Last week we tantalizingly mentioned that we would try and circle back to a subject that is near and dear to our hearts as elder law attorneys: Medicaid. And since the suspense you’ve experienced waiting for this week’s follow-up email has probably been only slightly less intense than waiting for the final season of Game of Thrones, we sincerely hope that what follows will meet your expectations. Also, please note that we’ll be on Spring Break next week and so the next issue of The Senex won’t come out until Friday, April 12.
A bit of history is in order here. When Congress created the Medicaid program in the 1960s, it was designed to be funded by both the federal government and the states. Moreover, there was (and currently is) no cap on the amount of federal funding that could be spent on the program. In recent years, members of Congress have proposed transitioning from the currently open-ended source of federal funds to a capped amount in the form of block grants for each state. The net effect of the transition would be to limit federal spending on the Medicaid program and put the states in a position of either absorbing the additional costs or curtailing services covered by their Medicaid programs. Congress has never had the votes to effectuate this change, but this month President Trump submitted a federal budget that proposes moving in that direction, and has ignited the debate once again.
Originally Medicaid would only pay for long term care services in an institution (nursing home), but in recent years the federal government has encouraged states to offer Medicaid to individuals in need of long term care in non-institutional settings. What’s the difference? Well, this week the Centers for Medicare & Medicaid Services (CMS) told us. The
newly issued guidelines
are probably more dense than most of our readers care to parse through, but the take-away is that CMS is trying to expand the range of settings in which someone can receive non-institutional long term care services without making the regulatory costs for state compliance too burdensome. Medicaid recipients don’t need to worry much about these regulations, but should always remember to inquire whether any particular community providing long term care services accepts Medicaid as a payment source.
While the question of whether a particular community accepts Medicaid as a payment source is a relatively easy one to answer, the question of whether an institutional setting or community-based care setting is better for you is not. Practical day-to-day care considerations are paramount when evaluating this choice, but so are the financial and legal consequences. For these reasons, we’d encourage you to involve us in your decision making process.