Understanding Medicaid Funding

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Today, there are more than 60 million Americans enrolled in Medicaid—but what is Medicaid and how is it financed? This video explains how Medicaid is funded and how it will change under the Patient Protection and Affordable Care Act (PPACA).

Chief lawyer for R.I.’s HHS quits to direct nonprofit

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Top lawyer at Rhode Island Department of Human Services quit

Jennifer L. Wood will become executive director of the nonprofit public interest law group, the Rhode Island Center for Justice.

Source: Chief lawyer for R.I.’s HHS quits to direct nonprofit

This issues the State of Rhode Island has experiences with the roll out of the new computer system designed to integrate all human services offered to all eligible Rhode Island residents has been well documented. What gets lost in the conversation are the dedicated and hard working people that battle through these transition pains for the benefit of the public. There are breaking points for all people and though this is certainly a loss for the State, the factors prompting the chief lawyer to quit should not be deemed unexpected.

The more important thing for Rhode Islanders who need Medicaid is that they understand the rules and regulations to qualify, and that they file the application timely and accurately and comply with the program. Even though the state struggles with the administration of the program, nothing has changed the rules for Medicaid eligibility. Thus it is perhaps more important that today, individuals receive strong, competent advice as to qualification and application for benefits understanding that the state is struggling to transition the administration of the program for the future.

Medicaid is a program that has asset rules and medical eligibility requirements. In our office, we focus on advising folks who need and seek long-term care, skilled nursing, called Long Term Support Services on the Medicaid application for the state of Rhode Island. If you want or need to discuss Medicaid qualification and application for yourself or a loved one, please contact our office for a free, no obligation consultation.

Deloitte to pay R.I. $27 million for Medicaid Computer failures

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PROVIDENCE, R.I. — Deloitte Consulting, the contractor for the state’s troubled public-benefits computer system, has agreed to credit the state $27 million to cover problems associated with the system’s launch.   The credit will cover a “temporary hiring surge” at the state Department of Human Services and other personnel expenses. It will also pay for contracted service expenses for the remainder of the current fiscal year and the first quarter of fiscal 2018, according to a statement

Source: Deloitte to pay R.I. $27 million for UHIP failures

Legal battles brewing over Aaron Hernandez’s estate

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BOSTON — How much money and property did former NFL star Aaron Hernandez leave behind, and who has a rightful claim to those assets? Legal battles have been brewing for years over who should get Hernandez’s money, but his suicide in prison last week ramped up those questions and more. Here’s a look at the various legal claims and the key players: THE PLAYER Hernandez, who grew up in Bristol, Connecticut, and played football at the University of Florida, was considered an up-and-coming

Source: Legal battles brewing over Aaron Hernandez’s estate

Hospitals Now Must Provide Notice About Observation Status

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Hospitals Now Must Provide Notice About Observation Status

All hospitals must now give Medicare recipients notice when they are in the hospital but only under observation status. The notice requirement is part of a law enacted in 2015 but that just took effect. Signed by President Obama in August 2015, the law
was intended to prevent surprises after a Medicare beneficiary spends days in a hospital under “observation” and is then admitted to a nursing home. Medicare covers nursing home stays entirely for the first 20 days, but only if the patient was first admitted to a hospital as an inpatient for at least three days. Many beneficiaries are being transferred to nursing homes only to find that because they were hospital outpatients all along, they must pick up the tab for the subsequent nursing home stay.

The law, the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, did not eliminate the practice of placing patients under “observation” for extended periods, but it does require hospitals to notify patients who are under observation for more than 24 hours of their outpatient status within 36 hours, or upon discharge if that occurs sooner. The Act required hospitals to begin giving patients this notice as of March 8, 2017. Some states, including California and New York, already require such notice.

To avoid violating the law, hospitals that accept Medicare patients will now have to explain to patients under observation that their hospital stay will not count toward the three-day inpatient stay requirement and that they will be subject to Medicare’s outpatient cost sharing requirements. The law does not make hospital observation stays count towards Medicare’s three-day requirement.

While these 100 days of skilled nursing care that is covered by Medicare is an important benefit to be aware of and to plan for, the more significant issue that people need to plan for is long term skilled nursing expenses that exceed the 100 days and planning to pay for those expenses. Married and single individuals are encouraged to plan for these expenses 5 years ahead of expected need to be in the best possible position to preserve the assets they have acquired during their lifetime. If the medical needs are unexpected, emergency planning steps can be taken as well. Meeting with a skilled elder law attorney who can review and explain qualifying for Medicaid after Medicare runs out is vitally important for the financial well being of you and your loved ones.

Medicaid for Medicare Enrollees

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Seniors & Medicare and Medicaid Enrollees

Medicaid provides health coverage to more than 4.6 million low-income seniors, nearly all of whom are also enrolled in Medicare. Medicaid also provides coverage to 3.7 million people with disabilities who are enrolled in Medicare. In total, 8.3 million people are “dually eligible” and enrolled in both Medicaid and Medicare, composing more than 17% of all Medicaid enrollees. Individuals who are enrolled in both Medicaid and Medicare, by federal statute, can be covered for both optional and mandatory categories.

What Medicaid Covers for Medicare Enrollees

Medicare has four basic forms of coverage:

  • Part A: Pays for hospitalization costs
  • Part B: Pays for physician services, lab and x-ray services, durable medical equipment, and outpatient and other services
  • Part C: Medicare Advantage Plan (like an HMO or PPO) offered by private companies approved by Medicare
  • Part D: Assists with the cost of prescription drugs

Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid (e.g. MSPs, QMBs, SLBs, and QIs). Medicaid also covers additional services beyond those provided under Medicare, including nursing facility care beyond the 100-day limit or skilled nursing facility care that Medicare covers, prescription drugs, eyeglasses, and hearing aids. Services covered by both programs are first paid by Medicare with Medicaid filling in the difference up to the state’s payment limit.

Qualifying For Medicaid

Qualifying for Medicaid is a two part test: Asset Rules and Income Rules. Generally speaking, a person can only have $4,000 of countable resources under the asset rules component. As for Income, a recipient generally can keep the first $50 of monthly income and the balance is remitted to the skilled nursing facility with Medicaid picking up the balance due to the facility. The rules are different for spouses and the overall qualification is subject to a 5 year look-back at all of your finances.

Want to learn more about Medicare and Medicaid and how you should plan your estate around these programs? Contact us for a no-cost consultation.

Estimate: $595 million over five years to keep Medicaid coverage for Rhode Islanders

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Impact of Proposed Changes To Medicaid Program

PROVIDENCE, R.I. — Rhode Island officials estimate it would cost the state $595 million more over five years to prevent 75,000 low-income adults from losing their Medicaid coverage under the House Republicans’ plan to overhaul healthcare. And that’s just for the adults without children who became newly eligible for coverage in 2014 under the Affordable Care Act. Medicaid insures close to 300,000 Rhode Islanders, or nearly one-third of the population. “It’s hard to Fathom that Rhode Island could make up for the funding losses that we’d have here,” Anya Rader Wallack, acting secretary of Health and Human Services, said during a media briefing Wednesday morning. “And that’s just roll back of the expansion.”

The total cost to Rhode Island of the GOP plan’s proposal to cap federal spending on Medicaid has not been calculated by the state. But the Urban Institute, a Washington-based think tank, reports that Rhode Island is among 10 states that would experience the steepest declines in Medicaid spending under the plan.

Rhode Island is among 31 states, along with the District of Columbia, that adopted the federal law’s expanded eligibility criteria for Medicaid. In Rhode Island, that meant low-income adults who are not disabled and have no dependent children. Their coverage currently costs $450 million — or one-fifth of the state’s $2.3-billion Medicaid program.

Under the GOP plan, state officials estimate it would an additional $9 million more than 70,000 adults in the Medicaid expansion population from losing insurance during the first year of program — and another $220 million for their coverage during the program’s fifth year.

(The Medicaid expansion population, currently at about 70,000, is expected to rise by year five to about 75,000.)

Rhode Island’s expansion of Medicaid, coupled with another 30,000 people who don’t have coverage through their employers and instead purchase insurance through the state exchange, have helped cut Rhode Island’s uninsured rate by nearly a third, to about 4 percent from close to 12 percent prior to Obamacare.

If the state is forced to scale back its Medicaid coverage and if people are no longer penalized for not having coverage, as they are under Obamacare, and go without insurance, hospitals — which accepted lower state reimbursement rates in anticipation of fewer uninsured patients — would be hit with higher costs for uncompensated care.

“There’s a good bet hospitals will be destabilized,” Radar Walleck said.

The 30,000 Rhode Islanders who buy coverage through HealthSource RI, state officials said, also are expected to pay more under the GOP plan.

Close to 90 percent of enrollees on the state exchange receive tax credits, which pay for about 70 percent of the monthly premiums. The Obamacare tax credits are based on income as well as age.

The average premium on the state exchange is about $458 per month — of which $247 per month is paid for through tax credits — so that the cost to the enrollee is $111 per month, according to HealthSource RI’s spokeswoman, Kyrie Perry.

The GOP plan provides age-based tax credits, which range from $2,000 for anyone under age 30 to $4,000 for people over age 60.

Under that plan, the individual premium costs on the exchange are projected to increase, on average, by 15 to 20 percent in 2018 and 2019, according to HealthSourceRI. They are expected to level out after 2019.

For the benchmark “Silver” plan, that amounts to about $1,700 less, on average, in tax credits and another $2,000 more in premiums, Zach Sherman, director of HealthSourceRI said.

“There are definitely winners and losers” under the age-based tax credits, Sherman said. “It will results in older folks having trouble affording coverage.”


On Twitter: @LynnArditi

Source: Estimate: $595 million over five years to keep Medicaid coverage for Rhode Islanders