December 2005

Last Updated: 12/24/2005

Topic: Medicaid

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/

Last Updated: 11/21/2005

Topic: Medicaid

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.

Topic Medicaid
[Oct 20, 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).
Drug Benefit In addition, KCMU and Georgetown University'sHealth Policy Institute surveyed state officials regarding the outpatient prescription drug benefit, finding that all surveyed states actively managed their benefits and imposed a variety of cost-control mechanisms. More than two-thirds of responding states use preferred drug lists. Sixteen of 37 states surveyed placed limits on prescription refills, but only two states automatically denied refills that surpassed limits.

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).

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.

In order to publicize the guide, NSCLC would like to be able to quote nursing home residents, family members, or advocates who have encountered any one (or more) of the Twenty Problems. If you or your client has heard any one of the nursing home falsehoods listed below, please contact Eric at (213) 639-0930, ext. 313, or This email address is being protected from spambots. You need JavaScript enabled to view it.. NSCLC will not mention you or your client without express permission.

1. Medicaid does not pay for the service that you want.
2. The nursing staff will determine the care that you receive.
3. We dont have enough staff to accommodate individual schedules. You will be woken up every morning at six a.m.
4. We dont have enough staff. You should hire your own private-duty aide.
5. If we dont tie your father into his chair he may fall or wander away from the nursing home. Theres just no way we can always be watching him.
6. Your mother needs medication in order to make her more manageable.
7. We must insert a feeding tube into your father because he is taking too long to eat.
8. Your children can visit you only during visiting hours.
9. We cant admit your mother unless you sign the admission agreement as a Responsible Party.
10. Please sign this arbitration agreement. Its no big deal. Arbitration allows disputes to be resolved quickly.
11. Medicare cant pay for your nursing home care because we have determined that you need custodial care only.
12. We must discontinue therapy services because you arent making progress.
13. We cant give you therapy services because your Medicare reimbursement has expired, and Medicaid doesnt pay for therapy.
14. Because you are no longer eligible for Medicare reimbursement, you must leave this Medicare-certified bed.
15. Even though youre now financially eligible for Medicaid payment, we dont have an available Medicaid bed for you.
16. We dont have to readmit you from the hospital because your bed-hold period has expired.
17. You must pay any amount set by the nursing home for extra charges.
18. We have no available space in which residents or family members could meet.?
19. You must leave the nursing home because you are a difficult resident.?
20. You must leave the nursing home because you are refusing medical treatment.?