Some Timely Recommendations for Persons on Medicaid
While the country is waiting for results in the United States Senate regarding a current budget proposal referred to variously as a Big Beautiful Bill which could impact large numbers of U.S. Medicaid recipients, current Medicaid recipients may be wondering what actions to take, if any, now regarding their own healthcare. Because we do not know what direction the legislation might take it is impossible to predict whether your case might be reviewed individually. However, if you are on Medicaid now or if you intend to apply here are some suggestions.
This might be done by the person receiving benefits or someone acting on his/her behalf with knowledge and authority to do so.
Review Your Current Information. It may have been some time since the original Medicaid application was filed. There may have been regular reviews, however, conditions may have changed since then. If you were to be required to refile for benefits now do you or your representative have current information regarding your health status, finances and other factors that determined your eligibility?
Research and Know How You Are Receiving Benefits. Medical Assistance may be paying for your care in a Medicaid Certified nursing home. In that case the application was approved and there is typically an annual review and PA Form 162 issued confirming your status. This is standard practice and the practice is unlikely to change. What is most likely to change, if any, is new admissions practice.
Under Home and Community Based Services/Community Health Choices Pennsylvania has some strict requirements especially regarding monthly income for senior applicants. There can be and often is a waiting period even after approval. There are multiple waiver programs with differing income, asset and other requirements regarding age, type of disability, disability status, family size and others. It is a good idea to keep track of the program requirements under which you are receiving benefits. If one program does not fit there may be others.This occurred with the “unwinding” after the COVID 19 emergency period ended. Pennsylvania has an insurance “marketplace” in addition to the federal. It is called “PENNIE.”
Look for Notifications From Providers But Recognize They Also Have Limited Information. No one knows currently how or if the federal legislation will reach final form. It would have to pass through the Senate and then be returned to the House for approval or further modifications. Based on current indications it seems that the bill that passed the House is likely to undergo more, possibly some significant modifications in the Senate and this could happen again on its return to the House if passed in some form by the Senate. Keep tuned. No one knows at this point.
Organizations That Lobby Regarding Your Disability May Be Helpful in Providing Information and Assistance. The National Association of Elder Law Attorneys (NAELA) to which I belong lobbies for continued access to programs including Medicaid and Medicare and for home-based care options. PAELA (Pennsylvania Association of Elder Law Attorneys) to which I also belong is the Pennsylvania chapter for the same. AARP lobbies for Social Security, health security and affordable prescription drugs and will probably give repeated updates.
There are multiple disability organizations.
Your Health Insurance Broker and/or Caseworker Can, Depending on the Circumstance Provide Helpful Information. Many specialized drugs depend on subsidies through the Affordable Care Act. Your healthcare provider and experienced health insurance brokers may be helpful here. Regarding caseworkers it has been the experience of our office that dedicated caseworkers in some cases have been the means of obtaining benefits to which applicants have been entitled in difficult situations where they have spent extra time and effort to see matters through.
If You Are Receiving Good Coverage In the State Where You Reside Research In Advance of Moving to Another State. For unknown reasons recently I have been receiving a number of inquiries from individuals or their representatives who went through the Medicaid process in other states and are now considering moving to Pennsylvania. In an unsettled time such as this my first impulse is to suggest waiting to move at least until there is a better understanding of the final outcome on Medicaid on the federal and state levels.
This is especially true if the services being received in another state are more than adequate there. There are exceptions especially when family is here and needed.
Recognize We Live In An Unsettled Time. Stay Tuned.
About the Author Janet Colliton
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.