A Six Figure Medicaid Mistake (Part 1)
We received a recent call from a child about her parents. Dad has been in a nursing home for more than a year. A Medicaid application was first filed by the facility on behalf of Dad 16 months ago. The reason for the call is that the application was denied. As far as I could tell, it appeared that they tried more than once. Now the outstanding bill was more than $150,000 and the facility had been sold to a new owner. The meter was continuing to run. Each month that went by without Medicaid resulted in the bill going up by approximately $12,000, the private pay rate for care. The new owner wanted to refile the Medicaid application and the family was understandably skeptical. That’s why they called our office. I told them I first needed to determine the reasons why the previous applications had failed. I asked for copies of all the communications from Medicaid and I asked some questions. Because they didn’t deal directly with the Medicaid caseworkers (because the facility did), the family only had a few documents and could only tell me what the facility employee told them that Medicaid had said. Very quickly, however, it became clear what had happened. Mom and Dad had numerous accounts but almost all
What Does the One Big Beautiful Bill Mean for Medicaid? Part 2
In my blog post last week, I reviewed some of the changes to Medicaid contained in the One Big Beautiful Bill (OBBB) that was signed into law earlier this month. These changes are specific ones, such as imposing a work requirement for some Medicaid recipients (doesn’t apply to those receiving long term care Medicaid benefits) and requiring states in certain case to conduct redeterminations every 6 months instead of once a year. Other changes are less direct in the sense that they may affect federal funding of Medicaid which is administered by each state. States also carve out money from their own budgets to apply towards their Medicaid programs. So, if the federal government provides less funding, each state must increase their own contributions to make up the difference. Alternatively, they can reduce the services or coverage they provide. States impose what is called a provider tax on health care providers. By raising the overall cost of services, this also raises the part that is reimbursed by the federal government, the federal matching funds. OBBB freezes this provider tax so states can’t raise it in the future. States are also prohibited from creating new provider taxes. This provision will take effect beginning Fiscal Year 2026 which begins July 1,
What Does the One Big Beautiful Bill Mean for Medicaid Recipients? Part 1
2 months ago in this blog I wrote about a bill that the House of Representatives passed which contained tax cuts and changes to Medicaid. That bill then went to the Senate and if approved would then be presented to the President for his signature. 2 months later with the typical back and forth negotiations a final bill was passed, what has been named the One Big Beautiful Bill (OBBB). So, clients and prospective clients are now asking , “what does this mean for Medicaid or more specifically what does it mean for the Medicaid benefits that provide long term care?” Let’s first examine what is in the bill as it pertains to Medicaid. Because Medicaid is not one single program but actually a series of different programs under a Medicaid “umbrella”, not all changes in OBBB apply uniformly to each program. For example, as with the House bill that was first passed in April, new work requirements are contained in the final bill that was passed. Certain Medicaid beneficiaries will have a work requirement of 80 hours per month in order to keep their benefits. Some groups are exempted from this work requirement. Those exempted include anyone over 65 and individuals who are medically frail and unable
The Perils of Medicaid “Redets” – Part 3
In this week’s blog post, I continue with the subject of Medicaid redeterminations and specifically the increased incidents of people terminated as a result of a failed redet application. In some cases it is because of a lack of notice a I detailed last week. There have been, however, more substantive reasons. One way to be terminated is failure to keep under the $2000 asset limit each and every month. Medicaid measures account balances as of the close of business the last day of the month to determine continued eligibility for the next month. After approval, Medicaid does not check the balances each month but when it comes time for an annual redetermination, that presents the County with an opportunity to do so. In a most recent case in our office, the family advised that on a redetermination last year, their mom’s asset balance exceeded the $2000 limit but the caseworker approved the redet anyway. This year, however, no such luck. The account balances exceeded $2000 by a mere $36. In today’s climate, with federal cuts coming, we cannot expect that the State will let such things slide. The $2000 limit is a strict one. If you are over by $1 expect that you will terminated. Another reason for termination focuses on
The Perils of Medicaid “Redets” – Part 2
In my blog post last week, I talked about a recent trend we are seeing - clients getting terminated from Medicaid as a result of a failed redetermination (“redet”). The purpose of a redet is for Medicaid to confirm that eligibility still exists (ie. the assets are still below the applicable limits and the QIT - if required - is being used correctly) and also to update the calculations of the Medicaid recipient’s cost share (the amount he or she is required to contribute from income towards the cost of care) due to cost of living and other adjustments. That being said, too many people are still losing benefits - sometimes in unfair ways. It starts with notice. When Medicaid is approved, the PR (the form with rows and columns of numbers used to calculate the cost share) also states at the top the month and year when the first redet is anticipated. That is just an estimate, however, since we have found the notice can arrive before or after that month. The problem is that the notice can be sent to the person who filed the original Medicaid application, a family member or the Medicaid recipient’s him or herself. Some counties insist they will only mail
The Perils of Medicaid “Redets” – Part 1
A few weeks ago in this blog, I posted about possible changes to Medicaid that may be coming from Washington. There are other changes, however, that have been happening here in New Jersey at the county and state level with respect to applications that we are now filing, but also with clients for whom we already successfully obtained Medicaid benefits several years ago. In the past 3 months we have received calls from 5 clients who told me that their loved ones’ Medicaid benefits had been terminated. The reasons were varied but it does highlight a disturbing trend. Before I get to the details of some of those cases let me first explain what happens after Medicaid is approved. As I always tell clients, Medicaid does annual redeterminations once you are approved. While these annual reviews were always part of the regulations as far back as I can remember, when I first starting filing Medicaid applications 30 years ago, “redets” as they are commonly referred to, were rare. Some counties did them others did not. Even counties that did them did so sporadically and. not annually. Within the last 10 years and especially since COVID, however, we have now seen them in all the counties we file in and