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Change in Medicaid rules

Published on February 11th, 2009

The New york Times recently how an article about the draconian changes to Medicaid rules.  The article explains how in the past federal law protected married couples from having to choose between divorcing or becoming impoverished when one spouse needs expensive nursing home care, allowing the healthier spouse to retain assets and income while the sicker one’s care is covered by Medicaid.   However, the Bush Administration changed those rules for those who are sick but still able to live at home. The federal government has ruled that New York has been too generous in applying the income protections to people at home, forcing several thousand couples to make a stark choice by March of this year.

“They’re saying if you put your spouse in a nursing home, you’re going to get to keep more income than if you keep your spouse out of a nursing home,” said Mark L. Kissinger, deputy commissioner of long-term care for the state Health Department. “That’s completely opposite to public policy and research of the last 10 years.”

Congress in 1988 passed a law intended to protect healthy spouses with lower incomes and fewer independent assets from being reduced to poverty by their better-off spouses’ need for long-term care.  For 2009, federal guidelines allow the couple to keep up to $2,739 a month in combined income and $109,560 in assets not including a home or car and still have Medicaid take care of the nursing home costs.

The federal Centers for Medicare and Medicaid Services sent a letter to state health officials in the fall of 2008 outlining a legal ruling that declares that couples in which both partners live at home are not entitled to the same protection.  The state Health Department estimates that 3,000 couples — out of 30,000 people in the long-term home-care program — are affected by the change, because the healthy spouse depends on the sick spouse’s income to survive; advocates for the elderly say the number is closer to 4,000.

Claudia Hutton, a spokeswoman for the state Health Department, said that New York wanted to keep the home health care program the way it was, and that any talk of changing income criteria was a “smokescreen” to gut the program.

“The Bush administration is trying to pull the rug out from under thousands of seniors in New York who depend on this critical program year in and year out just to survive,” Senator Charles E. Schumer, a New York Democrat, said in an e-mailed statement before this week’s transition.

Advocates say that the federal interpretation makes little sense. “The root of their interpretation is that Congress wanted to give states the option of extending these protections, but only to those whose incomes are so low that they would have no income to share with their spouse,” Ms. Bogart said. “It would be so absurd that no one would ever qualify.”

 

Joe Pioletti
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