Medicaid does not pay for the service that you want.