Posts tagged 'Medicaid Recipients'
There are stories about individuals and families having some issues with services through Medicaid because of misunderstandings with providers or not understanding their coverage. Sometimes mistakes are made and must be fixed. The majority of the time providers try to work with Medicaid recipients to provide the best service they can.
In New Jersey, however, there is a company that has been in the news lately for doing just the opposite. This story has been touched on before, but there are more details continuing to come out.
The company, Assisted Living Concepts, based in Wisconsin has a large number of assisted living facilities. As in any business, some things work well and turn out right and some things sometimes do not. There are many excellent assisted living companies throughout the country who work hard every day to balance their budgets, help the residents – whether on Medicaid or not – and deal with issues – especially financial ones – that come up.
Unfortunately, at least in this case, Assisted Living Concepts has handled a situation with eight of its facilities in South Jersey in a harmful and totally inequitable way. In these particular facilities, Assisted Living Concepts had a number of individuals staying there and receiving service who were paying for their services out of their life savings. The individuals say that they were told that if their savings ran out, they would be switched to Medicaid and could stay where they were in Assisted Living Concepts facilities.
Instead, when their savings were totally gone – because they had been paid to Assisted Living Concepts for their care – they were told that they had to leave. A complaint was made and a few weeks ago the Public Advocate began an attempt to review records to see how many more individuals were – or had been – in this position with Assisted Living Concepts.
The case has gone to Superior Court, and a judge will decide on whether the records will be released for review. The case is difficult because, though all Assisted Living facilities are supposed to keep 10% of their beds for Medicaid recipients (in New Jersey), some are exempted. The lawsuit being brought by these eight evicted residents has to do with the promises that were made to them that after they used their funds – in one case over $300,000 - they would be able to stay and be switched to Medicaid. These promises were broken, and it is not known how many other promises to other individuals were handled the same way.
It is important to get to the bottom of this so that individuals who are most vulnerable are not taken advantage of in this (or other) ways, but are protected by the system and by the individuals and organizations who are supposed to serve them.
Imagine having medical services performed, thinking you are covered by Medicaid, but instead, finding out that you have a lien against you instead.
This has happened to some people in Missouri who have become part of a class action lawsuit to eliminate the liens and get the financial situation resolved.
The Plaintiffs in the case are claiming that the liens are against monies that are not compensation for past medical bills and services and the liens are a violation against the plaintiffs, who are asking the supreme court for help in settling the situation.
The court granted a Class Certification because the money in dispute which resulted in liens is Workers’ Compensation funding that several hundred individuals received after accidents or injuries that kept them from working. Their contention is that the Workers’ Compensation payments, which mainly replace lost salary, have absolutely nothing to do with Medicaid benefits, which are for medical expenses. Another reason for the class action suit is to be sure that all of the plaintiffs will be treated the same and treated fairly.
Medicaid has said that many of the claims should be barred due to the fact that the statute of limitations eliminates them from being able to participate in a class-action lawsuit. The court ruled that this issue could be determined later, as well as issues of class certification.
In the meantime, this will be an interesting issue to watch. It is not a situation that comes up often, however with cuts in Medicaid budgets and services, as well as states who are dealing with tight budgets and fiscal cuts, issues – especially precedent-setting lawsuits such as this one – important precedents are being set for the future and could affect q great many people – even you. If you need information regarding your rights regarding Medicare or Medicaid, not only can you check with www.medicare.gov and www.medicaid.gov, but also AARP, The Disability Law Center in your area and the Medicaid Legal Information Institute at Cornell University on the internet at topics.law.cornell.edu/wex/Medicaid.
There is a new twist in health insurance that some states have initiated to give Medicaid recipients an extra choice in their health care This new provision is called a Health Opportunity Account.
The Health Opportunity Account is an account an individual who has high-deductible health insurance or who has Medicaid can use to offset some medical expenses. This is an account that gives an individual more of a choice in how their health care dollars are spent.
The Health Opportunity Account is set up through a state system in the state you live in, and it can be used to pay for out-of-pocket health care costs. If you choose to set up a Health Opportunity Account, you will be offered Medicaid benefits. That means that if you are not insured now, this might be a plan to look into and see if your state offers this program and whether you qualify.
If you are in a state that has Health Opportunity Accounts, the state will set aside up to a total of $2,500 per eligible adult or $1,000 per eligible child toward deposits in the account. In the event that you enroll in the program and eventually become ineligible for Medicaid, if there is money left in your account, you would be allowed to use the money for up to three (3) years to pay for such things as health insurance premiums and medical expenses.
The program is mostly geared toward relatively healthy adults and children who are Medicaid recipients. There are some restrictions to the program. A person will not qualify if they are:
• Age 65 or older
• Pregnant
• Blind or disabled
• Eligible for Medicaid benefits, but have only been eligible for less than three (3 ) months
• Certain individuals in hospitals, medical facilities or other medical institutions or nursing homes
• Individuals entitled to any part of Medicare
• Individuals who are terminally ill and receiving benefits for hospice care
• Certain individuals who are medically frail or who have special medical needs
• Children receiving Title IV-E foster care or adoption assistance
There are a limited number of states participating in this program. If you are interested in more information or in participating, contact your state Medicaid office, visit www.medicaid.com and enter your state where prompted or call
1-800-MEDICAID.
If you receive Medicaid, there have probably been some times that you wanted to go to a community health center but ended up having to go to the emergency room waiting for hours to get care. If you feel you have missed out on other services, such as education and non-emergency assistance, help is on the way.
A $50 million grant through the Centers for Medicare and Medicaid Services has been granted to be used by 20 states to provide alternative healthcare services and programs, such as establishing new community healthcare clinics, extend the hours of many existing clinics, create new services and provide electronic (computerized) sharing of information and more.
All of these are important improvements, and electronic sharing of information is critical because in the event that you live in a particular town – especially in a rural town – and a specialist in a large city 500 miles away can help you if he or she has your current information and tests, being able to share this information online could very well save you a 500 mile drive and save your life, as well. In fact, there are more and more reports of procedures – and even surgeries – have been done with electronic assistance.
It is important to note that this will not diminish or eliminate the benefits that you already have. The funding will help improve services and add additional ones.
They will also help individuals receiving services get the best services they can locally at a healthcare office instead of having to go to the hospital or having to go hours away.
If you want more information or have questions, click here or visit http://www.cms.hhs.gov/GrantsAlternaNonEmergServ/
Congress is in the midst of voting this week regarding changes to Medicaid that would cut services and cost the states millions of dollars.
This vote is extremely important – so much so that even though President Bush has threatened to veto, the Senate is still working to stop the Bush changes that would eliminate or greatly decrease services.
The House Energy and Commerce Commission voted last week – unanimously – to create a one year moratorium on the rules that Bush is pushing for, even though Bush could try to veto the vote.
States are worried that if the changes Bush wants actually come to pass, not only will services be cut, but states will have to pay out billions of dollars within the next five years, while at the same time experiencing serious disruptions in medical services and the Medicaid system.
Since Bush leaves office in January 2009, it is hoped that there will be a strong enough vote for the moratorium (2/3 of the House and Senate) to hold off until that time to re-address the issue.
Those who would be hurt most if Bush gets his way would be Children and Individuals with Disabilities. Special education services would be cut and services that allow individuals with disabilities to stay in their own homes and maintain home health services could lose essential benefits. In addition, indigent individuals would lose critical treatment and services.
Congress is fighting hard to stop President Bush from vetoing the moratorium. There is an excellent chance that Congress will win and the president will not be able to use his veto power.
This is an important issue to keep an eye on. Though states, communities and individuals will not feel the crunch immediately if the president has his way, it is still critical for all Medicaid recipients to stay aware of.
