Every summer the Pennsylvania Bar Institute holds its annual Elder Law Institute, usually in Harrisburg, which is a two day intensive review for elder law attorneys into current issues in the elder law and estate fields. This year was no exception and my daughter, Alisa, and I made our way to the Harrisburg Hilton last week, me for a two day back to back series of sessions provided by national and state experts in the field. Meanwhile Alisa, who is our paralegal, received a well deserved break from her daily routine.
For me this year was an opportunity, among other things, to see what attorneys throughout Pennsylvania and the country are viewing as the results of the One Big Beautiful Bill recently passed by Congress as well as practical information and changes to tax and other laws. The conference did not disappoint.
Here are some of the insights.
- Demographics. Life expectancy today for women averages 81 years, 76 years for men. Some disability is expected to affect those age 75 and older to about 46%. Estimated wealth transfer from the older generation to the next is approximately $30 trillion. The cost of care continues to rise.
- OBBB. The Kaiser Family Foundation, a respected resource in the healthcare field has provided estimates in the area of $860 billion in cuts to Medicaid. The regular increase of federal government to stategovernments relative to federal percentage participation (FMAP) will be eliminated as of January 1, 2026. In short, state governments will need to pick up a greater share of the burden from limited budgets.
- Long Term Care Trends.It was noted that Genesis, a major player in the long term care field, recently filed for bankruptcy. Nationally, some continuing care retirement communities have also filed for bankruptcy although no specific results as to Pennsylvania were indicated.
- Work Requirements. Work requirements for Medicaid recipients age 19-64 are expected to take effect in or about December, 2026 – notably after the Midterm elections for members of Congress. Eighty hours per month would be required with some exceptions. Based on the Georgia experiment it is noted that many if not most of the individuals hoping to continue Medicaid benefits already work. One of the greatest difficulties is the reporting requirement. It is not difficult to see that individuals of very limited means would have difficulty knowing when and how to report every period such as through complicated paperwork or computerized systems. In Georgia the administratively complexity was extraordinarily complicated and also expensive by the state to administer and resulted in few individuals who passed the filing requirements raising questions whether this is an effective way to hold down costs. Also the question of “able bodied” individuals can be an issue. Many individuals, for instance, who have not filed for Social Security Disability may be disabled in fact. Parents may in some instances be excused. Individuals who are denied Medical Assistance due to the work requirement may also be disqualified for the Marketplace which is the reduction in health insurance rates under Obamacare.
- Effective date for Medicaid for new applicants. As of January 1, 2027 Medicaid applications under the OBBB would receive no retroactive coverage. Current practice in Pennsylvania has been that, on admission to a nursing home Medicaid benefits can be granted from the first day of the third month prior to the application – in other words it is not necessary to have a fully completed Medicaid application from the date of admission. This would change and be eliminated, that is no retroactive coverage.
- Redeterminations for Medicaid for Nursing Home Residents. Under current practice Medicaid approval for nursing home residents who have already been approved for Medicaid is once a year. The federal law will require redeterminations every six months, also adding to the paperwork.
- Staffing Requirements. There has been a great deal of work done over the past few years to determine the level of staff needed to adequately care for individuals in nursing homes. The increase in staffing requirements under federal law may not be required until 2034.
Finally, there were several other issues covered in individual presentations over the two-day period. These included changes and exploration of tax laws, health insurance plans, updates to case law, administrative changes. We also discussed determination of capacity and so on. One speaker, in particular, discussed whether, before some provisions of the OBBB take effect there might be time for revisions or planning.
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.
