Wisconsin Medicaid Cost Reduction – A Little Bit Of Good News On Government Spending

Posted on December 10, 2011 by admin

It does not happen often but every once in a while we come across an instance of a government entity actually reducing its costs and inefficiency when it comes to spending taxpayer money. A short article by Ryan Tracy in the August 23, 2010 issue of Newsweek magazine reported on how the state of Wisconsin was able to make a significant cut in its Medicaid budget but still maintain quality and also keep the voters happy. Medicaid provides medical coverage and insurance for low income families and people across the country with both the Federal government and each state funding the program.

Last year, Mr. Ryan’s article stated that Wisconsin Governor Jim Doyle needed to slash the state’s Medicaid budget by 0 million. However, the Governor took a different approach than most politicians in defining what budget cuts to make. Past efforts to cut entitlement programs have usually been ineffective since it involved sitting politicians attempting to make the cuts without endangering their political futures and careers, or in Mr. Ryan’s words, “programs like Medicaid cannot be cut without political bloodshed.” Usually what happens when politicians have to make difficult decisions is they make suboptimal decisions since their actions are guided by their political careers and fortunes, not what is best for the citizens they represent.

Governor Doyle took a different approach in this case. Rather than rely on politicians to make the decisions on cutbacks, people that are mostly ignorant of how operations like Medicaid work and thus, are least likely to identify root causes of problems, the Governor turned to the people that that ran Wisconsin’s Medicaid program and asked them to come up with the 0 million in savings. The result: Wisconsin Medicaid officials found the necessary changes with the following positive effects:

- The 0 million target was met with a mix of new contracts and new procedures that steer customers to lower cost but just as effective treatments.

- Lobbyists lost influence since elected politicians were taken out of the loop and thus, lobbyists lost all of their leverage.

- Politicians were happy since they did not have to take any courageous but unpopular positions relative to budget cuts, preserving their political careers.

- Knock down, drag out political battles were avoided and changes were identified quickly rather than compromised, ineffective answers that took forever to agree on.

- Best of all, according to the article, voters are also happy.

Wow, a government entity that reduced itself in an effective and efficient manner, saving taxpayer money. How did it happen? It allowed the experts in the field, not politicians in the legislature, to identify the root causes and then solved the problem by attacking the right causes. Compare this behavior of the Federal political class that passed health care reform and financial regulatory reform where in each case, the politicians did not understand the root causes of the problems, resulting in idiotic legislation that will never solve the problems: the politicians never understood the root causes.

Since the Federal government usually pays at least fifty percent of the states’ Medicaid budget, you could assume that if the Wisconsin changes saved the state 0 million, it probably saved the Federal government about the same amount, resulting in the nation saving 0 million. Since Wisconsin’s population is about 1.9% of the country’s total population, a rough, rough estimate of national savings if the Wisconsin savings were rolled out coast to coast would be over billion a year. Taking it another step, what if those same types of changes were instituted in the bigger medical entitlement program, Medicare, on a national basis? Conservatively, at least another – billion could be saved just between Medicaid and Medicare.

This step is consistent with several steps outlined in the book, “Love My Country, Loathe My Government.” Step 1 would reduce Federal spending by 10% a year for five years in order to downsize the government out of inefficient and ineffective programs and departments. A major process for attaining these downsizing targets is to do exactly what the Wisconsin politicians did: allow the experts, i.e. the government employees who know the ins and outs of the government operations they are involved in, to identify and propose the necessary changes. The twist that “Love My Country, Loathe My Government” proposes is the implementation of a lottery system that would randomly pass on a monetary reward to employees that come up with true costs savings. Imagine what savings we could incur if similar savings were identified in all government departments.

Steps 26 to 29 would attack major issues such as reducing medical costs, instituting a national energy program, fixing public education, and implementing a comprehensive immigration reform
in the same manner. It would institute panels of experts, sans lobbyists and politicians, that would identify true root causes of each issue, just like they did in the Wisconsin Medicaid area, and develop cost effective solutions quickly, without the political infighting that is never good news for the American public.

Congratulations to the Wisconsin leaders, whose foresight and courage allowed their own expert state employees to solve their budget problem. We can only hope that the rest of the political class shows the same initiative. and show it quickly. Waiting for our Federal politicians to do the same has resulted in a national debt of over TRILLION.

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AFSCME No Questions For They Will Just Tell You Lies

Posted on November 11, 2011 by admin

“Ha ha! You fool! You fell victim to one of the classic blunders! The most famous is ‘Never get involved in a land war in Asia,’ but only slightly less well known is this: ‘Never go in against a Sicilian when death is on the line!’” – Vizzini (The Princess Bride)

 

There is another classic blunder that should be added to the list.  And I am sure that Vizzini would have added it had he not, just seconds after uttering these words, fallen over dead from unwittingly poisoning himself.  I am referring to of course the classic blunder of believing anything a government union tells you.  AFSCME, the American Federation of State, County and Municipal Employees, provides us a stark lesson as to why this is true.

 

The race is on for the House of Representatives seat once held by one of the most embarrassing and corrupt human beings to ever be called an American; the late John Murtha.  Spare me the false praise and silly defenses of the unindicted coconspirator of ABSCAM, the man who went to his grave having called our Marines in Iraq murderers and a man who secured so much unconstitutional pork for his district that he oinked.  I am not in the mood for it.

 

In PA-12 they are currently preparing for a special election to fill out the remainder of Murtha’s term and like Golem fearing that he is about to lose the One Ring forever the Democrats and their allies are plotting, lying, scratching, and even biting to keep that from happening.  The political intrigue aside about how Tim Burns was chosen by Republican elders as their official candidate by party insiders over Bill Russell who has already run in the district once held by the King of Pork, the left is up to their old tricks again.  Right now AFSCME is running ads on the radio which included a half truth that is twisted into a lie.

 

I know!  A real shocker right?

 

These ads start out proclaiming that Tim Burns supports raising taxes 23% through a national sales tax.  From there on the ads deviate from the tracks of reality even further and start asking questions about how the middle class, the poor and seniors will be able to afford such a tax on gasoline, food and medicine.  In the end you are left with the impression that Tim Burns wants to put grandma under his boot and crush her.

 

But then again, this is AFSCME we are talking about here.  I think we’ve seen this ploy before.

 

The facts?  Tim Burns’s stance on a national sales tax is a little murky.  He has spoke in favor of a specific plan called the FairTax and then turned around to later call it not practical.  I presume that this is because he simply could not speak intelligently enough on the subject and just decided to beat a hasty retreat.

 

So what is the FairTax?  This is a tax which is a national retail sales tax on new goods and services and not just a national sales tax.  Buy a home previously built and owned by someone else and you pay no sales tax.  Buy a used car and you pay no sales tax.  The FairTax also does not tax any money spent up to the poverty line through a prebate system where Americans are refunded each and every month the amount of taxes they would pay on that amount of money based on government tables of family size and poverty levels.  FYI, this is also one of my biggest gripes with the FairTax in that it makes the tax progressive and maintains a segment of our population who still would pay no taxes.  Thus they would still not interested in how tax dollars are spent and that is bad for a representative Republic such as ours.

 

The FairTax also does something else that AFSCME does not want voters in Pennsylvania’s 12th District to know because, well, it would really hurt their chances at slandering Tim Burns after all.  See, the FairTax actually replaces not just the personal income tax and the corporate income tax but also federal payroll taxes for things like Medicare and Social Security.  It does not however repeal the 16th Amendment because legislation cannot do that and leaving the possibility that liberal politicians who love to tax labor and spend our money could reinstate a new income tax on top of the FairTax.  This is why supporters of the FairTax, to a man, also support the repeal of the 16th Amendment.  But, as has been said, that has to be done separately.

 

So while there is a new national retail sales tax on new goods and services of 23% there is an elimination of all sorts of income taxes which strip money from your paycheck before you even see it and get to touch it.  It also, through the elimination of corporate income taxes, which are just rolled up into the final cost of the goods and services you buy anyway and, takes away about 19% to 30% of the cost you pay for those goods and services.  The exact rate depends on exactly what you are buying because different goods and services travel different paths to you, the consumer, and thus accrue a different level of tax burden passed on down the line.  Yeah, the reality is that companies do not pay taxes.  They just collect them from you and then transfer those dollars to the government.  So if you are middle class and paying a 25% marginal tax rate on your income (,000 – ,000 per year as a single person) plus all these rolled up corporate taxes on goods and services every time you purchase something it is pretty hard to explain how the such people will actually wind up paying more once you realize that direct debit from your paycheck each payday is removed.

 

Oh, and just in case you are worried about what will happen to people that rely on Medicare and Social Security if the FairTax were to be implemented and those payrolls taxes removed, the FairTax rate of 23% actually has been designed to include these taxes and maintain these programs.  In fact it maintains all these little fiefdoms of power over the people from Food Stamps to Medicaid. Yeah, that is another problem that I have with the FairTax too; it keeps the socialist nanny state rolling right along.

 

If you want to learn more about the FairTax you can visit FairTax.org.  Because taking AFSME’s word for what the plan involves would be a blunder too big to excuse.  Yes, even bigger than getting involved in a land war in Asia.  But hey, did you really expect the truth from a bunch of people that have made their lives off the government dole?

 

I am not saying run out and vote for Tim Burns if you are in Pennsylvania’s 12th Congressional District just because AFSCME is a bunch of lying cretins.  I am saying just make sure you are educated on the issues come Election Day.  Because an educated public is the last thing AFSCME wants for they fear that their own little piece of the government pie might be shrunk.  If it wasn’t, well then they would be telling you the truth wouldn’t they?  The facts are that too many people have a vested interest in a complicated, arcane and easily manipulated tax code like the one we have now and anything that threatens to simplify said system must be lied about and shot down by any means necessary.

 

And let’s be even more brutally honest here.  AFSCME would love Mark Critz to win in PA-12 because, well you know, he’s a Democrat and being an ex-Murtha staffer it would mean they can pretty much count on his vote in Congress to be just like Murtha was still there doing all the unconstitutionally things Murtha loved to do.  Besides, you know that Republicans are just evil S.O.B.s who would rather you, “die quickly,” not be able to ever retire and wallow in misery.  You know that right?  Right!?!

 

What do you mean you don’t know that?  What are you?  Some sort of troublemaker?  Ok, be that way then.  Some of AFSCME’s fellow travelers from the SEIU will be visiting you shortly to beat some sense into you.  Literally!

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Why You Need Nursing Home or Long Term Care Coverage

Posted on October 26, 2011 by admin

There are many reasons why nursing home insurance or long term care is so important.  Approximately 70% of those reach age 65 will require some type of living assistance in their lifetime.  The average stay in a nursing home is 904 days, almost two and a half years.  The average cost of those 904 days is just under 8,000.  Can you write a check for this?  40% of us pay out of pocket.  50 percent of all couples and almost 3 quarters of individuals are impoverished in less than 12 months of entering a long term care facility.

There are only three ways to pay for nursing home care:   Medicaid, your assets, or Long term care insurance coverage.  For people with low income and assets, Medicaid pays for nursing home care.  In most parts of the country 50% to 65% of residents of nursing home have their care paid by Medicaid.   It is probably not coincidental that nursing homes funded primarily by Medicaid (which offers a very low reimbursement rate) generally offer a lower standard of care when compared to other nursing homes. 

It should be noted that Medicare Insurance (as opposed to Medicaid) does not pay for assisted living expenses.  These policies only pay for a limited amount of skilled nursing care after a qualified hospitalization.  In addition, these costs must be for skilled care and not custodial care.  Three quarters of these costs (as opposed to custodial nursing home costs) are paid by the family.

It takes more than what most people have to pay for a typical stay in a long term care facility, and still leave enough for a surviving spouse’s living expenses and nursing home care. 

As the average retirement “nest egg” is slightly under 0,000, very few families can afford the cost of even one spouse requiring quality personal care, let alone two.  In many cases one spouse becomes ill and needs specialized care.  This can result in leaving the remaining spouse in poverty for the rest of their life.

Experts the need for Long Term Care insurance coverage both for estate preservation reasons and maintaining as high quality of life as possible for the longest period of time. 

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Yes, there are some people who will never use Long Term Care insurance – close to 30%.  Even so, the average long-term care insurance contract bought by a 65-year-old and held until death pays out 82 cents for every dollar of paid.  

Because Long Term Care plans are not standardized and there are such a wide variety of options available for coverage, it  is may not be a good idea to research and buy LTC without help.  It is important to understand which options each insured needs, and be able to able to give you good advice.   A long term care insurance agent is the best resource to compare contracts, coverage, and endorsements. An independent agent can make sure the policy you purchase is the best plan for you and your family.
The author recommends that you get prices and additional information about insurance for nursing home care and click here for Medigap rates” on his site.  Alston J. Balkcom is a veteran insurance professional with over 25 years of experience as a licensed agent.
There are many reasons why nursing home insurance or long term care is so important.  Approximately 70% of those reach age 65 will require some type of living assistance in their lifetime.  The average stay in a nursing home is 904 days, almost two and a half years.  The average cost of those 904 days is just under 8,000.  Can you write a check for this?  40% of us pay out of pocket.  50 percent of all couples and almost 3 quarters of individuals are impoverished in less than 12 months of entering a long term care facility.

There are only three ways to pay for nursing home care:   Medicaid, your assets, or Long term care insurance coverage.  For people with low income and assets, Medicaid pays for nursing home care.  In most parts of the country 50% to 65% of residents of nursing home have their care paid by Medicaid.   It is probably not coincidental that nursing homes funded primarily by Medicaid (which offers a very low reimbursement rate) generally offer a lower standard of care when compared to other nursing homes. 

It should be noted that Medicare Insurance (as opposed to Medicaid) does not pay for assisted living expenses.  These policies only pay for a limited amount of skilled nursing care after a qualified hospitalization.  In addition, these costs must be for skilled care and not custodial care.  Three quarters of these costs (as opposed to custodial nursing home costs) are paid by the family.

It takes more than what most people have to pay for a typical stay in a long term care facility, and still leave enough for a surviving spouse’s living expenses and nursing home care. 

As the average retirement “nest egg” is slightly under 0,000, very few families can afford the cost of even one spouse requiring quality personal care, let alone two.  In many cases one spouse becomes ill and needs specialized care.  This can result in leaving the remaining spouse in poverty for the rest of their life.

Experts the need for Long Term Care insurance coverage both for estate preservation reasons and maintaining as high quality of life as possible for the longest period of time. 

Yes, there are some people who will never use Long Term Care insurance – close to 30%.  Even so, the average long-term care insurance contract bought by a 65-year-old and held until death pays out 82 cents for every dollar of paid.  

Because Long Term Care plans are not standardized and there are such a wide variety of options available for coverage, it  is may not be a good idea to research and buy LTC without help.  It is important to understand which options each insured needs, and be able to able to give you good advice.   A long term care insurance agent is the best resource to compare contracts, coverage, and endorsements. An independent agent can make sure the policy you purchase is the best plan for you and your family.

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An Overview of Treatment Foster Care

Posted on October 25, 2011 by admin

Foster care is certainly not a new concept; in fact, references can be found to caring for the children of others as far back as the New Testament and the Talmud. In the 1500s, children without families were served in the Almshouses in England. By the 1800s, the so-called Orphan Trains were organized by the first child welfare organization in America, the Children’s Aid Society in New York. These trains transported children whose families could not care for them to western states where they were taken in by families to work on farms. A highly publicized case of child abuse involving a girl named Mary Ellen illustrated the fact that the laws which protected animals from abuse were stronger than those that protected children. As a result of this case, the first child abuse laws in the United States were enacted, and some states began providing subsidies to families that took in foster children.

 

In 1909, the problems facing children in America were recognized by the first White House Conference on Children. This, the first White House Conference on any subject, signaled a new era where government increasingly recognized its responsibility to its youngest citizens.  In fact, after a 38 year hiatus, legislation has been introduced to Congress this year that proposes a 2010 White House Conference on Children to mark the 100 year anniversary of this historic event and to renew our attention and focus on the problems faced by children and families in this new century.

 

The roots of Treatment Foster Care are found in the 1950s, 1960s and 1970s, when agencies began to train foster families to provide more than just a home to their foster children. This model has, at its core, evolved to believe that a foster family, provided with specialized training, supervision, and other clinical supports, can be a powerful agent of change for a child with special behavioral, emotional and/or medical needs. Unlike traditional foster care, where a child’s primary need is for placement, in treatment foster care, the positive aspects of a nurturing family environment are combined with active and structured treatment interventions.

 

From the initial experiments in small agencies around the country, the popularity of the model grew as the deinstitutionalization movement of the 1970s became the national policy of the 1980s. In the 1990s,research demonstrated that the model produced outcomes that in many cases were comparable to residential treatment and, when compared to traditional foster care, had 20 – 30% fewer disrupted placements. Many states used the Medicaid program to expand the availability and service intensity of  Treatment Foster Care. Today, Treatment Foster Care is widespread and a viable alternative to residential treatment, with foster parents receiving specialized, intensive training to help their foster children heal while residing in normalized family settings.

 

Ken Olson is a Foster Care and Family Services Regional Director for KidsPeace, overseeing treatment foster care programs in Maine, Georgia and North Carolina to help children with a multitude of emotional, psychological, social and behavioral needs. Having started out as a treatment foster parent in 1975, Ken has seen the system from both sides and always keeps the challenges faced by foster parents in mind when making decisions. He definitely understands when foster parents describe their work as “the hardest job you’ll ever love.” He relates when foster parents are having a particularly bad day or worrying about how the foster child’s meltdown will affect their biological children or how they will be able to do everything they need to do in a day and still take their foster child to treatment or for a supervised visit with the birth parents. Ken also has no problem explaining to foster parents that they will be held accountable for the safety and well-being of their foster children, and that they must never use physical restraint or punishment on their foster children. He refers individuals who want to learn more about foster care to www.fostercare.com provides information and resources on foster care for current and potential foster parents.

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According to 2005 U.S. Adoption and Foster Care Analysis and Reporting System (AFCARS) estimates, there were 513,000 children in our nation’s foster care system that year, with more than 114,000 waiting for adoption. Those estimates also indicate that, while 24% were in foster care in the home of a relative, 46% were living in foster homes with which they had had no prior contact. Quite obviously, more trained foster parents are needed.

 

“The federal mandate is to reduce ‘drift,’ which means kids being placed in home after home, which is very damaging to their ability to attach and their self-esteem. It is therefore the job of organizations such as ours to be extremely selective when interviewing potential foster families and providing them with in-depth training and support to deal with any crises that arise, 24/7,” Ken explained. “At KidsPeace, we pay close attention to the matching process and do everything in our power to make our placements successful. We want our kids to stay in one foster home until they are returned to their families or are adopted, often by their foster families.”

 

According to Ken, trends in foster care are to reduce the number of kids in the system and their time in the foster care system. This has resulted in an explosion of home-based services that were not available 10 years ago, allowing many kids to remain at home while receiving the treatment they need, even if that means counselors visiting a home three times weekly to work with the children and their families.

 

“At KidsPeace, we work with families during supervised visits on parenting and psychoeducational issues, medical problems and dealing with behavior disorders in order to get the kids back home as quickly as possible,” Ken said. “When reunification is impossible, we work to find the appropriate adoptive family, which is often the foster family that has grown to know and love the child. This is a blessing, but it also can reduce the number of trained foster parents available due to the number of children in the home.” Most states limit foster families to one or two foster kids unless the family takes a group of siblings, which all agencies strive to keep together.

 

The Past 25 Years

Ken discussed how treatment foster care has changed over the past few years. “It has become more focused on permanence as an outcome,” he said. “We are seeing kids who present with great emotional and behavioral acuity. This poses many more challenges in terms of finding and training foster parents. Additionally, Medicaid, which provides a source of funding for TFC in about 50% of our states, is under increasing pressure to cut the amount it spends, requiring higher standards to qualify for funding, which, in turn, creates a mountain of additional paperwork.”

 

Funding and some aspects of the model are different in each state, depending on whether treatment foster care is considered a  “mental health” or “child welfare” program. “What we have learned,” Ken explained, “is that best practices mean that services need to be integrated, and integrated services need to wrap around the kid and blend treatment with daily living.” Foster parents are seen as professionals in some states and volunteers in others. Regardless of how their roles are defined, Ken described foster parents as the most powerful agents for change in foster children’s lives.

 

Treatment foster families come from a wide variety of backgrounds and are by no means strictly defined. While the screening process to become a foster parent can be cumbersome, it is imperative to ensure the safety and well being of any child placed in the home. Home studies are conducted with all families to ensure that the right children are matched with the right family. There are background and criminal history checks, personal interviews about attitudes and prior experiences and comprehensive training. According to Ken, it can take anywhere from three to six months to become a licensed foster parent, and annual training is ongoing for the entire time one remains a licensed foster parent.

 

Aging Out

Ken said that one of the “huge problems” with the foster care system is that kids age out at 18 without the skills, resources or support to move on to independent living. He believes that, in this regard, the system has poorly prepared our foster kids socially. Ken said that studies have shown that few kids from any background are ready to live on their own at 18 or 19 years old. There need to be more programs that prepare foster kids to transition into independent living and help them avoid the pitfalls of homelessness, unemployment, dropping out of high school or not attending college, illegal activities and drug and alcohol abuse.

 

The Future

Finding new foster parents can be challenging, but, according to Ken, foster parents are the best recruiters, showing family and friends how rewarding foster parenting can be and being walking, talking advertisements for the program. “Friends visit their homes and see what goes on, and then they call us to see if they qualify to be foster parents, and the word of mouth just keeps spreading,” Ken said. “Our foster parents develop a fantastic support system for each other, and our staff go above and beyond to do everything possible to help our foster families stay together. The most difficult recruitment issue we experience is finding families for teens. They can be the most difficult age group to place because they can be the most difficult to control and reach and often have the greatest number of emotional and behavioral problems.”

 

Ken is optimistic by nature, and is hopeful about the future of foster care, predicting that it will continue to evolve. He believes that government agencies are getting better at understanding which kids are best served by the foster care model and that other foster care organizations will improve their matching processes. Ken also looks forward to permanency options improving for foster kids, with many states establishing policies to terminate parental custody after one year of foster care, freeing the children up for adoption sooner. Foster parents are also helping birth parents with parenting skills and becoming role models for parents, as well as for their foster children. Ken predicts that kinship foster care will continue to grow, especially with the assistance of technology that can help locate relatives who live far away from other family members.

 

Ken asked readers to “Call us. Let us show you how you can become a foster parent and how you can have a really positive impact on the life of a child. It is an extraordinary experience that will change you forever.”

 

For more information on KidsPeace Foster Care Programs across the country, please call 800-8KID-123 or visit www.fostercare.com.

KidsPeace is a private charity dedicated to serving the behavioral and mental health needs of children, families and communities. Founded in 1882, KidsPeace provides a unique psychiatric hospital; a comprehensive range of residential treatment programs; accredited educational services; and a variety of foster care and community-based treatment programs to help people in need overcome challenges and transform their lives. Visit our websites, KidsPeace.org, ParentCentral.Net, and Fostercare.com for more information. 

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Medicaid- Healthcare

Posted on October 24, 2011 by admin

As healthcare in the united states become costly, most people have not been able to get basic healthcare  due to their economic status. There are millions of Americans who today live in fear of getting sick because they are not sure of how they will meet their healthcare needs. Good health is important for all people and for a productive nation.  Medicaid was established to provide healthcare for the low income individuals and their families. As the number of peoele who were not insured increase, it became  concern to the government  and  it became necessary for the federal and state government to  put in place a program that would insure low income individuals and their family. Medicaid is available for all low-income  indivdiails and families who fit  in the eligibility criteria. Medicaid does not pay money to individuals but it sends  the payment directly to  healthcare care providers after healthcare services have been provided. In some states, individuals have to share the cost of medical care with the government (co-payment) which means individuals have to meet  a part of their medical expenses. Medicaid  is a means tested program  which means its effectiveness in meeting healthcare needs of the population has been tested and proved. It has become the backbone  of public healthcare in the country, being the largest source of funding for public healthcare.

Social problem in Medicaid

Medicaid can be defined as a federal-state entitlement program  that is meant ot provide insurance coverage for low income indivdiauls and their families.  This programs is a part of the 1965 Title XIX act. It provides federal mathing funds to all states to  offset cost which are incurred paying healthcare providers  who serve all individuals covered under the program. Although state participation is voluntary, all 50 states have participated in Medicaid since 1982.

Medicaid provide medical benefits covering basic healhcer and also long-term healthcare services for all individuals who are eligible.  More than 50 percent of Medicaid spending usually goes to cover hospitial and acute care expenses. The remaining 52 percent of Medicaid expenses usually covers nursing home and long term care. Any state that chooses to get Medicaid has to offer the below given services:

Hospital care, provided for inpatient and outpatients
Nursing home care
Physical caser services
Laboratory and diagnostics services like X-ray services
Immunization
Family planning services
Nurse and midwife services
Physical assistant services
Health center and rural health  clinic

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States participating in the program may offer blow optional services and get federal matching funds:

a)      Drug prescription

b)      Institutional care for the mentally retarded patients

c)      Home or community based care

d)     Disabled personal care

e)      Dental and vision care

Since every state has the freedom to  design its own beneiftis package, so long aas the benefits meet the minimum federal requirements, Medicaid benefits there vary from state to state depending on state-specific design.

In eligibility, Medicaid covers about three major groups of low income individuals including:

(i)               All recipients including all individuals who qualify through the eligibility criteria

(ii)             Parents and their children who qualify under the different criteria – Medicaid covers more than one fifth of children in the United States. It provides coverage to more than 10 million low income adults, most of who include adults.

(iii)           Elderly individuals – Medicare provides coverage to more than five million adults aged above 65 yeas.  It is the single largest purchase of longer-term nursing care in the country

(iv)           Disabled individuals – More than 17% of Medicaid recipient include blind and disabled individuals.  Most of the receive Medicaid through Supplementary Security Income (SSI) program

For individuals to qualify for Medicaid, they must prove their resources and incomes fall below the federal specified eligibility levels. However, these levels varies from state to state and depend on the local cost living. For example in 2001, federal poverty levels (FPL) stood at ,630 for a family of three members. In Hawaii, it was estimated at ,830 in Hawaii and in Alaska it was ,290.  This shows that federal poverty level varies from one state to another.   To qualify under the specified criteria individuals must be citizens of the United States. Legal immigrants also qualify depending on the date they entered into the United States.  However, illegal immigrants are not eligible to Medicaid except in cases of emergency.  To receive Medicaid, individual are required to fit into the eligibility criteria, even if they are coming from low income families.  Childless couples and single childless adults also do not qualify for Medicaid unless they are disabled or elderly.  

In terms of cost, Medicaid is the most expensive welfare program. In 1965, it account for only 1.4% of the budget but today, it accounts for more than 10% of the federal budget. For both state and federal government, it account for 20 cents for every tax dollar. More than half of beneficiaries are children (54%) while more than 70% of the total cost goes elderly.  The cost of medical case has increased due to a number of factors include increase in the number eligible individuals due to increase in the number of  elderly  above 85 years, increase in cost of medical and long term care, increase  in use of services, and expansion of state coverage  from minimum benefits packages.

Medicaid historical antecedents

Medicaid was created by the same policy that created Medicare. Both programs were signed into law in 1965 after the government realized that there was a growing problem of increasing number of people without health insurance coverage.   Health insurance for the public was first proposed in 1945 but the legislation dragged with the government for a long time until it was realized that the cost of healthcare was becoming a heavy burden to most Americans. The Social Security Amendments of 1965 provided the ground for establishment of the two healthcare policies which have now become the backbone of U.S  insurance coverage for the low income people, retirees, and soldiers returning back from war.  

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Choosing Your Policy Wisely

Posted on October 23, 2011 by admin

Planning your retirement? Insurance companies offer a range of long term care insurance policy options so that every individual will be able to receive the right coverage for a specific type of long term care (LTC).

However wise it is to consider a long term care insurance (LTCI) policy for your future health care needs, you have to follow a certain process when negotiating for one. By doing so, you will definitely be able to clinch the type of LTCI policy that will be suitable for your future health care needs.

According to experts on the LTC field, nobody is 100 percent sure of what he will need in the future but everybody can determine how much he is willing to risk for a policy. For instance, upon checking with a reputable insurance company you find out that acquiring a policy with lifetime coverage will cost you ,000 on annual premiums. So, you back out from making the purchase when in fact you could’ve settled for a shorter benefit period.

Of course, you would rationalize that it is unreasonable to buy a policy with a shorter benefit period only to seek further care afterwards once your insurance benefits have been exhausted.

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Since we’ve reached that part of exhausting LTCI policy’s benefits, guess now is the best time to discuss LTCI policies under the partnership program. New York, Connecticut, California, and Indiana are four states responsible for implementing the partnership program in the country.

Long Term Care Insurance Policy Options

In hopes of getting every citizen of the country to plan his and her future health care needs, various state government agencies and private insurance companies that market LTCI collaborated and established the partnership program.

Anybody who owns an LTCI policy that complies with the guidelines of the partnership program can apply for Medicaid assistance should they need additional care after having exhausted their policy benefits.

Under the law, before a person can get Medicaid coverage he should deplete his assets first up to the program’s asset limit requirement which varies in every state. Fortunately, those individuals with a partnership- qualified LTCI policy are exempted from this spend down rule as they are allowed to protect a portion of their assets, or the total amount of their assets that is equivalent to the maximum benefit amount of their insurance policy.

Meaning to say, owners of an LTCI policy that qualifies under the partnership program get to enjoy both worlds — topnotch health care coverage and asset protection.

Another type of LTCI policy which is actually favored by the majority is the indemnity policy. With this type of policy, you will receive the exact amount of your maximum daily or monthly benefit regardless of your total expenses on care.

Since it allows you to be in full control of your cash benefits, an indemnity LTCI policy is more expensive but many people believe it’s worth investing your money into this kind of LTCI product.

The most common LTCI policy is the reimbursement type. It is the opposite of indemnity insurance as it would only reimburse to you the exact amount of your LTC expenses.

There is absolutely a lot to choose from but when out shopping for an insurance policy be sure to weigh your long term care insurance policy options very well to be able to get the best deal.

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Special Deals In Health Bill Under Fire

Posted on October 22, 2011 by admin

Special legislative favors, especially one designed to secure a Nebraska senator’s vote for the embattled health care package, ignited so much public outrage that President Barack Obama is calling them a mistake and House leaders say the bill can’t be resurrected unless such sweetheart deals are scrapped.

Obama says Americans were understandably upset by the backroom dealmaking that he called ugly. In a cruel twist, the reaction helped elect a Republican senator in Massachusetts last week, putting the health legislation in peril.

Rep. Jim Clyburn of South Carolina, the No. 3 House Democrat, said Tuesday the House may be able to pass the Senate health bill — and salvage Obama’s top domestic priority — if the offending items are deleted.

“We’ve got to get rid of that Nebraska stuff, we’ve got to get rid of the Louisiana stuff,” Clyburn said, referring to provisions inserted to help secure the votes of holdout Democratic senators Ben Nelson of Nebraska and Mary Landrieu of Louisiana.

Obama, speaking to ABC News this week, said, “I didn’t make a bunch of deals.” But he acknowledged making “a legitimate mistake” by letting White House and congressional negotiators include the items during last month’s closed-door negotiations.

Most ire has focused on the Nebraska provision, even though it resembled countless other favors that have secured lawmakers’ votes for decades. Republicans caught Democrats flatfooted by turning derision of the “Cornhusker Kickback” into a national furor.

Strategists say Democratic leaders underestimated their foes’ ability to use the Internet and other outlets to feed unsavory depictions of legislative dealmaking to angry voters already suspicious of Congress.

“The political dynamics have changed,” said Democratic consultant Chris Kofinis. “The Google electorate,” he said, can swap political information and opinions with lightning speed. Average Americans may know little about congressional traditions for brokering deals, he said, but when they hear about it, “they don’t have a lot of patience for the sausage-making process.”

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Obama basically conceded the point this week, after reaction to the Nebraska item helped Republican Scott Brown win a stunning victory to succeed the late Sen. Edward Kennedy in Massachusetts. Brown’s election jeopardized the health care overhaul that Kennedy long championed by taking away the 60-vote Democratic supermajority and the Democrats’ ability to cut off GOP filibusters.

“It’s an ugly process and it looks like there are a bunch of backroom deals,” Obama told ABC News. In Wednesday night’s State of the Union address, he said, he will “own up to the fact that the process didn’t run the way I ideally would like it to and that we have to move forward in a way that recaptures that sense of opening things up more.”

He said he has kept “the promises we made about increased transparency” at the White House, even though he once had advocated televising health care negotiations on C-SPAN.

Nelson, who defended his actions in a Senate speech Monday, was upset last year that Nebraska would have to pay for a proposed expansion of Medicaid starting in 2017. He says he argued that the federal government should cover the full cost for all 50 states, not just Nebraska.

But such an agreement would have cost about billion over 10 years. So White House and Senate Democratic negotiators agreed to apply the break only to Nebraska, at a cost of about 0 million, Senate officials said.

As soon as GOP operatives spotted the change, they dubbed it the “Cornhusker Kickback,” and denounced it as a blatant payoff for Nelson’s vote. Democratic leaders, knowing that both parties have often used such tactics to placate holdout lawmakers, seemed slow to react.

The most immediate impact was in Massachusetts, where Brown was running an under-the-radar campaign against heavily favored Democrat Martha Coakley. With conservative talk shows and bloggers fueling the fire, Democrats belatedly realized that Brown was surging.

“That Nebraska thing is really hurting us,” former President Bill Clinton told House Democrats a few days before the Jan. 19 Massachusetts special election.

In a final-hour campaign speech, Brown denounced “those backroom deals for Nebraska and others.”

A post-election poll by The Washington Post, the Kaiser Family Foundation and Harvard University found that Brown hit a nerve, even though Massachusetts voters had mixed feelings about health care in general. Nearly half said they opposed Obama’s health initiatives. But 68 percent said they favored their own state’s universal health care plan, which Massachusetts enacted several years ago — with Brown’s vote.

Worcester teacher Kathleen Halloran, 47, told The Associated Press that a national health care revision “really needs to be a collaborative effort at real, true reform, not some political agenda, not these backroom deals where Nebraska gets exempt.”

Nelson says he feels unfairly targeted by taunts of a “Cornhusker Kickback,” when all he wanted was to stop Congress from imposing more unfunded mandates on the states. He said he was slow to realize the firestorm’s impact because he was more focused on other matters, such as blocking a publicly run health insurance program.

Asked about the condemnation of the Nebraska deal, Senate Majority Leader Harry Reid, D-Nev., said Tuesday, “All senators, Democrats and Republicans, work hard to represent the states and the needs of their states.”

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New York Long Term Care and More

Posted on October 21, 2011 by admin

Growing old in New York is quite a unique experience that a retired New Yorker will hardly feel he’s any different from the younger generations as he continues a busy life. Even those folks in a New York long term care facility will always find activities that will continue to sharpen their minds and hone their creative skills. That is New York.

Perhaps, the reason most senior New Yorkers are less likely to feel self-pity even as losing their independence occasionally gleams in their minds is that they have been toughened by their times. Natural-born New Yorkers have seen the best and the worst conditions of their state and have managed to emerge unscathed as they are imperturbable.

So as they begin their life after retirement New York’s baby boomers can’t help but feel excited about what awaits them. While some of them still have their minds preoccupied with long term care (LTC) stuff, majority of them are more concerned about traveling places that they’ve never been to yet.

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New York happens to be among the big states with the most number of insured residents. Raised to be independent individuals, most New Yorkers are too proud to even imagine receiving care from others, not even their own family.

However tough and full of pride, they don’t ignore the fact that one day they shall be robbed of their youth, strength and cognitive abilities. That triggered many of New York’s baby boomers to invest into a long term care insurance (LTCI) when they were still younger and at the prime of their careers.

New York Long Term Care

Wondering which state has the most expensive nursing homes? New York is next to Hawaii as the state’s average annual rate for a private nursing home room according to Genworth Financial is 9,355.

Although you will definitely receive topnotch care from a New York nursing home, you can’t possibly save up &119,355 in just a matter of three years. Even swellheads who claim that they are expecting 0,000 upon retirement 10 years from now should be weary of New York’s cost of care which is expected to double in 15 years and quadruple in the succeeding five years.

Anybody who has no plans for his retirement in New York is most likely to wipe out his assets in less than two years from the time that he qualifies for senior care. Now senior LTC does not only cover medical care.

When you wake up one morning and you find that you can neither manage to get up from bed nor get yourself to doing what you’re supposed to do in the bathroom that qualifies you for LTC. With a comprehensive LTCI policy, a senior citizen in New York can simply hire a home health aide to assist him with his activities of daily living (ADL). Unfortunately, those who reach old age unprepared are left with no choice but to rely on Medicaid’s average LTC offerings.

New York long term care is worth experiencing not passing up. So start planning now.

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Designating the State Medicaid Agency as a Beneficiary

Posted on October 19, 2011 by admin

The majority of elder law attorneys are very familiar with the Deficit Reduction Act of 2005 (“DRA”); however, I have found that much confusion still surrounds the requirements regarding designating the state Medicaid agency as a beneficiary of a Medicaid Compliant Annuity.

While Krause Financial Services rarely experiences an annuitant predeceasing the term of his or her Medicaid Compliant Annuity, in the rare occurrence of a premature death, if the designation is not correct the results can be detrimental to any remaining heirs.

42 U.S.C. § 1396p(c)(1)(F) states:

(F) For purposes of this paragraph, the purchase of an annuity shall be treated as the disposal of an asset for less than fair market value unless–
(i)  the State is named as the remainder beneficiary in the first position for at least the total amount of medical assistance paid  on behalf of the annuitant under this title; or
(ii)  the State is named as such a beneficiary in the second position after the community spouse or minor or disabled child and is named in the first position if such a spouse or a representative of such child disposes of any such remainder for less than fair market value.

Take for example the following designation: State of Texas for the total amount of Medicaid benefits provided.  What government agency is entitled to collect?  Who is the claim amount based on?

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I always advise providing as specific of a designation as possible, such as: The State of Texas – Department of Health and Human Services for the total amount of medical assistance benefits provided on behalf of the institutionalized individual, namely John C. Smith.  This specific of a designation appears to leave no room for error, or for the State of Texas to use its own judgment as to the claim amount, in the instance where the institutionalized spouse predeceases the community spouse.

Thus, the most appropriate designation, covering all instances, appears to be: The State of Texas – Department of Health and Human Services for the total amount of medical assistance benefits provided on behalf of the institutionalized individual, namely John C. Smith; the primary beneficiary’s claim amount ends on the date of death of the owner, namely Shirley C. Smith.  This designation ensures that the state’s claim amount does not continue to run past the date of the death of the community spouse – typically the owner of the Medicaid Compliant Annuity.

Several other interesting points exist regarding designating the state Medicaid agency as a beneficiary of a Medicaid Compliant Annuity:

When an institutionalized spouse owns a Medicaid Compliant Annuity, the community spouse can always be designated before the state Medicaid agency.
15 post-DRA states* allow for the institutionalized spouse to be designated before the state Medicaid agency in instances where a Medicaid Compliant Annuity is owned by a community spouse.
Two post-DRA states* do not require the state Medicaid agency to be designated as a beneficiary on annuities consisting of tax-qualified funds (i.e. funds from an IRA, 401(k), etc.).

The staff of Krause Financial Services have extensive experience in the appropriate beneficiary designations, and reviews each Medicaid Compliant Annuity application to ensure that the language meets each state’s requirements.  Other advisors may tell you they can “get the same product,” but don’t be fooled – they can’t!  Purchasing a product and obtaining the service you need – and the knowledge behind it, are completely different things.

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Prescription Assistance and Pharmaceutical Deals for Low-Income Seniors

Posted on October 18, 2011 by admin

Millions of low-income seniors struggle financially on a daily basis, trying to make ends meet. Coupled with the exorbitant cost of prescriptions, many other necessities, like nourishing food and medical supplies, fall to the wayside. Fortunately, low-income seniors reliant on their medications have recourse – the majority of pharmaceutical companies offer ‘discount medication’ programs and/or prescription assistance services, provided, of course, that these seniors can prove financial hardship. Though many low-income seniors take advantage of these incredible discount offers, many more are unaware that these prescription assistance programs exist. For eligibility information, seniors should contact the manufacturer directly; however, basic criteria for each savings program can also be found below.

AstraZeneca: For more than 30 years, AstraZeneca has offered a prescription assistance program, and in 2008 alone, AstraZeneca helped over 440,000 low-income seniors and patients fill 2.7 million prescriptions, which amounted to a savings of 0 million (1). To qualify for the AZ and Me Prescription Savings program, individuals must make ,000 or less or a family of four must make less than ,000. Eligibility requirements also stipulate that applicants must have spent or currently be spending 3% or more of their annual income on prescriptions. AstraZeneca offers its prescription assistance program to people without insurance, people with Medicare Part D, and healthcare facilities.

AstraZeneca medicines include CRESTOR, NEXIUM, PRILOSEC, and SYMBICORT, though you can view a full list of medicines here: http://www.astrazeneca-us.com/our-medicines The website also provides a quick questionnaire to help determine eligibility in just a few moments. In addition to AZ and Me, the company also directs low-income seniors and patients to a number of other helpful prescription assistance and savings programs, including ElderCare, Associations of Clinicians for the Underserved, BenefitsCheckUp, Health Resources and Services Administration, Medicare (and My Medicare Matters), Partnership for Prescription Assistance, RxAssist, RxHope, and Rx Outreach.

Eli Lilly: In 2007, Eli Lilly donated more than 4 million in pharmaceutical products to patients and agencies in need around the world (2). With seven prescription assistance programs, Eli Lilly is dedicated to helping patients get the prescriptions they desperately need. Two of the discount medication programs, geared towards low-income seniors, are Lilly Cares and the LillyMedicareAnswers program.

Lilly Cares, in particular, is a patient assistance program that provides access to Eli Lilly products for legal U.S. residents who are uninsured and whose income is less than 200 percent of the federal poverty level. Eligibility is based on inability to pay for prescriptions as well as a lack of third-party drug payment assistance, such as Medicaid or Medicare. To begin receiving prescription assistance benefits, patients must complete an application and have it signed by their doctor. The medication can then be picked up from your doctor’s office. Medications covered by Lilly Cares include CYMBALTA, PROZAC, and ZYPREXA. Please visit www.lillycares.com for more information or to download an application.

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In addition to Lilly Cares, Eli Lilly also offers the LillyMedicareAnswers program, which makes medications more affordable. Eligible program participants should also be enrolled in Medicare. LillyMedicareAnswers covers FORTEO, ZYPREXA, and HUMATROPE, among many. Other eligibility requirements include enrollment in Medicare Part D, income criteria satisfaction, low-income subsidy denial, and signed certification that medications paid for by the LillyMedicareAnswers program will not be claimed as out-of-pocket expenses. Medications are shipped to the patient’s home. For more information on either Eli Lilly prescription assistance program, please call 1-877-RX-LILLY.

GlaxoSmithKline: Bridges to Access, GlaxoSmithKline’s patient assistance program for non-oncology medicines, provides prescription benefits to individuals without any other insurance or third-party payment aid. Bridges to Access allows low-income seniors and patients to enroll over the phone so they can begin receiving benefits the same day. Enrollment is necessary only once per year, though participants must have an ‘advocate,’ usually a doctor, to be eligible. Medicines from GlaxoSmithKline include ADVAIR, FLONASE, IMITREX, PAXIL, and ZANTAC. For a complete list, please visit http://www.bridgestoaccess.com/ProductList

Low-income seniors and patients eligible for or currently enrolled in the Medicare Part D Plan can also receive benefits, though GlaxoSmithKline offers this prescription assistance program through a separate program called GSK Access. Criteria stipulate that you must have spent at least 0 on medications through the Part D plan, are a legal U.S. resident, and your total household income is at or below 250% of the federal poverty level (3). Visit www.gsk-access.com to download an application and enroll.

Merck: The Merck Patient Assistance Program was created to make medicines more affordable to everyone, whether they meet insurance criteria or not. To be eligible for the prescription assistance program, low-income seniors and patients must submit proof of financial and/or medical hardship as well as inability to pay for their prescriptions. Applications are completed only once per year, and if accepted, medicine is provided free of charge. Merck requires that applicants are a U.S. resident, have a prescription for a Merck medicine from a licensed U.S. doctor, do not have insurance or third-party coverage options such as Medicaid and Medicare, and annual household income is less than ,320 for individuals, less than ,280 for couples, or less than ,200 for a family of four (4). Medicines covered by Merck include COSOPT, COZAAR, JANUMET, JANUVIA, SINGULAIR, and TRUSOPT. For more medications that are covered by this program, please view the full list here: http://www.merck.com/merckhelps/patientassistance/whats_covered.html Or, for questions relating to the Merck Patient Assistance Program, please call 1-800-727-5400.

Pfizer: With seven prescription assistance programs, Pfizer offers low-income seniors and patients of all means the ability to get the medication they need. Four in particular, Connection to Care, FirstRESOURCE, The Pfizer Bridge Program, and Pfizer RSVP Program, all provide medications either free of charge to qualifying patients or at reduced costs through reimbursements and appeals. Eligible medications include CADUET, CELEBREX, DETROL, LIPITOR, LYRICA, and ZOLOFT.

Most of Pfizer’s prescription assistance programs require that you have no prescription coverage or are eligible for a hardship exception, meet household income criteria, and are a U.S. resident. To learn more about the programs that Pfizer offers, please visit the Pfizer website (http://www.pfizerhelpfulanswers.com/pages/Find/FindAll.aspx) to download applications and read pertinent program information.

Wyeth: Through the Wyeth Patient Assistance Program, uninsured and/or low-income seniors and patients are able to receive their prescription medications free. Though the prescription assistance program is not usually extended to patients with Medicare (or Medicare Part D), the company will evaluate situations on a case-by-case basis to determine eligibility. To enroll, low-income seniors and patients should obtain and complete an application and privacy authorization form with help from their doctor or healthcare provider, who should also write a prescription for a one, two, or three-month supply, specifying up to three refills. The privacy authorization form should be given to the doctor, and the application and prescription write-up should be mailed to the address provided on the paperwork. Depending upon the circumstances, the medication will be mailed either to your home or your doctor’s office.

For information on the Wyeth Patient Assistance Program, please call 1-800-568-9938 or visit the Wyeth website: http://www.wyeth.com/contact?rid=/wyeth_html/home/shared/footer/Patient/contact_patient_assist.html Eligibility is determined by an individual’s inability to pay for the medications, lack of insurance, annual household income is at or less than 200% of the federal poverty level, sufficient evidence of significant financial hardships, and is a resident of the U.S. or Puerto Rico. Medications covered by the prescription assistance program include EFFEXOR, ENBREL, PREMPRO, NEUMEGA, and RELISTOR.

Taking Advantage of the Programs

Usually, enrollment in any of these prescription assistance programs can be done quickly, and eligible low-income seniors and/or patients can pick up their prescriptions on a regular basis, either at no cost or at a significantly reduced price. Pharmaceutical companies know that many low-income seniors with tight budgets are unable to afford the high costs of their prescriptions, so taking advantage of these deals is not only economical but recommended to stay in the best of health.

Sources

1. http://www.astrazeneca-us.com/help-affording-your-medicines/
2. http://www.lilly.com/responsibility/programs/
3. http://www.gsk-access.com/
4. http://www.merck.com/merckhelps/patientassistance/home.html

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