Search Results for: medicaid

Do You Really Want to Depend on Medicaid for Your Long Term Care?

January 15, 2018 by Honey Leveen Leave a Comment

What does government-paid long-term care actually provide? And just how effective is that care?

The New York Times reports that “Since 2013, nearly 6,500 nursing homes — four of every 10 — have been cited at least once for a serious violation, federal records show. Medicaid has fined two-thirds of those homes. Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.”

Many health care advocates support these penalties as effective plans to monitor and maintain acceptable levels of care. Objections from the nursing home industry, however, have resulted in a significant reduction in these fines. The industry’s main trade group, The American Health Care Association, complained that the federal inspectors focused excessively on catching wrongdoing rather than helping nursing homes improve.

As a result, the federal government is now scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury. The new guidelines discourage regulators from levying fines in some situations, even when they have resulted in a resident’s death.

Burning the Medicaid Candle

We seem to be burning the Medicare – Medicaid Candle from both ends. Medicare and Medicaid fund most of U.S. nursing home care. We know they are not an endless well of money. On the patient side, Medicaid doesn’t pay enough per patient day for nursing homes to provide good care. Medicaid-funded nursing homes cannot hire enough caregivers, because they cannot pay them enough.

As my colleague Stephen Moses aptly describes, “Beatings will continue until morale improves!”

Many people expect Medicaid-funded nursing home facilities to provide them with long-term care. Medicaid eligibility requires asset spend down. In addition, quality of care is dependent on our financial resources. People who own long term care insurance (LTCi) have necessary funds and are far more likely to be able to avoid Medicaid, stay at home, or access quality assisted living if they need long term care.

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Medicaid’s Woes Highlighted

October 14, 2016 by Honey Leave a Comment

This past month I’ve come across a few articles describing Medicaid’s woes, and highlighting peoples need to plan for funding their own long-term care, now!

This Washington Post story describes why our system is incentivized to discharge patients when they are still very needy, but their Medicare-paid re-hab benefits are exhausted. Medicaid can then often pick up costs, but it pays facilities poorly. This incentivizes facilities to admit the least needful and costly patients. In addition, “The Medicaid system is overly cumbersome and too slow to provide benefits.”

The true heroines of long-term care, paid home care providers, earn an average of $10.11 an hour, states this September New York Times article. About a third of these caregivers rely on food stamps and 28% rely on Medicaid for health insurance. Annual caregiver job turnover rate is 40-60 percent.

The article continues by stating caregivers at Medicaid-funded facilities got their pay raised to minimum wage: $7.15 per hour last year. Such caregivers are often overwhelmed with the sheer number of patients they must care for. “Ms. Walker left her job at a nearby nursing home because “sometimes you had 12 to 15 people to take care of,” she said. “You’re trying to feed everybody, give them baths, but a lot of people got neglected.”

This testimonial about Medicaid’s flaws on the receiving end of care is heart-wrenching, “When Roy Potter was weakened from postpolio syndrome and his wife, Joan, could no longer help him out of bed, a nursing home was “unthinkable,” said Ms. Potter, 83.

For a year, they paid private aides $14 an hour to come to their home in Mount Kisco, N.Y. When they could no longer afford that, Mr. Potter qualified for Medicaid, which pays the preponderance of home care costs in this country.

Over the next two and a half years, more than a dozen agency aides — some caring and competent; some not; some disappearing without explanation — cycled through their home, as did a number of short-term substitutes.

“A new person would come, and I’d have to walk them through everything all over again,” Ms. Potter said.

She grew increasingly anxious about whether an aide would show up. “Every morning I’d hold my breath until the doorbell rang,” she said. “Several times, I had to get in the car and drive to the agency and say, ‘Who is coming today?’”

Last year, when federal overtime provisions took effect, the agency cut back helpers’ hours.

She and her children succeeded in keeping Mr. Potter at home until he died in April, at 86, but finding and keeping help proved a continual battle.

Are you sure you want to count on Medicaid to pay for LTC?

January 14, 2015 by Honey Leveen Leave a Comment

The bottom line, illustrated in this May, 2014 New York Times story, is that there’s been an increasing trend towards managed care for Medicaid patients. The patients featured in this story are Medicaid-paid long-term care (LTC) recipients. An increasing number of Medicaid providers are paid “capitated” rates. Capitated means they get a flat, per person allowance to care for each Medicaid recipient. In the Medicaid-paid LTC described in the article, providers are “cherry picking” out less needful, easier to care for patients, leaving more needful LTC patients with fewer options.

A reasonably priced long-term care insurance (LTCi) policy is a better option than planning on letting Medicaid pay for your long-term care.

Nursing Home Murders: Connecting the Dots with Medicaid-Paid LTC

May 1, 2014 by Honey Leveen Leave a Comment

With permission from The Center for Long-Term Care Reform, I republish their Monday, April 28, 2014 post about my prior blog.

The reason I chose to cover the horrific nursing home murders still in the headlines here in Houston, is because there is a link between failing to plan responsibly for long-term care well in advance and tragic outcomes, whether or not they’re of the magnitude of the Lexington Place murders.

Many who can afford reasonably priced long-term care insurance simply won’t entertain it. They make excuses to avoid such conversations. It’s an uncomfortable conversation to have.

The horror and negligence that occurred at Lexington Place Nursing Home may be isolated (or maybe not since most of us choose to turn our heads away from this type of event). Even so, the importance of these posts is to understand that such events may be indicative of a widespread trend that’s just beginning.

I’ve chosen to cover these tragic murders because to me, they’re the tip of the iceberg. The industrialized warehousing of the indigent who need care will increase as our national debt grows, Medicaid and Medicare reimbursements continue to drop, and the partisan stalemate in Washington continues. And this financial catastrophe is approaching at an increasingly rapid rate as government programs are deluged with unprepared Baby Boomers who need long-term care but did not plan for it when they were able to afford and obtain reasonably priced long-term care insurance (LTCi). Sadly, events like the Lexington Place murders may become more common.

This blog and the one before it are meant to educate. If these tragic posts help even one person wake up and decide to defer their purchase of a new flatscreen TV or more expensive car in favor of buying a reasonably priced LTCi policy, they’ll be worth it.

LTC E-Alert #14-014: The Nursing Home Murders and LTC News and Comment

Monday, April 28, 2014

Seattle –

LTC Comment: Did you see the news coverage last week about two nursing home residents bludgeoned to death by their roommate in Houston? We opted not to cover it then, but the story does illustrate an important point. Nursing homes, especially those in poorer areas, are heavily dependent on Medicaid which pays them less than the cost of providing the care. Generous Medicare reimbursements help to make up part of the shortfall (at least for now), but the nursing homes most heavily dependent on Medicaid resort to cutting caregiver staff to a minimum and paying extremely low wages in order to operate.

So what? Well, Honey Leveen, the self-proclaimed “Queen of Long-Term Care” and the Center’s Regional Representative in Houston, draws out the ramifications in her recent blog post here. We encourage you to read it and to follow her links to more of the background. Honey points out that the nursing home in which the murders occurred has “nearly all” Medicaid residents. She opines that inadequate revenue led to dysfunctional management which resulted in poor care and finally in this awful crime. She links to an earlier article she wrote for LifeHealthPRO questioning the value of “Partnership” policies that leave people dependent on Medicaid’s mostly nursing-home based care.

This is sad stuff, but information all LTCI producers should consider as they advise clients on long-term care planning.

Continued Medicaid Payment Shortfalls Are Very Scary

December 21, 2012 by Honey Leave a Comment

Here’s a link to the December 2012 Report on Shortfalls in Medicaid funding. This is an annual report commissioned by the American Health Care Association (AHCA) and performed by Eljay, LLC.

Not surprisingly, the report (page 6) states that:

“Between 2010 and 2012, the… projected (Medicaid) shortfall climbed to $22.34 from $18.54 in 2010, a 20.5 percent increase in the shortfall amount.”

“We estimate that in 2012, state Medicaid programs, on average, reimbursed nursing center providers only 88.9 percent of their projected allowable costs incurred on behalf of Medicaid patients. This means that for every dollar of allowable cost incurred for a Medicaid patient in 2012, Medicaid programs reimbursed, on average, approximately 89 cents. This represents the lowest percentage since the inception of this study in 1999.

This is very scary stuff!

Obviously, the government is less and less capable of providing long-term care.

I hope that those of you who do not already own reasonably priced long-term care insurance (LTCi) will take heed and plan responsibly for your long-term care. LTCi is the reasonable – and sure – way to ensure you will have all the options you’ll prefer if long-term care is needed.

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