Category Archives: Maryland Medical Assistance

NAELA Praises House Passage of Bill to Ensure Access to Home Care

July 1, 2019

courtesy of NAELA eBulletin:

The National Academy of Elder Law Attorneys (NAELA) praises House passage of H.R. 3253, the Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 2019, introduced by Reps. Debbie Dingell (D-MI), Brett Guthrie (R-KY), Fred Upton (R-MI), Frank Pallone (D-NJ), Greg Walden (R-OR), Anna Eshoo (D-CA), Peter Welch (D-VT), Kurt Schrader (D-OR), Michael Burgess (R-TX), and Tim Walberg (R-MI).

The legislation extends, through March 2024, funds for the Medicaid Money Follows the Person Demonstration Project (MFP) and the guarantee that Medicaid’s spousal impoverishment protections will apply to home and community-based service (HCBS) waivers.

Medicaid provides the primary coverage for long-term services and supports (LTSS). Unfortunately, its strict means testing and bias toward restrictive institutional settings puts a severe strain on families. Providing spousal impoverishment protections in HCBS settings better ensures that families can stay together while reducing the risk that the spouse will end up poor due to his or her significant other’s disability.

Additionally, MFP allows individuals with disabilities of all ages to voluntarily transition from a nursing home back into the community. Since the program’s creation, more than 88,000 individuals have been able to move out of a nursing home to a less restrictive setting.

“Keeping families together at home in the face of a chronic illness sadly remains difficult in many cases. Unfortunately, too many individuals wind up in an institution against their wishes. That’s why we are extremely thankful for this bipartisan bill to extend Money Follows the Person, which covers transition services out of a nursing home, and the guarantee that Medicaid’s spousal impoverishment protections applies to home and community-based services,” said NAELA President Jennifer VanderVeen, CELA, CAP, NAELA Fellow.

About NAELA
Members of the National Academy of Elder Law Attorneys (NAELA) are attorneys who are experienced and trained in working with the legal problems of aging Americans and individuals of all ages with disabilities. Upon joining, NAELA member attorneys agree to adhere to the NAELA Aspirational Standards. Established in 1987, NAELA is a non-profit association that assists lawyers, bar organizations, and others. The mission of the National Academy of Elder Law Attorneys is to educate, inspire, serve, and provide community to attorneys with practices in elder and special needs law. NAELA currently has members across the United States, Canada, Australia, and the United Kingdom. For more information, visit NAELA.org, or to locate a NAELA member in your area, please visit NAELA.org/findlawyer.

Updated 2019 Spousal Impoverishment Standards

July 1, 2019

courtesy of NAELA eBulletin:

CMCS Informational Bulletin
DATE: May 30, 2019
FROM: Chris Traylor, Deputy Administrator and Director
Center for Medicaid and CHIP Services
SUBJECT: Updated 2019 Spousal Impoverishment Standards

This CMCS informational bulletin provides an update to the 2019 Supplemental Security Income (SSI) and Spousal Impoverishment Standards.

Click here for the complete CMCS Informational Bulletin

‘Medicare for All’? How About ‘Medicaid for More’?

June 3, 2019

On Monday, Washington Gov. Jay Inslee signed the nation’s first “public option” health insurance bill. Other states aren’t far behind.

BY  MAY 13, 2019 AT 9:19 AM

SPEED READ:

  • Washington Gov. Jay Inslee signed the nation’s first “public option” bill. 
  • Similar legislation is pending in 10 other states.
  • Some states may need the federal government’s permission.

Colorado and Washington state both passed legislation in April that could offer a new health insurance option to people who make too much money to qualify for Medicaid but not enough to afford private health coverage.

Most Medicaid recipients pay no premiums, but the idea of letting some people buy a form of Medicaid is gaining steam.

The public option was first introduced in Nevada in 2017 at a time when Congress seemed poised (yet ultimately failed) to repeal the Affordable Care Act and leave millions of people without health coverage. The state legislature passed a bill that would have let anyone buy publicly run insurance. It was vetoed by then-Gov. Brian Sandoval, but similar proposals have since been introduced in states across the country. In addition to Colorado and Washington, legislation to study or start a public option or Medicaid buy-in program is currently pending in Connecticut, Maine, Massachusetts, Minnesota, Missouri, New Hampshire, New Jersey and Oregon.

No state, however, has pushed the proposal further than Colorado, where the bill has been sent to Gov. Jared Polis, or Washington, where Gov. Jay Inslee — a 2020 candidate for president — signed the bill on Monday. The expansion of public health insurance is a key talking point among Democrats running for president — several of whom have endorsed a “Medicare for All” bill in the U.S. Senate.

“It’s a landmark move, and [states] are a great testing ground to see how much the public option can reduce costs,” says Tara Straw, a senior policy analyst for the liberal Center on Budget and Policy Priorities.

According to a survey by the United States of Care, a significant majority of voters — Democrats and Republicans — support Medicaid buy-in. Advocates believe a public option could offer a lower-cost alternative to the health-care marketplace and spur enough competition to lower premiums overall.Critics, including the insurance industry, argue that introducing a public option would force private insurers off the marketplace, resulting in fewer options for care.

“Introducing the concept of a public cure for what is broken in Obamacare seems hypocritical,” Jim Smallwood, a Colorado state senator and insurance broker, told the Associated Press.

No two of the proposed Medicaid buy-in bills are the same.

Minnesota’s would allow people to sign up for Medicaid if they don’t qualify for tax subsidies on the exchange or live in a county with only one plan.

Washington’s will have the agency that runs Medicaid contract directly with at least one privatehealth insurer to offer a “qualified health coverage” plan that meets Affordable Care Act standards on the state’s marketplace. It will expand subsidies to people making up to 500 percent of the federal poverty line, or $62,450 a year, for a single person.

Colorado’s bill, on the other hand, is lighter on details. It directs the state’s departments of Health Care Policy and Regulatory Agencies to draft a public option that would compete with private insurance plans. It’s unclear whether this public option would be sold on or off the marketplace and whether it would offer subsidies. Some say the subsidies are key.

“If you don’t offer tax credits, I don’t think there’s a super good chance for them to be competitive,” says Emily Johnson, director of health policy analysis at the Colorado Health Institute.

Subsidies aren’t the only element of Medicaid buy-in that states would have to decide. There are many other questions surrounding eligibility, benefits and whether the federal government would greenlight their plans. If states want to offer federal tax subsidies, they may need the federal government’s permission to implement Medicaid buy-in. Washington, however, won’t need its approval since the state would contract with a private insurer. While the head of the Centers for Medicare and Medicaid Services, Seema Verma, reiterates that she wants to give states more health-care flexibility, she has publicly lambasted “Medicare for all.”

Colorado’s proposal is due by November. Some observers commend the state’s “pass first,
figure out the details later” tactic.

“It’s a smart approach to complicated policy,” says Straw. “It’s understandable they want
time to figure out what’s going to work best.”

Both Colorado and Washington have a blue trifecta — Democratic governors and majorities in the House and Senate. It’s a level of power that Democrats have only had in Colorado since November.

“This is the year to do stuff like this,” says Johnson. “Also our bill is the study of the state option, not the actual design of the state option, making it a bit easier to pass.”

Legislative Victory for Aging-in-Place in Maryland

May 30, 2019

Credit: Executive Office of the Governor, “Bill Signing” by Patrick Siebert & Joe Andrucyk, May 13, 2019 used under CC BY 3.0 / cropped from original
Standing L to R: Morris Klein, Esq., Jason A. Frank, Esq., Federico Salas, J.D.
Sitting L-R: Maryland Senate President Thomas V. Mike Miller Jr., Governor Lawrence J. Hogan, Maryland House Speaker Adrienne Jones

By Federico Salas, J.D.

On May 13, 2019, Governor Larry Hogan signed into law Senate Bill 699, helping hundreds of Marylanders who receive services at home through Community First Choice (CFC) to avoid losing access to those services once they get Medicare. Beginning July 1, 2019, affected Marylanders will be allowed to apply to the Medicaid Home & Community Based Options Waiver without having to go on its eight-year waiting list or having to go through unnecessary and extremely costly nursing home admission.

Background

Under federal law, Medicaid Expansion coverage ends at age 65, or when the individual gets Medicare (i.e., either enrolls due to disability or turns age 65). In Maryland, if the individual qualified for CFC services through their Medicaid Expansion coverage, this also means that they will lose their CFC services when they get Medicare.

For most, or about 75% of those affected with too much income or assets, the only viable option to resume receiving CFC services is to access the Medicaid Home & Community Based Options Waiver. However, the Waiver currently has a 22,000-person, eight-year waiting list. In addition, prior to Senate Bill 699, the only way to bypass the waiting list was to transition back into the community after a qualifying 30 day nursing home stay while on Medicaid. Thus, for many Marylanders who lost their CFC services after getting Medicare, accessing the Waiver typically meant that they had to first go through unnecessary and extremely costly nursing home admission.

How Do I Know If I Am Affected?

Generally, those that may be affected are Marylanders who both: (1) have or had Medicaid Expansion coverage; and (2) receive or received Community First Choice services at home. In addition, those at risk of losing access to services tend to have monthly incomes of $771 – $1,396 (in 2019)*, or, assets greater than $2,000 (not including the home and one car).

To find out if you or a loved one can benefit from Senate Bill 699, contact your local Maryland Access Point office or the lawyers at Frank, Frank & Scherr, LLC.

*These figures are subject to change annually. Refer to the current income limits for SSI and Medicaid Expansion, respectively.

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.