MEDICAID MORATORIA

Sec. 5003 – Extends or creates moratoria – through June 30, 2009 – on four Medicaid regulations for the following: 1) outpatient hospital and clinic services, 2) targeted case management, 3) provider taxes, and 4) school-based administration and transportation services. Congress also included a Sense of Congress that the Secretary of Health and Human Services should not promulgate three regulations concerning rehabilitative services, intergovernmental transfers, and Graduate Medical Education. It is hoped that this action will result in the Administration repealing these draft regulations.

FEDERAL MEDICAL ASSISTANCE PERCENTAGE

Sec. 5001 provides for an $87 billion increase to the Medical Assistance Percentage (FMAP) over the next two years (Oct. 1, 2008-Dec. 31, 2010). All states will receive an increase in their FMAP by 6.2 percentage points. In addition, some states are eligible to receive additional ?hold harmless’ and unemployment-related FMAP increases. This means that a state’s FMAP rate is equal to its current FMAP rate, plus a 6.2% base increase and ?hold harmless’ and unemployment adjustments (see below). Lastly, the FMAP increase includes ?prompt pay’ requirements and a maintenance of effort clause, which is applicable for the next two years.

>>The first two quarters of the new funding for FY 2009 (approximately $15.2 billion) was released February 25th by the U.S. Department of Health and Human Services. See map on DHHS site for allocations for each state.
Scope of Application

>>This increase applies to Medicaid, Foster Care, and Adoption Assistance

>>This increase does not apply to: 1) Temporary Assistance to Needy Families (TANF), 2) child welfare, 3) child support enforcement, 4) State Children’s Health Insurance (SCHIP), 5) Disproportionate Share Hospital (DSH) Payments, 6) items/services subject to an enhanced match, 7) individuals who become eligible as a result of income eligibility standards (expressed as a percentage of the poverty line) that are higher than those that were in effect on July 1, 2008, including standards that were proposed to be in effect under enacted state law that was not effective on July 1, 2008 or a state plan amendment or waiver request that was pending approval as of that date.

>>>In these cases, the regular state FMAP applies.

HOLD HARMLESS

>>States that would otherwise experience a drop in their federal medical assistance percentages (FMAPs) under the normal FMAP formula would be held harmless against any decline.

>>In FY09: If a state’s FY09 FMAP is less than its FY08 FMAP, the FMAP increase will be added to the FY08 FMAP. So, if a state has an FY08 FMAP of 60% and an FY09 FMAP of 58%, the 6.2% increase via the ARRA will be applied to the FY08 rate.

>>In FY10: If a state’s FY10 FMAP is less than either the levels in FY08 or FY09, the FMAP increase in FY10 will be applied to the greater of the FMAP levels for FY08 and FY09. So, if a state has an FY08 FMAP of 60%, an FY09 FMAP of 58%, and an FY10 FMAP of 59%, the 6.2% increase via the ARRA will be applied to the FY08 rate.

>>For the 1st calendar quarter of FY11(through Dec. 31, 2010): If a state’s FY11 is less than the FMAP for FY08, FY09 or FY10, the FMAP increase for the first calendar quarter of FY 2011 will be applied to the greater of the FMAP level of the previous fiscal years. So, if a state has an FY08 FMAP of 60%, an FY09 FMAP of 58%, an FY10 FMAP of 59%, and an FY11 FMAP of 57%, the 6.2% increase via the ARRA will be applied to the FY08 rate.

UNEMPLOYMENT

>>$30.45 billion of the $87 billion is reserved for the unemployment provision based upon a formula for each state’s unemployment rate during the current economic recession. Under this formula, the FMAP increase and the unemployment bonus are weighted on a 65% (FMAP increase) and 35% (unemployment bonus). See the initial 2009-2011 projections for individual states.

MAINTENANCE OF EFFORT

>>A state will be ineligible for the FMAP increase if eligibility standards, methodologies, or procedures under the Medicaid state plan (including Medicaid and/or Section 1115 waivers) are more restrictive than the eligibility standards, methodologies or procedures under the state plan or waiver that was in effect on July 1, 2008 (see “Special Rule” below for exceptions).

>>States retain the flexibility to make changes in benefits and reimbursement.

>>State Reinstatement of Eligibility Permitted: A state that has restricted eligibility standards, methodologies, or procedures after July 1, 2008, will become eligible for the FMAP increase beginning with the first calendar quarter in which the state has reinstated eligibility standards, methodologies and procedures that are no more restrictive than those that were in effect on July 1, 2008.

>>>Special Rule: A state will not be ineligible for the increased FMAP under the following circumstances: 1) on the basis of a restriction that was     applied after July 1, 2008 and before the date of enactment of the ARRA and 2) on the basis of a restriction that was effective under state law as of     July 1, 2008, and would have been in effect as of that date if it weren’t for a delay (of no more than one calendar quarter) in the approval of a     request for a new waiver under section 1115 with respect to the restriction.

PROMPT PAY

>>Requires states to report monthly to HHS on the states’ compliance with the Medicaid prompt pay requirements in Medicaid Statute (42 U.S.C. 1396a(a)(37)(A)), which specifies that the state must pay 90% of clean claims within 30 days of the date of receipt of the claims and that 99% of claims are paid within 90 days of the date of receipt. States must also provide for procedures of prepayment and post-payment claims review, including review of appropriate data with respect to the recipient and provider of a service and the nature of the service for which payment is claimed, to ensure the proper and efficient payment of claims and management of the program.

>>Existing prompt payment provisions apply to practitioners, in individual or group practice, and the ARRA amendment extends its application to nursing facilities and hospitals.

>>Prevents a state from receiving the increased FMAP claims received by the state for days during any period when the state is out of compliance with the Medicaid prompt pay requirements.

>>Permits the Secretary to waive this requirement during any period in which there are exigent circumstances – including natural disasters – that prevent the timely processing of claims or the submission of required compliance reports.

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First and foremost, any questions you have about Medicaid information or Medicaid applications can be directed towards the Medicaid assistance program you are joining up with. However, some people still need someone to explain the terms and criteria to them, and I don’t blame them! Some of this stuff is really complex and hard to understand.

To begin, Medicaid assistance is a government program used to help certain people with their medical expenses. Not everyone can qualify for Medicaid assistance  you still have to follow certain criteria, but if you fall under those specific guidelines, you will be able to get help affording homecare services and other medical care.

Medicaid assistance is different from insurance and other private health plans. It is a program between the federal government and the state you are living in. The mission statement here is to give people coverage that cannot afford it. It doesn’t matter if you are a small business owner or just an individual. The criteria is as follows: you must be a member of a low-income household or suffer from certain qualifying disabilities. This includes low-income parents as well as their children.

In today’s society, a lot of people fall under these categorically eligible criteria areas. For them, Medicaid assistance can cover everything from doctors visits and surgery to homecare services and community Medicaid. Typically for the elderly, community Medicaid generally refers to any form of covered care that is not nursing home care. Examples include adult daycare, home care services, and assisted-living facilities. The Centers for Medicare & Medicaid Services, the largest distributor of Medicaid assistance, currently helps nearly 40 million Americans.

Medicare is another useful program to help cover medical expenses, however this is targeted toward a separate group of people. Rather than low income households, the Medicare option is for individuals that are 65 years or older. But, as with most other things, this rule comes with exceptions, as people with some disabilities and diseases are also eligible for this option. Individuals with End-Stage Renal Disease  permanent kidney failure demanding dialysis or transplant surgery  are eligible, for example.

Getting Medicaid assistance means you will have to go through a lot of “red tape” requiring you to answer questions and fill out Medicaid applications. But in the end, if you are truthful and you are eligible, Medicaid is going to take a lot of stress out of your life. This is because it’s extremely trying to worry about medical problems and whether you will be able to afford the necessary treatment and care  the resultant stress can sometimes even aggravate your health conditions.

Even if you are currently in good health, it is impossible to predict what circumstances you might be facing in the future. Illnesses and accidents can happen to anyone at anytime. That’s why Medicaid is so important.

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There are some important questions to consider when there is a chance that you will be in a nursing home in the years to come. You want to make sure your assets are protected completely.

Question 7: Medicaid income eligibility requirements: Can I transfer income and assets to my children before going into a nursing home and still qualify for Medicaid?

This is likely not possible. When applying for Medicaid you must understand that under the 60-month look-back Rule, Medicaid coverage can be denied if assets have been transferred within 60 months prior to applying for the benefits.  As described previously, if you were to gift or divest your assets to your children within 5 years of entering a nursing home and you apply for Medicaid online or off, you will be denied coverage until the money is returned.  The real problem comes in when the children spend the money and do not have it to give back in a situation like this one.

Question 8: Medicaid application: Is it too late to give away my assets and qualify for Medicaid if I am already in a nursing home?

It’s never too late to reallocate your assets. It is possible to give away all assets and then in 5 years become eligible for Medicaid.

Question 9: Should I make use of a trust to protect my assets?

It is much more beneficial to use an irrevocable trust instead of transferring assets to family members. Seek for the UltraTrust™ for superior irrevocable trust asset protection.

Question 10: How to apply for Medicaid: Are there other ways to protect my assets?

There are many ways to protect assets. Medicaid will not penalize anyone if they choose to spend their assets; however, one must be careful to avoid fraudulent conveyance. Fraudulent conveyance is the act of divesting your assets for less than a fair market value consideration or payment. An expert can walk you through a proper estate plan that will avoid these potential problems or contact Estate Street Partners.

Question 11: How can I protect my home?

Medicaid allows for the applicant to retain a principal residence. Your home is considered exempt property. However, unless there is a surviving spouse, Medicaid will be reimbursed if the home is sold after your death by a lien being put on the home. This is where it is advised to sell or transfer to an irrevocable trust such as the UltraTrust™

Question 12: Is it wrong to hide assets to qualify for Medicaid?

When applying for Medicaid, full financial disclosure is required. It is best to consult with an elder law expert before making any decisions or contact Estate Street Partners.

Question 13: Is this information reliable?

These are just a few questions that are commonly asked. When applying for Medicaid, it is always best to do the research. Find out what the current requirements are for eligibility in your state and consult with an experience attorney or contact Estate Street Partners to discuss your assets. States typically offer online information and forms that you may download and print, however no states allow you to currently apply for Medicaid online.  To get simple information about your state’s Medicaid application eligibility, forms, contact information, and address as well as an overview of your states plan, click here.

Question 14: Should I hire an expert?

Simply stated: absolutely. This is the best way to make sure laws are being followed and your assets are protected.

Question 15: How do I find an expert?

Any expert that practices elder law can help or contact Estate Street Partners. Make sure the expert is experienced and has a good rapport. You want to make sure you trust the right person with your assets.

Watch the video related to medicaid application

law, transferring the assets belonging to one spouse who is going into the nursing home to the well spouse is done without penalty. That means, that the spouse who is to go to the nursing home, can enter the nursing home and have Medicaid pay for it once the application is made. Many people to do not realize this, and so, it is a wonderful planning opportunity. However, this comes under the category of dont try this at home. It may be easy enough to transfer all of the assets from one spouse …

Help answer the question about medicaid application

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Medicaid providers are those doctor’s offices, clinics, and hospitals that have agreed to accept this form of payment for services. Individuals that are approved for Medicaid are often given a list of providers so they can choose who they want to be seen by. It is important to do this early instead of waiting until you need to be seen. Most hospitals accept Medicaid so it isn’t a problem. Yet doctor’s offices and clinics have a set number of slots they will allow to accept this form of payment for.

In many states, you only have 60 days to choose who your provider will be. You will then need to call an 800 number to have that information added to your Medicaid card. Should you not complete this process though a provider will be assigned to you. This can be complicated to straighten out. In the mean time you will either have to see a doctor you don’t want to or pay out of pocket to continue your services with your current provider.

Most Medicaid programs require you to either choose a Primary Care Physician known as a PCP or a Health Management Organization known as an HMO. In many instances though it will depend on what particular types of services are available in your area. Should your primary physician recommend that you see a specialist, you will need to get that approved by Medicaid. If you don’t, there is a very good chance that you will be stuck paying those bills on your own.

Not all specialists are willing to accept Medicaid even if you are approved to see one. Make sure before you make an appointment with someone that they are going to honor the type of coverage you have. Don’t wait until you show up for your appointment to discuss this issue. It can result in the treatment you need being delayed.

You do have the right to change your Medicaid provider should you choose to do so. Make sure you follow the procedure for doing so in your state. Some only require a phone call while others require something in writing before they can process such a change. Make sure you have contacted the new provide to ensure they will take you as a patient. If you have the name changed on your Medicaid card but they won’t take you this isn’t going to benefit you in any way.

Medicaid is a type of insurance for those that have a very low income. The program is federally funded and then independently operated by each state. One of the biggest problems with Medicaid though is finding a doctor that will accept it. Many individuals are quite frustrated to find out they are eligible for Medicaid yet they can’t find a provider that accepts it in their area.

Some individuals are traveling 60 or more miles in order to find a Medicaid doctor. If this is the case the individual is often eligible for reimbursement for the cost of gas to get to these appointments. There is a set amount that is paid per mile for the trip to the doctor’s office. You must have this type of reimbursement pre-approved though before you travel. Should there be a Medicaid doctor in your area available but you choose to ravel to see someone else you will be responsible for the cost of the travel on your own.

If you are struggling to find a Medicaid doctor in your area, contact your local department of human services. They should be able to provide you with a current list of providers. You will need to take some time to make some phone calls to find out who is accepting new patients with Medicaid coverage. If you aren’t having any luck make sure you report that information to your local legislator. That way they can be aware of the problem and work to resolve it.

Many local agencies including human services continue to contact doctors in the area. They try to encourage them to look at accepting patients with Medicaid. They also work hard to ensure that every single doctor that does accept Medicaid is offering quality services to their patients. Just because a person isn’t able to pay for the medical care out of their own pocket, they shouldn’t be denied the very best of care.

Should you have any problems with a doctor that is accepting Medicaid you need to report it. Too many people are afraid to do so as they worry about being able to find another provider. If you find your bills for Medicaid aren’t correct you also need to report this. There have been many cases of Medicaid fraud that have been uncovered this way.

Medicaid is a very good program that is to help those that need medical and dental coverage. In most instances, without the Medicaid they simply wouldn’t be able to afford it. Therefore they wouldn’t get the care they needed, especially when it comes to preventative care. One issue with Medicaid though is that it isn’t always used as it should be. There are problems with fraud both from people approved for the program and by providers.

Medicaid fraud happens in many ways from the individual side of things. A person many not report all of the information on their application correctly in order to be eligible. They may end up omitting income or various household members that have a sufficient income to contribute to the household. It also occurs when someone allows another person to use their Medicaid card for services.

There are auditors in place to review charges by medical providers. They look for patterns of behavior when it comes to billing of Medicaid patients. They want to make sure they aren’t billing for things that haven’t occurred. They also want to make sure Medicaid patients aren’t being subjected to tests that they don’t need in order for them to make money.

There are also fraud hotlines where people can call in to report other people who may be getting Medicaid benefits fraudulently. A person can make such reports anonymously so that they don’t have to tell anyone who they are. Generally it is friends or family members that don’t feel it is right that someone is illegally getting such benefits that turn them in. Most departments of human service agencies have a fraud unit that can investigate such matters.

It is believed the Federal government is bilked out of millions of dollars annually due to the various forms of Medicaid fraud. As a result they have implemented harsh penalties for those caught to be involved in such forms of fraud. Individuals have had to repay the funds, pay a fine, and even serve jail time as part of the requirements under our justice system. The repercussions for any form of Medicaid fraud aren’t going to be lenient. You can be sure the Federal government is working hard to make examples out of those they do catch.

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Medicare and Medicaid. Is there a difference? For adult children who are starting to consider eldercare solutions, these programs can trigger a bout of head scratching. Will they pay for eldercare at home? Will Mom be forced into the poorhouse before receiving benefits? This guide will give you an overview of basic Medicare and Medicaid facts.

Fact #1 – Medicaid does not necessarily pick up the bill when Medicare stops paying.
The federal Medicare program provides benefits regardless of income or the value of assets. In contrast, the federal/state-funded Medicaid program is specifically designed to provide medical benefits for those in need, such as people with low-income or disabilities. Once a senior has exhausted Medicare benefits for eldercare solutions, he or she will only receive Medicaid if they meet their state’s standard of eligibility.

Fact #2 – Medicare pays for home care or nursing care under very specific conditions.
The Medicare program will cover the cost of certain levels of care—but only in certain situations. For example, it will pay for skilled care or rehabilitation services only after your loved one has been hospitalized. Even then Medicare only covers the costs for up to 100 days. The result is that your family won’t be able to count on this program as a primary source of eldercare solutions funds. Medicare also doesn’t cover most eldercare at home situations either.

Fact #3 – Medicaid applications can be a time-consuming process.
There’s nothing simple about applying for this government program. One reason is that although the program receives federal funds, it’s administered by each individual state. That means there are 50 different ways to apply for this program, and you’ll need to research to find out what your state requires.

Despite the varying application processes, your senior parent will need demonstrate that they are financially needy enough for Medicaid. In general, applicants are asked to produce bank statements, pay stubs, proof of age, proof of citizenship, income sources (such as social security or veteran’s benefits), and insurance policies.

Perhaps Mom isn’t ready to apply for Medicaid yet. It’s still a smart idea to make sure you know exactly what your state’s application process entails and what documents your parent will need to show. Then, if Mom suddenly suffers a catastrophic illness, you’ll be saved the trouble of digging through shoe boxes for important documents.

Fact #4 – Seniors are penalized if they transfer assets to become Medicaid eligible.
Think that Dad can qualify for Medicaid faster if he sells you his $10,000 boat for $100? Think again. The system imposes a penalty for asset transfers that are less than fair market value. What’s more, the state will look for transfers that go back as far as five years. If transfers are made, they’ll use a formula to determine how long Dad will have to wait to receive benefits.

Medicare and Medicaid can be a baffling bureaucratic conundrum for many. Help your parent find an eldercare solution that works by learning how these two programs operate.

Fact #5 – Seniors must sell their homes to qualify for Medicaid.
Although state requirements vary, the home doesn’t count as an asset unless it’s worth more than $500,000. In addition, some states don’t consider the home as an asset if the patient intends to return there. It also won’t be counted as an asset if a spouse, minor child or disabled child lives in the home.

Related posts

• Medicaid Information For Homecare Services And Other Care Options
• Protect Assets from Nursing Home: Medicaid Eligibility & Application
• An Introduction to Medicaid NH Insurance
• Medicaid Provisions of the American Recovery and Reinvestment Act (ARRA)
• Learn Whom Are Medicaid Providers