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Toby Laping Associates www.WNYCareManager.com
Eldercare News |
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You Need To Know . . . Philosophical Changes in Medicaid by Toby F. Laping, Ph.D., C.S.W. Medicaid is a program that pays for medical care for people who can prove financial need. It is funded by federal, state, and county monies. States have options about how they’ll participate in the Medicaid program even including whether or not to participate, although all states now have Medicaid programs. Federal parameters are established for such things as how much money people may have and still qualify for Medicaid, and within those parameters, state legislatures determine how restrictive they want their programs to be. New York State has traditionally been relatively generous in its selection of where it falls in terms of allowing people maximal resources, income, etc. Proposals have been made in our state’s budget that would significantly change the way we determine financial eligibility and those proposed changes have caused great concern to many who work with seniors. They have their roots in political and/or fiscal considerations and are not necessarily in the best interests of recipients of services. Furthermore, those changes are not necessarily consistent with public policy as we have come to know it in this state. At the present time our state budget is not firmed up. Medicaid is a very significant factor in our state and county budgets, even though much of the cost of Medicaid is supported by Federal funds. It isn’t surprising that there have been efforts to contain costs. Medicaid is serving as a program to finance nursing home care and that’s not the way the program was originally designed. It’s a bad and very expensive fit although it’s the best plan in place right now for people without their own resources. Also, costs of all types of medical care services have increased exponentially and while some providers are dropping out of the system of reimbursement by Medicaid because it’s both too cumbersome and too stingy in payments, Medicaid still has become a major financial drain on state and county budgets. Our legislators have tried to push managed care for Medicaid recipients, the legislators have tried to limit coverage of prescription medications, they’ve lengthened the look-back periods over time. Presently, the State Legislature is considering dramatic changes in Medicaid eligibility such as a look-back period for all Medicaid programs, a more rigorous period of ineligibility for assets that are transferred out of a patient’s name, and a longer look-back period. How one perceives these changes probably depends on a variety of factors including one’s political persuasion, one’s financial health, and how personally one will be affected by the changes. Ultimately these issues challenge basic philosophical questions of health care as a right, of the relationships between generations, and of the depth of the obligation to maintain previously made implicit commitments to recipients of services. Is it reasonable for a parent to want to help a child financially? Is it reasonable for the State and County to cover the costs of nursing home care when a parent has in the past given money to his children? Should children have a financial responsibility for their parents? That idea of children being required to support parents is a concept that we dunked decades ago, but it’s been heard again. These are not questions that easily lend themselves to unemotional analysis but they have been raised and so they must be considered. Right now, our state budget is in flux. Call your state legislator and ask for information on proposed Medicaid rules. Read up and then let your voice be heard. |