The Trump Administration Allows States to Choose Medi-Cal Block Grants

The Trump administration has unveiled a plan to allow states the option to cap Medi-Cal spending using block grants. While this change does not directly affect nursing home residents on Medi-Cal and is billed as a way to improve state flexibility in running Medi-Cal programs, it could result in significant service cuts. 

Medi-Cal is a joint federal-state program that functions as an open-ended entitlement program, meaning it does not include any pre-set funding limits. Each state operates its own Medi-Cal system, but this system must conform to federal guidelines in order for the state to receive federal money, which pays for about half the state's Medi-Cal costs. The state picks up the rest of the tab.

Announced on January 30, 2020, the Centers for Medicare and Medi-Cal Services (CMS) plan, dubbed "Healthy Adult Opportunity," would allow states to apply for block grant funding instead of receiving unlimited matching funds. States that choose to enter such an arrangement would receive a pre-set amount of money in exchange for increased flexibility in how they administer their programs. 

The new funding option applies mainly to healthy adults under 65 who are covered under Medi-Cal expansion. People needing long-term care and individuals who are 65 and over would not be included in a potential state block-grant project along with children and individuals with disabilities. States also cannot block grant services that are required under the Medi-Cal statute, such as emergency and hospital services. 

While long-term care beneficiaries may not be directly affected by this new funding structure, there could be an increase in costs to other Medi-Cal beneficiaries. States that choose block grant funding can increase prescription drug costs or change which prescription drugs are covered. Medi-Cal traditionally covers all federal-approved drugs, but the new plan allows states to cover just one drug per class. States can also increase co-pays or cut non-emergency services. If enrollment in Medi-Cal dramatically increases due to a health crisis or a recession, states that received a pre-set amount of funding may not have enough money to cover everyone, resulting in additional cuts to services. 

Opponents of the block grant concept contend it is illegal because only Congress can make such program changes, and litigation against the proposal is almost certain. In addition, it is unlikely that a state could get a waiver before 2021, when there may be a new federal administration.

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Elise Lampert, Attorney at Law

9595 Wilshire Blvd. | Suite 900 | Beverly Hills , CA 90212

Phone: (818) 905-0601 / Email: elise@elampertlaw.com

http://www.eliselampert.com

****Member of the National Academy of Elder Law Attorneys

Program That Helps People with Disabilities Move Out of Institutions Temporarily Re-Authorized

Congress has temporarily extended the federal government’s largest grant program that helps states transfer people with disabilities from institutions into independent living arrangements.

Tucked into a larger federal appropriations package and signed into law by President Trump on December 20, 2019, the extension keeps the Money Follows the Person (MFP) program afloat for an additional five months, through May 22, 2020. However, this extension is the fourth such temporary extension in the past year, and a permanent funding stream remains elusive.

“While this is a disappointing turn of events, we have our marching orders for 2020 — advocate, advocate, advocate for a permanent commitment to Money Follows the Person,” Peter Berns, CEO of The Arc, told Disability Scoop.

Created in 2005, the MFP program is designed to help end Medicaid’s traditional “institutional bias,” referring to the historical tendency of the federal government to direct Medicaid funding for people with disabilities toward services in institutional settings, such as psychiatric facilities and nursing homes, as opposed to home and community based settings, such as individual homes or group homes with four or fewer unrelated residents.

Through the MFP program, the Department of Health and Human Services (HHS) awards grants to states for demonstration projects to experiment with ways to transition people from institutional to community settings. In addition, the MFP program also permits states to use grant funding for employment supports and other long-term services to ensure successful transitions.

Overall, 47 states have received funding through the program, which is credited with de-institutionalizing more than 91,000 people.

The program’s funding, however, has always been in limbo. Five years into its existence, the Affordable Care Act authorized six years of funding for the program, until it abruptly expired in 2016. After being dormant for two years, the program was reauthorized in early 2019 and has since remained on life support.

“While we have appreciated the short-term extensions passed this Congress . . . permanent reauthorization is necessary to ensure that states continue to participate in the MFP program,” the Consortium for Citizens with Disabilities wrote in a letter to Congress in December. “Several states have already stopped transitions under MFP or even dropped out of the program entirely while awaiting the assurance of long-term funding . . . MFP has consistently led to positive outcomes for people with disabilities and older adults and shown cost-savings to states since it began in 2005.”

Elise Lampert, Esq.
Law Office of Elise Lampert
9595 Wilshire Blvd., Suite 900
Beverly Hills, CA 90212
Tel. 818-905-0601
Email:elise@elampertlaw.com
***Member of the National Academy of Elder Law Attorneys

How Does Medi-Cal Treat Income?

The basic Medi-Cal rule for nursing home residents is that they must pay all of their income, minus certain deductions, to the nursing home. The deductions include a $60-a-month personal needs allowance (this amount may be somewhat higher or lower in your state), a deduction for any uncovered medical costs (including medical insurance premiums), and, in the case of a married applicant, an allowance for the spouse who continues to live at home if he or she needs income support. A deduction may also be allowed for a dependent child living at home.

In determining how a Medi-Cal applicant's income affects his or her eligibility for nursing home coverage, most states use what is known as the "medically needy" or "spend-down" approach.  These states allow the applicant to spend down their income on their care until they reach the state's income standard for eligibility, at which point Medi-Cal/Medicaid will begin covering their care.  In this way, those with incomes that exceed Medi-Cal's/Medicaid’s thresholds can still qualify if they have high medical expenses, assuming they meet Medi-Cal's/Medicaid’s other requirements.

But some states set a hard limit on the income permissible to qualify for Medi-Cal/Medicaid -- no spend-down is allowed.  In these states, known as "income cap" states, eligibility for Medi-Cal/Medicaid benefits is barred if the nursing home resident's income exceeds $2,349 a month (for 2020), unless the excess income above this amount is paid into a "(d)(4)(B)" or "Miller" trust. If you live in an income cap state, contact your attorney to set up a trust. The income cap states as of this writing are: Alabama, Alaska, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Nevada, New Mexico, New Jersey, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, and Wyoming.

For Medi-Cal applicants who are married, the income of the healthy spouse living in the community (the “community spouse”) is not counted in determining the Medi-Cal applicant's eligibility. Only income in the applicant's name is counted in determining his or her eligibility. Thus, even if the community spouse is still working and earning, say, $5,000 a month, he or she will not have to contribute to the cost of caring for his or her spouse in a nursing home if the spouse is covered by Medi-Cal.

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Questions? Contact us at Elise Lampert, Attorney at Law

Elise Lampert, Esq,

Law Office of Elise Lampert

9595 Wilshire Blvd. | Suite 900 | Beverly Hills , CA 90212

Phone: (818) 905-0601 / Email: elise@elampertlaw.com

http://www.eliselampert.com

****Member of the National Academy of Elderlaw Lawyers

Make Sure You Are Counted in the 2020 Census

By Elise Lampert

  Posted March 5, 2020 

 In elder law blog

 0

The 2020 census is starting soon, and seniors need to be counted. This may be more of a challenge this year because for the first time, the census will be completed largely online.

The U.S Constitution mandates that the federal government conduct a census every 10 years. Information from the census is used to determine how many representatives each state sends to Congress as well as where hundreds of billions of dollars from federal programs, such as Medicare, Medicaid, nutrition assistance and supportive housing, is allocated. In addition, communities rely on census data to apportion services like new roads, schools, libraries and emergency services.  Think of it as America’s 10-year checkup.

While the census is being conducted largely online, you do not need to fill out the form online if you don’t want to. Beginning in March 2020, the census will mail out postcards to each household, giving instructions on how to respond. You will have the option of responding online, by mail, or via the phone. If you don’t respond, a census worker will visit your home to collect the data.

If someone visits your home to collect information for the 2020 Census, check to make sure that they have a valid ID badge, with their photograph, a U.S. Department of Commerce watermark, and an expiration date. Census workers will not ask for donations or for your Social Security or bank account information.

For more information about the 2020 census, click here.

Elise Lampert, Esq.
Law Office of Elise Lampert
9595 Wilshire Blvd. | Suite 900 | Beverly Hills , CA 90212
Phone: (818) 905-0601 / Email: elise@elampertlaw.com
http://www.eliselampert.com

***Member of the National Academy of Elderlaw Attorneys

How Secure Is Social Security?

For years people have been worried about Social Security’s future, but what is the actual outlook? According to the federal government, unless Congress acts to intervene, Social Security shortfalls are expected beginning in 2035.

Social Security retirement benefits are financed primarily through dedicated payroll taxes paid by workers and their employers, with employees and employers splitting the tax equally. Employers pay 6.2 percent of an employee's income into the Social Security system, and the employee kicks in the same. Self-employed individuals pay the entire 12.4 percent Social Security payroll tax. This money is put into a trust fund that is used to pay retiree benefits.

The trustees of the Social Security trust fund have reported that if Congress doesn’t take action, the fund’s balance will reach zero in 2035. This is because more people are retiring than are working, so the program is paying out more in benefits than it is taking in. Additionally, seniors are living longer, so they receive benefits for a longer period of time.

Once the fund runs out of money, it does not mean that benefits stop altogether. Instead, retirees’ benefits would be cut. According to the trustees’ projections, the fund’s income would be sufficient to pay retirees 77 percent of their total benefit.

Congress can act to shore up Social Security before this happens. Some ideas include eliminating the cap on benefits. Right now, workers only pay Social Security tax on the first $137,700 of income (in 2020). That amount can be increased, so that higher-earning workers pay more in taxes. The Social Security tax or the retirement age could also be increased.

Social Security is immensely popular and lawmakers are unlikely to allow steep benefit cuts to take place. The last time the program was in financial trouble and received a major overhaul was in 1983, when President Ronald Reagan and congressional Democrats struck a deal to increase taxes and gradually raise the retirement age from 65 to 67.

Questions? Contact us at Elise Lampert, Attorney at Law

Elise Lampert, Esq.

Law Office of Elise Lampert

9595 Wilshire Blvd. | Suite 900 | Beverly Hills , CA 90212

Phone: (818) 905-0601 / Email: elise@elampertlaw.com

http://www.eliselampert.com

****Member of the National Academy of Elder Law Attorneys