As Florida struggles to reduce state spending, the debate over who qualifies for costly Medicaid long-term care assistance has reached a high pitch.
An individual can have no more than $2,000 in assets and monthly income of $2,022 to qualify for Medicaid. Florida has many low-income citizens who genuinely fit into that category. But many other individuals move assets to loved ones to qualify.
Two bills before the Florida Legislature - House Bill 1289 and Senate Bill 1356 - would make it more difficult to transfer wealth before applying for Medicaid.
The debate over the issue has gotten downright testy, probably because it involves billions of dollars. Start with State Rep. Larry Ahern, R-St. Petersburg, sponsor of the House bill.
"People are gaming the system," he said. "We heard testimony about kids buying new cars and taking vacations with their mother's money while the mom is in a nursing home and her care is being paid for by Medicaid."
Alan Sadowsky, senior vice president of the Morse-Life facility in West Palm Beach, which includes 280 nursing home beds, agrees that legislation is needed.
"I've seen people who I know are wealthy and a month after they get here they are on Medicaid," Sadowsky said. "They don't want their money to go to long-term care. They want it to go to their kids. So they transfer their money and make themselves 'technically poor.' "
Sadowsky said the amount paid by Medicaid per patient is $50 to $60 less per day than it costs to provide care, and his facility is forced to make it up through other means.
"The long-term health facility is left holding the bag," he said. "If this bill tightens up eligibility, not so many people will be able to circumvent the law."
Penalizing responsibility?
But attorney Howard Krooks of Elder Care Associates in Boca Raton, who helps clients protect savings and investments, sees it differently.
"This bill rewards people who didn't save as they went along, and the people who worked their butts off and saved, it penalizes them," he said. "And if you look at the salaries pulled down by executives of some of these nursing home companies, I don't think they are losing money."
Ahern said it is the attorneys, like Krooks, who specialize in elder law who are "making money off of this," in ways that he calls "legal fraud" and "morally reprehensible."
Total Medicaid spending in Florida in 2009 - the last year for which numbers are available - was $15.1 billion. Of this, 67 percent was paid for with federal money - $10.2 billion. The remaining 33 percent was paid by the state, totaling $4.9 billion.
In separate legislation, Florida lawmakers want to funnel almost all of Florida's Medicaid recipients into state-authorized, for-profit health maintenance organizations, which would steer elderly people away from nursing homes and into at-home care.
But nursing home care is inevitable for some.
Some Americans buy long-term care insurance. But some can't afford it, including people with pre-existing conditions, and end up on Medicaid.
However, Ahern said, too many people who do have means also end up on Medicaid. His bill, sponsored in the Senate by Dennis Jones, R-Seminole, would allow state investigators to more closely monitor asset transfers made by would-be Medicaid recipients.
The bill specifically targets "personal services contracts" by which individuals often pay family members for everyday care, "rather than hiring strangers to help them," Krooks said. Those services can include being assisted with bathing, dressing, feeding and being taken to the supermarket. By transferring funds to loved ones, the patient lowers his assets and qualifies for Medicaid.
The bill would require that such payments not exceed what a person would pay on the open market for those services and would require much stricter accounting .
According to Ahern's bill, the payment must be "computed in a manner that clearly reflects the actual number of hours to be expended and (that) the contract clearly identifies each specific service and the average number of hours required to deliver each service each month."
The bill also would make it harder for a spouse to separate his or her assets from that of the patient when Medicaid eligibility is calculated.
Federal law allows a spouse to protect $109,560 in assets - not counting basic holdings such as a dwelling, household goods and a vehicle. According to Krooks, that allowance can be increased, and often is, for people who have expenses - for example, their own medical costs - that will require much more in assets for them to stay above water.
Source http://www.palmbeachpost.com/
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