Medicaid Cuts Will Hurt
Bob Mason
Originally published in the Asheboro Courier-Tribune (10/22/2005)
For those who may be depending on Medicaid to cover nursing home care: Beware. Congress is seriously considering (as in “soon”) providing new rules that would require states to look at family transfers occurring within five years of an application to determine whether an ineligibility period should apply. If an eligibility period should apply, then it would begin to run at the time of the application.
Current rules generally provide a three year look back period and begin ineligibility (or sanction) periods back on the first day of the month in which the transfer was made. For example, $20,000 transferred two years before an application would create a 4 month sanction period that expired 20 months ago. Under new rules being considered (as in: “this week”), a $20,000 transfer made four years ago would create a four month ineligibility period beginning currently.
Our General Assembly has been busy, too. Tucked into the book-length August budget bill at the last minute are provisions (poorly written by the state’s Medicaid agency) that will increase the likelihood that families facing nursing home care for a loved one will lose much of the modest assets they have accumulated over years of hard work. The provisions attack “life estates” in real property and set up a system for placing liens on the real property of Medicaid recipients. The lien provisions will take effect on July 1, 2006, unless our legislators wake up before then. You can help wake them up.
Medicaid cuts are an emotional topic, and like most emotional topics, not clearly understood. Medicaid has been an easy program to bash in a non-partisan fashion. President Clinton, after all, went after so-called “Welfare Queens” with welfare reform. Many of our state law makers and the current federal administration similarly cast nursing home benefits under Medicaid as a “dodge for the middle class” and as an “attempt by the wealthy to put the burden on taxpayer backs”. Absurd, and not founded in fact. Have there been abuses? Yes, but those can easily be fixed.
Make no mistake; I believe the subject of paying for long term care should be a high priority “conversation” (maybe even a “debate”). There are plenty of us aging boomers beginning to feel creaky in the old bones. The status quo is not sustainable.
On the other hand, the way to “fix” the system is not to wade into the problem swinging a budgetary axe. That will create new problems and do nothing to solve the current problem. It will create misery. It will penalize people who have done everything “right” and by the rules.
The folks who will be hurt have worked hard for years, paid for their homes, and amassed a “fortune” worth perhaps a hundred thousand dollars or so to see them through so they wouldn’t be a burden. They bought health insurance and they paid their Medicare premiums every pay day. Medicare would cover most of the care associated with catastrophic medical emergencies that could run hundreds of thousands of dollars. No problem. Covered.
But what if instead of brain surgery, Grandpa has Alzheimers and has to go into a nursing home? Should the family lose great-granddad’s farm? Mom’s and Dad’s home? All $100,000 in CDs? If these people try to protect what they have before losing everything (before eventually going on Medicaid in any event), are they shirking? Failing to carry their share? Using Medicaid as a middle class entitlement? Many people believe that to be the case . . . until it is his Mom or her Grandpa.
Is the way to solve the very real problem of paying for long term care for the State of North Carolina to grab the equity in some widow’s home? For the Feds to require very real impoverishment from a citizen who has done everything “right” except develop Alzheimers or some other wasting condition?
The “Greatest Generation” with which I am privileged to work deserve better. Those of us Boomers who have not purchased long term care insurance, do so. Those Boomers who cannot for some reason, and those for whom it is simply too late to purchase protection that wasn’t available a few years ago: Pray. It also might not hurt to write Howard Coble, Arlie Culp, Harold Brubaker, and Jerry Tillman. After all, the people who will be harmed are the type that tend to vote.
Bob Mason is a certified elder law attorney with a law practice in Asheboro.
