For the past twenty-five years I have been writing about elder law issues -usually on a weekly basis – many of which relate to health care, health care insurance, Medicare, Medicaid, Social Security and similar programs. Over the years as readers might imagine there have been significant changes – Obamacare, for instance, came into effect during this time. A dizzying number of
proposals have been made for significant change some of which include proposed caps, cuts or block grants. Most of us would remember the tug of war involving the
Affordable Care Act (Obamacare) when John McCain cast the deciding vote causing it to remain in effect. U.S. Supreme Court decisions also ultimately resulted in sustaining both Medicaid and the Affordable Care Act. Medicaid, of course, was the older program, instituted in 1965 along with Medicare. The Affordable Care Act/Obamacare expanded eligibility (Medicaid expansion) and provided health insurance options not previously available to many Americans.
Now, as Congress considers what to do to allow for continuation of very large tax deductions that otherwise would expire effective January 1, 2026, Medicaid and Obamacare are once again up for consideration and on the potential chopping block. It is times such as this when we are being asked to consider whether and how important such programs are to Americans and to vulnerable populations including seniors, disabled persons of all ages including young children, and Americans in need of health insurance that might otherwise not be available to them. The answer can decide whether many Americans will continue to receive health insurance of any kind. The percentage of insured Americans has increased dramatically since Obamacare was instituted. One question is whether we want this to continue.
What Does Medicaid Do? Most Americans know that Medicaid is essentially the payor of last resort for seniors and disabled persons in nursing homes. After personal resources have essentially been exhausted and after, in most cases, an exhaustive review of financial transactions over the five years prior to the application has been completed, and after the individual has been certified
as NFCE (Nursing Facility Clinically Eligible – Pennsylvania term) (even if actually at home for Home and Community Based Services – Pennsylvania) and after either being approved for at-home Community Health Choices or admitted to a Medicaid Certified skilled nursing home (Pennsylvania) and approval by the assigned caseworker Medicaid can assume the cost of care. It is not a simple process. Also the number of Medicaid certified nursing homes has not been increasing. Absent Medicaid to contribute to the cost of care it is difficult to see how elderly Americans who run out of funds will continue to receive care unless families assume the cost and burdens of care personally. Pennsylvania, in fact,
has familial responsibility in this regard.
The nursing home process is recognized by most Americans. What we may not know is that Medicaid is also a potential payor for services for disabled children and adults or newborn infants for multiple programs and hospitalizations and other such services.
What would we do without Medicaid? Most of the proposals circulating through Congress do not definitely state they would eliminate Medicaid entirely.
Other criteria or cuts are proposed instead. These include mandating work requirements for recipients, instituting “block grants,” or per capital caps or dramatically lowering the federal share of money that states receive (FMAP).
Work requirements obviously could not be applied to elderly nursing home residents already determined to be disabled. Grandmom would not be told to
leave her bed and work. Then, the question is to whom would these requirements apply? Primarily they relate to people who have received Obamacare by way of
its health insurance features. Sometimes the description is “able bodied” persons. First, I would note that, in my experience, not everyone described as “able bodied”
is, in fact able to go out and be employed. It could simply mean they have not been officially determined to be “disabled.” I wrote a prior column on this
indicating that whether or not you are disabled can depend on which standard is used.
However, we have an actual result from a state that instituted work requirements. Arkansas briefly mandated work requirements in 2018-19. More
than 18,000 people lost Medicaid coverage, primarily because of reporting requirements, lack of communication, technology challenges for persons applying
or attempting to apply.
There might not be an easy answer to balancing the budget but eliminating Medicaid is not a positive result.
Janet Colliton, Esq. is a Certified Elder Law Attorney recognized by the American Bar Assn and Pa. Supreme Court and limits her practice to elder law, estate planning and
administration, retirement planning, Medicaid and special needs, with offices at 790 East Market St., Ste. 250, West Chester, PA 19382, 610-436-6674. She is a member of
the National Academy of Elder Law Attorneys and, with Jeffrey Jones, CSA, co-founder of Life Transition Services, LLC, a service for families with long term care needs.
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.