Fighting Nursing Home Discrimination Against Medicaid Recipients

 

While it is illegal for a nursing home to discriminate against a Medicaid recipient, it still happens. To prevent such discrimination, nursing home residents and their families need to know their rights.

The potential for discrimination arises because Medicaid pays nursing homes less than the facilities receive from residents who pay privately with their own funds and less than Medicare pays. Nursing homes are not required to accept any Medicaid patients, but Medicaid payments are a steady guaranteed payment, so many nursing homes agree to accept Medicaid recipients.

When a nursing home agrees to take Medicaid payments, it also agrees not to discriminate against residents based on how they are paying. Medicaid recipients are entitled to the same quality of care as other residents. A nursing home cannot evict residents solely because they qualified for Medicaid.

Unfortunately, discrimination against Medicaid patients does occur, and the discrimination can take different forms. The nursing home may refuse to accept a Medicaid recipient or may require that a resident pay privately for a certain period of time before applying for Medicaid. When a resident switches from Medicare or private-pay to Medicaid payments, the nursing home may transfer the resident to a less desirable room or claim that it doesn't have any Medicaid beds.

There is at least one way that nursing homes can treat Medicaid recipients differently, however. Nursing homes are allowed to switch residents who were privately paying for a single room to a shared room once they qualify for Medicaid. In addition, the nursing home is not required to cover personal and comfort care items, such as a telephone or television. In some states families are allowed to pay the difference to get a private room or the care item. Other states do not allow any supplementation.

About to Turn 65? Your Health Insurer May Be Automatically Enrolling You in Its Own Medicare Plan

 

As people approach age 65, they should be thinking about their Medicare enrollment choices, including whether to sign up for traditional Medicare or with a Medicare Advantage plan, and if so, which one.  But it turns out that some Medicare-age people are having these important decisions made for them, often without their knowledge.

Before they become eligible for Medicare, many Americans are covered by a commercial or a Medicaid health care plan run by an insurance company. These insurers often also operate Medicare Advantage plans, which are the privately run managed-care alternative to traditional Medicare. Under a little-known process authorized by the federal government, insurers can shift their beneficiaries who are turning 65 to their own Medicare Advantage plan.  It’s called “seamless conversion,” and all it requires is that the health plan obtain Medicare’s prior approval and send a letter to the beneficiary explaining the new coverage, which takes effect unless the member opts out within 60 days.

The idea is to preserve continuity for those who want to stay with the same company, but some seniors are unaware that they have been signed up, in part due to the flood of mail they get from insurers around age 65.  In a recent Kaiser Health News expose, reporter Susan Jaffe related the stories of several new Medicare beneficiaries who were shocked to learn that they had been enrolled in a Medicare Advantage plan.  One, Judy Hanttula of Carlsbad, New Mexico, signed up for traditional Medicare and then ignored the subsequent mail, which apparently included the notice from her insurer telling her that it had automatically enrolled her in its Medicare Advantage plan.

“I felt like I had insured myself properly with Medicare,” she said. “So I quit paying attention to the mail.”

Unfortunately for Ms. Hanttula, before she became aware of the automatic assignment to a Medicare Advantage plan, she had surgery that her new plan subsequently refused to cover, leaving her with a $16,622 bill.  Eventually, with the help of David Lipschutz, a senior attorney at the Center for Medicare Advocacy in Washington, Medicare officials disenrolled Ms. Hanttula from her unwanted Medicare Advantage plan, restored her traditional Medicare coverage and agreed to cover her medical bills, reports Jaffe.

Medicare officials won’t say which insurance companies have sought or received approval to seamlessly convert their members to their own Medicare Advantage plans, but Jaffe reports that among the insurers that are already automatically enrolling members into Medicare plans in at least some parts of the country include Aetna and United Healthcare, and that Humana, the nation’s second largest Medicare Advantage provider, has asked for federal permission to also do auto-enrollment.

Medicare officials are developing procedures for seamless conversion requests and implementation, but in response to complaints from her constituents and health care advocates, Rep. Jan Schakowsky (D-Ill.) wants to build in stronger consumer protections. 

In the meantime, those enrolled in a health plan offered by a Medicare Advantage organization when they become eligible for Medicare should “be attentive,” advises attorney Lipschutz of the Center for Medicare Advocacy.  “Be on the lookout for written notice regarding conversion and carefully consider whether to opt-out of the [Medicare Advantage] plan.”

How to Vote While in a Nursing Home

 

Although voting is the hallmark of a democracy, it isn't easy if you are in a long-term care facility. Nursing home and other long-term care facility residents face several challenges to voting, from registering to vote to actually casting a ballot.

When you move into a nursing home or assisted living facility, your address changes, which means you probably need to register to vote based on the new address. You can register in person, by mail, or, in some states, online. To register in person, visit your local elections office or your local department of motor vehicles. To find out where to register in your state, go here:http://www.eac.gov/voter_resources/contact_your_state.aspx.  Alternatively, there is a national voter registration application that you can use to register by mail. The form includes state-specific instructions. Finally, more than 30 states have online registration.

Once you are registered, you still need to physically cast your ballot. This can be difficult if you have trouble leaving your facility. There are several methods that nursing home residents may be able to use to vote. All states allow absentee voting, but the requirements are different in each state. Some states require an excuse –- such as a physical disability -- to vote absentee. In many states being at least aged 60 to 65 (depending on the state), is a reason to qualify for an absentee ballot.

Twenty-three states allow mobile polling, which is supervised absentee voting conducted in the residential facility. Mobile polling is often based on demand, so to get mobile polling in your facility, contact your local elections office.

If it is difficult for you to get to the polls on Election Day, 37 states offer early voting. Early voting allows voters to visit an election office and vote in person without providing an excuse. This can give you the flexibility to vote when it works for you.