Cuts to Medicaid May Limit Access to Nursing Homes

[TomCADem]

Source: MSN/New York Times

Medicaid pays for most of the 1.4 million elderly people in nursing homes, like Ms. Jacobs. It covers 20 percent of all Americans and 40 percent of poor adults.

On Thursday, Senate Republicans joined their House colleagues in proposing steep cuts to Medicaid, part of the effort to repeal the Affordable Care Act. Conservatives hope to roll back what they see as an expanding and costly health care entitlement. But little has been said about what would happen to older Americans in nursing homes if these cuts took effect.

Under federal law, state Medicaid programs are required to cover nursing home care. But state officials decide how much to pay facilities, and states under budgetary pressure could decrease the amount they are willing to pay or restrict eligibility for coverage.

“The states are going to make it harder to qualify medically for needing nursing home care,” predicted Toby S. Edelman, a senior policy attorney at the Center for Medicare Advocacy. “They’d have to be more disabled before they qualify for Medicaid assistance.”

Read more: http://www.msn.com/en-us/news/us/cuts-to-medicaid-may-limit-access-to-nursing-homes/ar-BBD7kZ8

---

Well, given that a lot of elderly folks watch Fox News, they may not notice or will just blame the left.

[davsand]

1. Medicare covers 30 days of nursing home care.

After that it is either Medicaid or self pay. A LOT of seniors will suffer with this change. They may be the only tRump voters I have even a shred of sympathy for. Maybe...


Laura

[cstanleytech]

4. If they voted for Trump and were of sound mind when they voted then I wont shed a single tear

for them because they would have brought it on themselves just like I wont shed a single tear for anyone that loses their insurance or their childs insurance that voted for Trump because they will have brought it on themselves.

[TomCADem]

12. Listening to Fox, Breitbart or Rush Limbaugh...

...they may not even notice. Or, they will be convinced that its the Democrats who took these benefits away.

[Hortensis]

27. We might weep for some better children they produced.

In fact, some of us here on DU would have our lives blighted and face destitution in old age if the Kochsters succeeded even this far. (Without proceeding to the worst they absolutely intend.) It could take a generation of blighting years for us to turn this giant ship of state back on a prosperous course.

In the meantime, someone would have to take care of relatives who can't take care of themselves. And for a long time families have been getting smaller, and scattering. In many there are only one or two who might be able to take on the burden, and thus be forced to.

Those designated caretakers who would be forced to quit their jobs or cut back on hours to care for relatives (7 times more women than men) generally stop paying into personal retirement savings, and in many cases start drawing from them long before they would have. They won't receive raises that would have enabled them to someday earn higher Social Security benefits. They won't move to a better home in a better neighborhood that could have helped finance their retirement. Some will have to give up their homes (and with that their previous lives and friends) and go live in their dependents' homes that will ultimately be sold for distribution of the estate among a number of people. And so on and on.

And this is just part of a cascade of consequences. THEIR descendants won't inherit even modest estates that might have helped at least maintain the family at its current level of prosperity through this century. They themselves won't be able to help pay for grandchildren to attend college.

If this happened, it would all take place in a meaner, far less safe, lassez-faire world where poverty would be far more prevalent than it has been for a century and thus the consequences more devastating than children of the New Deal are used to imagining. Notably, many young Americans are already hurt by the meaner, less prosperous era conservative policies have embarked us on. Because we failed to protect the widespread prosperity our forebears left us.

[jovibennett]

28. My thoughts exactly

I was thinking the same thing this morning after seeing all these videos of sick kids and parents pleading with their elected officers. I wanted to post the same thing without sounding like a complete ass or sounding like I am blaming the poor kids. But if the parents or seniors put this POSUS in office thinking he would keep his word on insurance or even try to make it better then they have only themselves to blame. They really should have stayed away from the Kool-Aid and did their studying on this POS and follow his life-long track record of NEVER keeping his word, stealing from the poor ( not paying his workers ) and looking out for only him. If they voted for him and now are crying because of what he is doing I have absolutely no sympathy for them at all. Maybe when 2018 and 2020 comes around they will stop and use their head and vote for someone who actually cares about other Americans and what happens to them.

[pnwmom]

10. Actually, Medicare has been covering up to 100 days, with a co-pay after day 20 --

though many nursing homes don't seem to be aware that the Federal law on this changed several years ago.

But you're right -- the cutbacks in Medicaid could have a terrible effect on seniors and others in nursing homes.

https://www.medicare.gov/coverage/skilled-nursing-facility-care.html

[davsand]

17. Not sure what determines that.

My aunt just had to leave the nursing home because the 30 days were up. She's dealing with a spinal issue that physical therapy isn't helping at all. She has a pretty good coverage for most things, but for some reason after 30 days she had to either self pay the full amount or else go home. NO idea what was at work there, but I do remember talking to the social worker after my mom had her quad bypass a few years ago, and they said then that she had 30 days for in-patient rehab PT or else her nursing home insurance was gonna have to pay.

Very scary stuff for this older set.

Laura

[pnwmom]

19. Your aunt was misled. I'm so sorry. This shouldn't still be happening YEARS after the new regs were

put into place.

About 18 months ago I had to fight with my mother's nursing home to allow her to stay beyond the 21 days. They were holding on to the old standard, that said a patient had to be IMPROVING -- and in their opinion, she had "plateaued." The current standard is that if daily rehab is needed to MAINTAIN health status (not deteriorate) then Medicare would pay for up to 100 days (with a co-pay after 20 days.)

So I faxed them a letter along with the Federal regulations and they finally caved. (The new regs are often to their benefit, too -- since the reimbursement for Medicare is higher than for Medicaid.) Two months later, when Mom WALKED out of the nursing home (she was still in a wheel chair at 30 days), the staff stood by the door and clapped for her!

https://www.elderlawanswers.com/medicares-limited-nursing-home-coverage-12131

Nursing homes often terminate Medicare coverage for SNF care before they should. Two misunderstandings most often result in inappropriate denial of Medicare coverage to SNF patients. First, many nursing homes assume in error that if a patient has stopped making progress towards recovery then Medicare coverage should end. In fact, if the patient needs continued skilled care simply to maintain his or her status (or to slow deterioration) then the care should be provided and is covered by Medicare.

Second, nursing homes may wrongly believe that care requiring only supervision (rather than direct administration) by a skilled nurse is excluded from Medicare's SNF benefit. In fact, patients often receive an array of treatments that don't need to be carried out by a skilled nurse but that may, in combination, require skilled supervision. In these instances, if the potential for adverse interactions among multiple treatments requires that a skilled nurse monitor the patient's care and status, then Medicare will continue to provide coverage.

When a patient leaves a hospital and moves to a nursing home that provides Medicare coverage, the nursing home must give the patient written notice of whether the nursing home believes that the patient requires a skilled level of care and thus merits Medicare coverage. Even in cases where the SNF initially treats the patient as a Medicare recipient, after two or more weeks, often, the SNF will determine that the patient no longer needs a skilled level of care and will issue a "Notice of Non-Coverage" terminating the Medicare coverage.

Whether the non-coverage determination is made on entering the SNF or after a period of treatment, the notice asks whether the patient would like the nursing home bill to be submitted to Medicare despite the nursing home's assessment of his or her care needs. The patient (or his or her representative) should always ask for the bill to be submitted. This requires the nursing home to submit the patient's medical records for review to the fiscal intermediary, an insurance company hired by Medicare, which reviews the facilities determination.

SNIP

[LeftInTX]

38. Thanks for this..This is helpful. Will bookmark this thread just for your article.

You know that the BRCA cuts Medicare?

It is on page 29 of the bill:

SEC. 117. REPEAL OF MEDICARE TAX INCREASE.
21 (a) IN GENERAL.—Subsection (b) of section 3101 of
22 the Internal Revenue Code of 1986 is amended to read
23 as follows:
24 ‘‘(b) HOSPITAL INSURANCE.—In addition to the tax
25 imposed by the preceding subsection, there is hereby im-
26 posed on the income of every individual a tax equal to 1.4529
ERN17282 Discussion Draft S.L.C.
1 percent of the wages (as defined in section 3121(a)) re-
2 ceived by such individual with respect to employment (as
3 defined in section 3121(b).’’.
4 (b) SECA.—Subsection (b) of section 1401 of the In-
5 ternal Revenue Code of 1986 is amended to read as fol-
6 lows:
7 ‘‘(b) HOSPITAL INSURANCE.—In addition to the tax
8 imposed by the preceding subsection, there shall be im-
9 posed for each taxable year, on the self-employment in-
10 come of every individual, a tax equal to 2.9 percent of the
11 amount of the self-employment income for such taxable
12 year.’’.

[pnwmom]

39. Let me know if you need any help. I could help you look if you need more info. n/t

[davsand]

43. That is excellent information.. Thank you!

My aunt has not had a lot of family involvement (not even gonna start on that aspect of this!) and as a result she's not had any advocacy beyond what little we can/are allowed to provide her. It's very sad. She's alone except for us, in pain, and drugged to the teeth trying to make decisions. It's a recipe for disaster.

There's an added level of problem here because all of it is getting filtered through what I call "the little old lady grapevine." No matter how many times I explain it, nobody really seems to understand. I feel like I'm speaking Martian some days. My own mom is 87, dealing with her own medical issues, and I can't even let her go to her own doctors alone any more. I am pretty limited on how much I can do for my aunt beyond calling her or giving my mom the information to give her. I've resorted to printing out stuff and sending it to her.

Very scary. I honestly have no idea how anybody can do this on a regular basis.


Laura

[pnwmom]

46. Has your aunt given anyone her medical power of attorney? She should.

It wouldn't prevent her from making the decisions she wants to, but it would allow someone to talk to her care givers without the filter.

[FarPoint]

32. Do we know if Medicaid will pay for Home Care?

Currently it does but I have yet to get clarification if not in nursing home..... I'm thinking it will be determined state by state for Medicaid Home Care.

[virgogal]

42. Medicare now only pays in full for 20 days and

that's only when being released after THREE DAYS as an inpatient in a hospital and the MD considers aftercare medically necessary.

[pnwmom]

47. Right. There's a co-pay after that for a total of 100 days.

But that is better than in the past, when only 21 days were covered at all.

[leftofcool]

2. If they voted for Trump, they did it to themselves

Let their kids and grandkids take care of them.

[pnwmom]

20. This won't just affect the seniors in nursing homes who voted for DT. n/t

[leftofcool]

30. I know.

When the cuts come, kids will just have to start taking care of their parents instead of calling "a place for mom." Those kids who voted fro Trump or wrote in Bernie, or a gorilla, or didn't get off their ass to vote will be screaming the loudest.

[pnwmom]

36. The "kids" of many nursing home residents are elderly themselves -- not in a position

Last edited Sun Jun 25, 2017, 02:55 PM - Edit history (1)

to do the lifting and other physical care that's often involved.

My mother is much happier in a wonderful nursing home than she was living with family half the time and living in her own home the rest of the week, with aides. She loves having peers (even has a boyfriend) and has gained back the 20 pounds she had lost.

She would hate it if she had to leave there. She would be hurt and I would be screaming just as loud as any Trump voter.

[Docreed2003]

3. So the states have the following choices:

1). Pay for elderly care
2). Pay for poor families
3). Pay for the needs of children
4). Pay for the needs of the disabled




That's your choices....and states will be forced to make the same. All states will have to make this choice....which do you choose?

[cstanleytech]

5. #2 and #3 you can roll together often its the disabled and elderly that will suffer the most and be

unable to compensate or fight back.

[virgogal]

44. What's the difference to the consumer if the state or the feds pay for it?

[Docreed2003]

49. The answer is simple...

Right now Medicaid is a joint program run between the states and the Feds. If the fed cuts all funding, states will be forced to allocate funds for the program. How well do you think that will work in red states? People are going to be hurt...the choices I listed are where the impact will be felt.

[dembotoz]

6. Imagine go after kids assets, imagine folks dying at home,

Imagine fewer options for rehab unless odds are good... hospital rehab has stringent goals, nursing home rehab more slowly but how to admit if Medicaid not ultimate funding back stop

Also tons of senior care facilities with move here and then u have a place as u grow infirm....think their business plan just took it in the shorts

[Hoyt]

7. One positive is that the serious cuts don't happen for a few years, at least giving us 2018 and

maybe 2020 to make a difference in Congress and into Presidency, that's assuming these two trash Bills are actually enacted.

[rpannier]

22. My guess is, they won't notice because it hasn't happened yet

and liekly will believe that it will get fixed, so they can still go on doing what they're doing now

[Rollo]

8. Maybe McConnell Care will include free suicide kits for the elderly poor...

[DURHAM D]

9. Nursing homes will start closing down particularly in

rural areas where 60% of the occupants are on Medicaid. Who works in nursing homes??? Mothers, mostly single mothers. Starting pay is $11 - $12 dollars. Most have second jobs. Those second jobs are at Subway, McDonalds - about $8. Their second jobs will become their only job.

Currently 85% of the kids at the grade school down the street are on free or reduced lunches. Soon 100% of the kids will qualify for free lunches. However, I assume that program is also on the chopping block.

Republicans are murderers.

[pnwmom]

11. I think the percent on Medicaid is closer to 70% most places. If they don't start on Medicaid,

they switch when they run out of funds.

[DURHAM D]

14. I know that the biggest nursing home in my area has a cap.

I think right now it is 60%. Some of them around here have a higher percentage and one small facility with 13 beds, 11 on Medicaid, has already closed because the state managed the federal funds and would not pass the money on for months and months. In fact, the only way it stayed open for the final several months is because one of the larger churches and a Kroger store provided all the food. Also, Subway delivered left over bread to them every night.

[pnwmom]

15. That's terrible.

Someone should be suing the state for holding back the FEDERAL Medicaid money. Sounds like the state is trying to balance its budget on the backs of disabled seniors.

[Batship]

24. I couldn't agree more.

They're murderers, pure and simple. And they're proud of it. I can't imagine anything more evil.

[I hope this shows up under the right post. I was replying to DURHAM D, but I accidentally clicked the wrong thing, I think. As you can tell from my post count, I'm new and clueless!]

[FarPoint]

33. There goes the jobs too.

Medical supply companies and small local pharmacies will suffer as medical and medication will not be needed when nursing home closes...

[Thinkingabout]

51. Good point, there will be a loss of jobs.

[Midnight Writer]

13. I think a well done advertisement pointing out that 67% of nursing home fees are Medicaid covered

would gin up a lot of outrage among folk.

Nursing home and home care costs add up really fast. Would break most families.

[TomCADem]

18. Will Fox, Rush and Brietbart Run It?

Also, the Koch Brothers will run ads calling the truth lies on a 3 to 1 basis.

[roamer65]

16. This may be in our future slightly sooner than thought.

https://m.

[SergeStorms]

21. Ahhhh, you beat me to it!

SOYLENT GREEN IS PEOPLE!

Sad to say, there will be a marked increase in the number of senior suicides. The Republicans have ensured a very bleak future for anyone who's not wealthy. Let THIS be their legacy. The party of death.

[Achilleaze]

25. "Under the freaking bus with you gramps & granny" - repubes

[DeminPennswoods]

26. $300/day in a nursing home/SNF private pay

That's what it was 4 yrs ago, over $9,000/mo and 100k/yr. When Mom and/or Dad's money runs out, then the kids will have to start dipping into their own salaries and savings to pony up or care for their parents at home themselves. Although it's not financially motived, I'm watching a friend work a couple jobs and spend half the week at parent's house just to have said parent, who needs to be monitored 24/7, at home. To say nothing of my friend having kids and spouse.

Kids with inheritances in the balance won't like this one bit. I'm sure a lot of my generation and younger are secretly counting on moms and dad's savings to help pay down/pay off their debts.

[Catmusicfan]

29. The whole entire home health industry is destroyed.

Elderly and disabled won't be able to have a level of independence and now not even a nursing home to allow them a small dignity.

Yeah MAGA help to the unemployment numbers.

[Honeycombe8]

31. "May" limit? Well, that's an understatement. Of course it will. Yes, it will.

My sister had a massive stroke in her early 50s such that she had to go to a nursing home. She needed total care that others could not provide. She also needed rehab.

Medicaid helped foot the bill for that. Later, there was a combination of SSI, Medicare, and Medicaid that cont'd to pay for her, as her condition worsened over the decade leading to, finally, death.

What would she have done, if there had been no Medicaid available for her? What would her stay in the home have been like with huge cuts? It was already not very good care.

Our country is now going to cut the already meager funding for nursing homes, home health care, disabled kids? This is so cruel as to shock the conscience. Greed. Pure greed.

[BumRushDaShow]

34. "little has been said about what would happen to older Americans in nursing homes"

What do you think will happen? They will be forced out. THAT is what will happen.

Particularly in those states that continued to enact huge tax cuts for their wealthy and corporations and now find themselves with huge budget holes. Things like Medicaid "go", school funding will "go", road and bridge repairs will "go", state workers will "go", and on and on, while the state spirals into an abyss.

[dalton99a]

35. "All our healthcare money is going to blacks/Mexicans/immigrants instead of OUR senior citizens"

It's OBAMA!

[left-of-center2012]

37. "... blacks/Mexicans/immigrants ..."

And, of course, many Americans are black and Mexican,
and we are all descendants of immigrants.

[Moral Compass]

40. Both of my grandmothers were on Medicaid when they died

Both of my grandmothers were on Medicaid when they died. We did the spend down for my father's mother Nanny. My mother's mother gave me her last shares of IBM stock (which saved my ass as I had spent my student loan money for that semester on "other" things) and then she was able to get on Medicaid.

This cutting of Medicaid doesn't just affect those nasty, worthless poor people--it affects anyone who isn't very wealthy.

Spread the word. The Republicans are trying to surreptitiously screw over pretty much all of us.

Medicare doesn't pay for nursing home care. The chances are close to 100% that you'll be on Medicaid before your life is done.

Again, spread the word.

(By the way, my two Senators are Cornyn and Cruz and my representative is Crypt Keeper Sam Johnson so I won't be spending a lot of time on the phone. The never respond. Their constituents are the corporations and lobbyists that give them money, buy them dinner, and take them on junkets. The rest of us are the sheep that never seem to figure it out.)

[Bayard]

41. Elder Abuse?

I wonder if good attorneys could make this case?

Wikipedia defines it as:

Elder abuse (also called "elder mistreatment," "senior abuse," "abuse in later life," "abuse of older adults," "abuse of older women," and "abuse of older men&quot is "a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person."[1] This definition has been adopted by the World Health Organization (WHO) from a definition put forward by Action on Elder Abuse in the UK. Laws protecting the elderly from abuse are similar to and related to, laws protecting dependent adults from abuse.

The core element to the harm of elder abuse is the "expectation of trust" of the older person toward their abuser. Thus, it includes harms by people the older person knows, or have a relationship with, such as a spouse, partner or family member, a friend or neighbor, or people that the older person relies on for services.

Actually, aren't members of Congress also in positions of trust, to protect the elderly and disabled? People in nursing homes "rely on them for services"?

[John_Doe80004]

45. i didn't read through all the replies

not sure this was mentioned but do they think about the millions of lost jobs in healthcare that will result from these steep medicaid cuts.

my fiance is an RN in skilled nursing and i am disabled and rely on medicaid for my healthcare.

our family would be put out on the street by these cuts and in my case certain death from my conditions!!!

[John_Doe80004]

48. also this is going on in the UK as well

they are attempting to cut benefits to the elderly disabled and poor and are having the same protests as we are here while protests are going unheard by unsympathetic politicians and are being censored form the news.

[PossiblePasts]

50. It isn't easy finding a Medicaid bed in a nursing home now

My Mom fell a few months ago and was hospitalized. She wasn't doing very well (also had C-Diff) so I wasn't sure if she was going to be able to go back to her apartment (in an affordable senior citizen complex). She has Medicare primary and Medicaid secondary.
I started calling around to the area nursing homes to see if they had any Medicaid beds. The nice ones didn't. I can only imagine what it is going to be like in the future.
I worry for her, I worry for my daughter that has special needs. There will come a day when we will no longer be able to carry her as a dependent on my husband's insurance. I don't see her ever being able to live independently.