Facilities for Elderly Investigated by New Jersey State Advocate

When elderly individuals go into along term care facility or a similar facility and self pay, the cost can be astronomical.  Making sure that the person is comfortable, well cared for, in a clean environment and positive atmosphere is not a low budget issue.  What happens, though, when a private pay individual converts to Medicaid?

Well, one would think that because all of the payments are now guaranteed, albeit possibly lower, that these facilities that have been raking in money from these individuals and their families, that they would leave grandma, grandpa or aunt Minnie in comfort and without worry without changing a thing.

Unfortunately, this doesn’t always happen.  In fact, there is an investigation taking place in New Jersey regarding the company Assisted Living Concepts, owner of eight assisted living homes in southern New Jersey.  The investigation was started by the Public Advocate for the state, who has filed papers against the company because of their alleged practice of discharging the elderly when they change from self pay to Medicaid.  

Public Advocate Ronald K. Chen is asking for the names, admission and discharge summaries, as well as contact information for every resident of the company who is or has been a Medicaid beneficiary. 

Chen says that the investigation was sparked because there is an indication that this company “is placing elderly vulnerable residents at risk by displacing them from their homes in violation of ALC’s state license.  Our primary concern is to protect the safety well being and peace of mind of these residents.”

The representative of Assisted Living Concepts, Laurie Bebo, who is also the CEO of the company, refuses to cooperate with the subpoena and states that the company does not have any Medicaid conditions in their license; therefore, they do not have to honor Medicaid patients.

Chen says that state licenses for all eight facilities stipulate that at least 30% of the residents of each of the facilities are to be Medicaid eligible and no resident would be discharged because or if they spent all their money.

Assisted Living Concepts operates more than 200 assisted living residences in 17 sates, containing more than 8,000 units, so this is no small issue.  New Jersey may just be the tip of the iceberg.

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Do You Know Your Medicaid Law?

Medicaid was designed to cover low income individuals and their families for hospital services ( in and out patient), laboratory services, x rays, home nursing care, doctors services, physical therapy, hospice and rehabilitation care.  Medicaid recipients must go to a Medicaid-approved doctor who is on the Medicaid list.  Sometimes, in some areas, there are a limited number of doctors that accept Medicaid, so some individuals have to search carefully and, once they find the right physician that they are comfortable with that are Medicaid approved and accept Medicaid for payment.  As a result, there is often a waiting list for an appointment, even if it’s an urgent situation.  In a serious emergency, the doctor’s office may take you right away and “squeeze you in” to their schedule.  More often, they send you to the emergency room, which ends up costing you, taxpayers, the community, the hospital and Medicaid more money than if Medicaid reimbursed good doctors enough money to be able to enroll and appoint more, thus eliminating some of the long waiting line.

Federal laws state that if you become eligible for Medicaid, which is based on income and need, the states may not reduce other welfare benefits you are receiving.  In addition, we have been hearing a lot about trying to exclude legal immigrants from Medicaid system.  The problem with this is that Medicaid only requires – by law – for an individual to establish and prove residency (and meet low income requirements) to apply for and, if approved, receive Medicaid benefits.  States cannot impose citizenship requirements on anyone who needs Medicaid benefits.  Regardless of age or whether or not the individual works is not a reason that Medicaid can use to eliminate you from the program. 

Unfortunately, these situations are taking place in a number of states.  If you or someone you know feels that they are not being treated fairly regarding Medicaid benefits, you can contact some places that can help.  Information is available to you through www.seniorlaw.com.

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