Category Archives: Maryland Medical Assistance

President Signs 3-Month Extension of NAELA Priorities

February 27, 2019

NAELA Advocacy Update

President Signs 3-Month Extension of NAELA Priorities
Last Friday, the President signed an extension of NAELA’s two top legislative priorities for the year:

• $112 million for Money Follows the Person (MFP)

• Extension of the guarantee that Medicaid’s spousal impoverishment protections will apply to home and community-based services (HCBS) through March 31, 2019.

Both policies were extended for a short-time due to a compromise from the last Congress on how to offset the costs to the federal government. Importantly, no new limits to Medicaid eligibility were included, such as limits to community spouse annuities. NAELA is now working with key members of Congress to pass a multi-year extension of both programs.

For more information go to Money Follows the Person (MFP) and Home and Community-Based Services (HCBS)

Key Elder Law Numbers for 2019: Our Annual Roundup

February 4, 2019

Below are figures for 2019 that are frequently used in the elder law practice or are of interest to clients.

Medicaid Spousal Impoverishment Figures for 2019

The new minimum community spouse resource allowance (CSRA) is $25,284 and the maximum CSRA is $126,420. The maximum monthly maintenance needs allowance is $3,160.50. The minimum monthly maintenance needs allowance remains $2,057.50 ($2,572.50 for Alaska and $2,366.25 for Hawaii) until July 1, 2019.

Medicaid Home Equity Limits

Minimum: $585,000

Maximum: $878,000

For CMS’s complete chart of the 2019 SSI and Spousal Impoverishment Standards, click here.

Income Cap

The income cap for 2019 applicable in “income cap” states is $2,313 a month.

Gift and estate tax figures

Federal estate tax exemption: $11.4 million for individuals, $22.8 million for married couples

Lifetime tax exclusion for gifts: $11.4 million

Generation-skipping transfer tax exemption: $11.4 million

Annual gift tax exclusion: $15,000 (unchanged)

Long-Term Care Premium Deductibility Limits for 2019

The Internal Revenue Service has announced the 2019 limitations on the deductibility of long-term care insurance premiums from income. Any premium amounts above these limits are not considered to be a medical expense.

Attained age before the close of the taxable year Maximum deduction
40 or less $420
More than 40 but not more than 50 $790
More than 50 but not more than 60 $1,580
More than 60 but not more than 70 $4,220
More than 70 $5,270

Benefits from per diem or indemnity policies, which pay a predetermined amount each day, are not included in income except amounts that exceed the beneficiary’s total qualified long-term care expenses or $370 per day (for 2019), whichever is greater.

For these and other inflation adjustments from the IRS, click here.

Medicare Premiums, Deductibles and Copayments for 2019

  • Part B premium: $135.50/month (was $134)
  • Part B deductible: $185 (was $183)
  • Part A deductible: $1,364 (was $1,340)
  • Co-payment for hospital stay days 61-90: $341/day (was $335)
  • Co-payment for hospital stay days 91 and beyond: $682/day (was $670)
  • Skilled nursing facility co-payment, days 21-100: $170.50/day (was $167.50)

Part B premiums for higher-income beneficiaries:

  • Individuals with annual incomes between $85,000 and $107,000 and married couples with annual incomes between $170,000 and $214,000 will pay a monthly premium of $189.60.
  • Individuals with annual incomes between $107,000 and $133,500 and married couples with annual incomes between $214,000 and $267,000 will pay a monthly premium of $270.90.
  • Individuals with annual incomes between $133,500 and $160,000 and married couples with annual incomes between $267,000 and $320,000 will pay a monthly premium of $352.20.
  • Individuals with annual incomes between above $160,000 and married couples with annual incomes above $320,000 will pay a monthly premium of $433.40.
  • Individuals with annual incomes above $500,000 and married couples with annual incomes above $750,000 will pay a monthly premium of $460.50

High-earner premiums differ for beneficiaries who are married but file a separate tax return from their spouse. Those with incomes greater than $85,000 and less than $415,000 will pay a monthly premium of $433.40. Those with incomes greater than $415,000 will pay a monthly premium of $460.50.

For Medicare’s “Medicare 2019 costs at a glance,” click here.

Social Security Benefits for 2019

The new monthly federal Supplemental Security Income (SSI) payment standard is $771 for an individual and $1,157 for a couple.

Estimated average monthly Social Security retirement payment: $1,461 a month for individuals and $2,448 for couples

Maximum amount of earnings subject to Social Security taxation: $132,900 (was $128,400)

For a complete list of the 2019 Social Security figures, go to: https://www.ssa.gov/news/press/factsheets/colafacts2019.pdf

Jason Frank Presses Maryland Senate for “Aging in Place”

January 28, 2019

by Federico Salas, J.D.

On January 17, 2019, the Maryland Senate Finance Committee held a briefing that, among other topics, addressed the Home and Community Based Options Waiver (HCBOW). Jason A. Frank, Esq. specifically discussed the problems with the HCBOW that he expects will be fixed by current proposed legislation that:

  • Ensures that those people who lose Community First Choice services because of aging into Medicare can access the HCBOW and continue to receive services in the community; and
  • Eliminates the 22,000-person HCBOW Registry (waiting list) and serves eligible people who want services directly in the community without first entering a nursing home.

Resources from the Briefing

View the recording of the Senate Finance Committee briefing (presentations on the HCBOW begin at 1:23:00).

Download Mr. Frank’s presentation on Aging in Place (PDF, 24 pages).

Senate Bill 699

This is a summary of SB 699 regarding Maryland’s Community First Choice program:

The Problem

Marylanders who have community Medicaid, including Medicaid Expansion, and get long-term care services through the Community First Choice (CFC) program for as little help as having someone to assist in bathing and dressing at home, will lose all access to services if both: (1) they get Medicare and (2) they have too much income or assets. For individuals in 2019, CFC-Medicaid Expansion enrollees who have a monthly income between $791–$1,396 per month or assets greater than $2,000 are at risk of losing services. The Home & Community Based Options Waiver (HCBOW) program can provide the needed services to Marylanders with disabilities at home, but it has an 8-year, 22,000-person waiting list (“the Registry”).

Currently, there is no way for Marylanders living at home to bypass the 8-year, 22,000-person waiting list and stay at home, except by unnecessarily entering a nursing home. This means that the people who lose CFC when they get Medicare must choose between having to enter a nursing home or go without help for 8 years in order to continue getting the help that they need.

The Solution

Permit certain individuals who are affected, or will be affected, by “the CFC problem” to bypass the 8-year, 22,000-person waiting list in order maintain CFC services WITHOUT having to wait out the 8-year Registry or go through unnecessary and extremely costly nursing home admission just to transfer back out into the community.

Senate Bill 700

This is a summary of SB 700 regarding Maryland’s HCBOW:

The Problem

Most Marylanders who need as little help as having someone to assist them in bathing and dressing—but lack the money to pay for it—must choose between entering a nursing home or going without help for 8 years. The Maryland Medicaid Home & Community Based Services Options Waiver (HCBOW) program can provide the needed services to Marylanders with disabilities at home, but it has an 8-year, 22,000-person waiting list (“the Registry”). The HCBOW has an 8-year-long waiting list because the HCBOW is not required to meet the demand for services.

This year, the HCBOW can serve 5,659 individuals. When the Maryland Department of Health (MDH) readjusts HCBOW program availability every few years, it does not count eligible people on the 8-year, 22,000-person waiting list. In 2016, the MDH actually reduced program availability DESPITE the size of the 8-year, 22,000-person waiting list.

There is no way for Marylanders living at home to bypass the 8-year, 22,000-person waiting list and stay at home, except by unnecessarily entering a nursing home. While on the Registry, registrants are also in the dark for 8 years regarding where they are on the waiting list.

The Solution

  • Require registrants to come off the Registry at a rate that would eliminate the 8-year waiting list within 12 months;
  • Require the HCBOW to meet the projected “demand” for services;
  • Require services to HCBOW-eligible individuals within 30 days; and
  • Provide information for registrants about their exact place on the Registry or when they might expect to receive services.

Aging in (Whose?) Place?

December 11, 2018

Almost twenty years after Maryland established Medicaid “home and community-based services” waiver programs designed to keep older Marylanders and Marylanders with disabilities in their own homes rather than in a nursing home, Marylanders are still unable to “age-in-place.” Maryland continues to underfund the Maryland Medicaid Home & Community-Based Options Waiver, despite the program’s over 22,000-person, eight-year waiting list. Not only are many Marylanders unable to get the services they want and need to continue living at home, Maryland fails to save millions of dollars that can be realized by adopting a strong policy of avoiding unnecessary nursing home admissions.

To find out more, and what your legislators can do about this problem, read Jason A. Frank’s opinion-editorial published in The Baltimore Sun, available online at: https://www.baltimoresun.com/news/opinion/oped/bs-ed-op-1127-aging-place-20181126-story.html.

2019 Spousal Impoverishment and Home Equity Figures Released

November 29, 2018

The Centers for Medicare and Medicaid Services (CMS) has released its Spousal Impoverishment Standards for 2019, confirming the earlier projections of Pennsylvania ElderLawAnswers member Robert Clofine, who based his estimates on the consumer price index for urban consumers for September.

The official spousal impoverishment allowances for 2019 are as follows (we include Medicaid’s home equity limits, which Clofine did not project):

Minimum Community Spouse Resource Allowance: $25,284

Maximum Community Spouse Resource Allowance: $126,420

Maximum Monthly Maintenance Needs Allowance: $3,160.50 

The minimum monthly maintenance needs allowance for the lower 48 states remains $2,057.50 ($2,572.50 for Alaska and $2,366.25 for Hawaii) until July 1, 2019.

Home Equity Limits:

Minimum: $585,000

Maximum: $878,000

For CMS’s complete chart of the 2018 SSI and Spousal Impoverishment Standards, click here.

Kentucky Waiver Case a Win Against Unilateral Executive Authority

September 5, 2018

Advocacy/Public Policy

By David M. Goldfarb and Ron M. Landsman, Esq., CAP

NAELA News

Ron M. Landsman, CAP, Fellow

Low-income Kentuckians won a signal victory last month in a suit challenging the Trump Administration’s attempt to undo Medicaid by administrative sleight of hand. It’s also a big win for Americans concerned about the ability of the executive branch to ignore the mandate of Congress.

A federal district court in D.C., in a suit spearheaded by the National Health Law Program, Kentucky Equal Justice Project, and the Southern Poverty Law Center, ruled that the Secretary of Health and Human Services’ (HHS) approval of a Kentucky waiver to eliminate Medicaid benefits and protections – in the name of introducing Medicaid beneficiaries to life in the private insurance world – violated the Federal Medicaid law. Stewart v. Azar, U.S. Dist.Ct., D.C. Civil Action No. 18-152 (JEB), June 29, 2018.

NAELA joined Justice in Aging, AARP, AARP Foundation, and the Disability Rights and Education Defense Fund with an amicus brief supporting the plaintiff’s motion.

The suit was brought by 15 Kentucky Medicaid beneficiaries who feared losing their benefits. The suit was originally against the Secretary of the Dept. of Health and Human Services; Kentucky intervened as a defendant.

National Academy of Elder Law Attorneys

David M. Goldfarb

The suit challenged the HHS Secretary’s approval earlier this year of a Kentucky Medicaid “waiver” proposal to “comprehensively transform” its Medicaid program to look more like commercial insurance. It would have imposed a combination of news limits, including work and reporting requirements, elimination of retroactive coverage, increases in premiums, limits on non-emergency medical transportation, and a 6-month lock-out period for beneficiaries who made procedural errors.

The factual basis to the district court’s decision was the program’s own assessment that the changes would cause around 95,000 low-income Kentuckians to lose Medicaid coverage.

The decision turned on whether a proposal that reduces coverage can promote the Act’s objectives since, to win approval, a waiver must be an “experimental, pilot, or demonstration project” that “is likely to assist in promoting the [Act’s] objectives.”

The court held that it could not. The objective of the Medicaid program was to provide health care to people, including specific medical services, and the agency’s failure to assess and explain how a reduction in the Medicaid population would promote that fundamental objective was fatal.

The state sought to avoid that attack by saying the waiver would promote health, rather than provide health services. It claimed that its proposals would improve “health outcomes” by addressing “behavioral and social factors” that affect health, “incentivize beneficiaries to engage in their own healthcare,” and familiarize them with what they would encounter in the commercial market “and thereby facilitate smoother … transition to commercial coverage.” The plaintiffs attacked the assumptions that supported the connection between less Medicaid coverage and fewer services, on the one hand, and better health outcomes, on the other, but the court said it need not enter that thicket:
[T]his focus on health is no substitute for considering Medicaid’s central concern: covering health costs. While improving public health and health outcome might be one consequence of “furnishing … medical assistance,” the Secretary cannot choose his own means to that end.

Slip op. at 44.

This error in defining and addressing the fundamental purpose of the Act exposed the Secretary’s approval to review under the arbitrary and capricious standard, which requires that an agency “examine the relevant data and articulate a satisfactory explanation for its action including a rational connection between the facts found and the choice made.”

The United States sought to argue that the Secretary could be allowed to redefine the objective of Medicaid, “furnishing medical assistance,” to the more amorphous “promoting health.” That is, the court held, “little more than a sleight of hand.” The focus on promoting health “is no substitute for considering Medicaid’s central concern: covering health costs.”

According to the Court, “the Secretary’s interpretation here runs counter to the statute’s plain text, its structure, and legislative history.” Thus, it is not entitled to deference, because interpretation cannot fall “outside the bounds of reasonableness.”

Given the Secretary’s misdirected attempt to redefine the purpose of the Medicaid statute, he did not bother to inquire into the impact, let alone the promotion of health care coverage. Approving the Kentucky waiver was thus arbitrary and capricious.

The court rejected other arguments seeking to circumvent the “purposes” argument, for example, that some of the 95,000 might get coverage in other ways. There was neither analysis or discussion of such rationales, so that they could not salvage the Secretary’s approach.

It is likely the United States will appeal the ruling, but for now, it is a major setback for the Administration and those states seeking to impose eligibility restrictions and benefit cuts contrary to the will of Congress.

About the Authors
David Michael Goldfarb, Esq., is NAELA’s Senior Public Policy Manager. Ron M. Landsman, Esq., CAP, is a NAELA Fellow and former member of the NAELA Board of Directors.

Trump expected to hit Medicaid, Medicare with spending cuts package

May 31, 2018

April 27, 2018

President Donald Trump

President Donald Trump

Congressional leaders say the Trump administration is preparing to propose up to $25 billion in federal  spending cuts, which will hit Medicaid and other safety net programs.

The so-far unreleased White House plan would call on Congress to rescind funding already enacted, and it would be submitted next month, Reuters reported Thursday.

Rep. Tom Cole (R-OK) told reporters the administration was originally considering $60 billion in mid-year cuts. He said the president’s team is considering slicing mandatory adjustments that “Democrats probably wouldn’t like.” Mandatory programs include Social Security, Medicare and Medicaid.

Those cuts would be unrelated to a two-year budget deal enacted in February as the federal government approached its third shutdown of the fiscal year.

But they align with Trump’s previous budget proposals, which both called for reducing mandatory program spending — including slashing $800 billion from Medicaid over 10 years.

Cole and other senior House Republicans warned the White House against rescinding money from Democrat-backed programs while largely sparing Republican priorities such as defense.

Cuts could be politically damning as midterm elections near, some observers believe.

On Thursday, the head of the Democratic Congressional Campaign Committee told Bloomberg Law that Democrats plan to make healthcare a central theme during this fall’s races.

Those comments focused on efforts to attack Republicans for their efforts to repeal Obamacare. But Republicans have noted in the past few months that 2018 would not be the time to tackle entitlement reform, possibly because of the popularity of Medicare and Medicaid benefits among many voters.

Senate Majority Leader Mitch McConnell (R-KY) has has said he is opposed to reopening the fiscal 2018 budget.

Trump Signs Order to Require Recipients of Federal Aid Programs to Work

May 1, 2018

Source: ELA news

The order that President Trump signed on Tuesday is directed at Medicaid and other low-income assistance programs across the government, but many of its changes are already underway. Credit Doug Mills/The New York Times

President Trump quietly signed a long-anticipated executive order on Tuesday intended to force low-income recipients of food assistance, Medicaid and low-income housing subsidies to join the work force or face the loss of their benefits.

The order, in the works since last year, has an ambitious title — “Reducing Poverty in America” — and is directed at “any program that provides means-tested assistance or other assistance that provides benefits to people, households or families that have low incomes,” according to the order’s text. Continue reading

Nursing Homes Acting As Authorized Representatives for Medicaid Applicants Lack Standing

May 1, 2018

Source: ELA news

A federal district court rules that nursing homes acting as authorized representatives for residents whose Medicaid applications were denied do not have standing to sue the state on the residents’ behalf. Communicare, LLC v. Dungey (U.S. Dist. Ct., S.D. Ohio, No. 2:17–cv–934, April 12, 2018).

Three nursing home residents in three different Ohio nursing homes applied for Medicaid. The residents were all incapacitated, and the nursing homes acted as their designated representatives. The authorized representative forms empowered the nursing homes to initiate an application for Medicaid benefits and take action necessary to establish eligibility for Medicaid. The state denied all three Medicaid applications. Continue reading