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5-10-06 Georgia - medical costs, homestead and Medicaid estate recovery

AJC 3.12.06 Congress in 1993 required the states to recover the assets of Medicaid patients after their deaths, as part of an effort to cut soaring costs. But some states have been slow to comply. Georgia and Michigan are the last to do so….

AVOC - The Legislature recently raised the exemption to $00,000 and removed the provision for retroactivity.   That is good.  There is some concern that the Feds may not go along with the higher exemption.

 

Medical care and expenses is a wider problem than we realize.  With the steep climb in health insurance premiums, more and more middle class folks are having trouble coping.

 

This is a serious problem in the United States.  It needs reasoned leadership and not political demagoguery.   Unfortunately, neither Democrats nor Republicans are being statesmen about it.  Meanwhile it just gets worse and worse.  A day of reckoning is coming……

AVOC

 

May 7, 2006

 

Georgia - medical costs, homestead and Medicaid estate recovery

 

By Wendell Dawson, Editor, AVOC, Inc.

 

In my private law practice, elderly law and estate planning are frequent issues.  Many families struggle with the cost of long-term nursing home expenses.   Several years as a private pay nursing home resident can exhaust life savings of many folks.

 

Until recently, homes and home-places were exempt in consideration for eligibility and as a recoverable asset by Medicaid.  The skyrocketing costs of Medicaid have caused the Federal Government to pressure states to seek asset recovery against the estates of persons who reside in nursing homes.  Georgia was one of the few states that did not seek recovery.

 

The state started talking about moving on this in 2004.   The policy had a couple of provisions that seem harsh to many folks;

 

            1.  Only estates valued at $5,000 or less would be exempt; 

 

            2.  Recovery for retroactive benefits would be sought.

 

This has been a real problem for families who had planned on saving the Homeplace.  Now it has become part of the assets on which the state can claim a lien.

 

There are other provisions about caregivers, dependent relatives residing in the house, Life Estates, Years Support, etc that have a bearing.

 

The Legislature recently raised the exemption to $00,000 and removed the provision for retroactivity.   That is good.  There is some concern that the Feds may not go along with the higher exemption.

 

Medicaid Rules need to be amended to allow for patients to pay on the basis of their means in a blended way.   If you miss a cutoff by a few dollars, you are not eligible.  A part payment would be better than exhausting all assets and becoming completely covered by Medicaid.

 

Medical care and expenses is a wider problem than we realize.  With the steep climb in health insurance premiums, more and more middle class folks are having trouble coping.

 

This is a serious problem in the United States.  It needs reasoned leadership and not political demagoguery.   Unfortunately, neither Democrats nor Republicans are being statesmen about it.  Meanwhile it just gets worse and worse.  A day of reckoning is coming……

 


3-15-06 Medicaid to go after home of nursing home residents

 

The Atlanta Journal-Constitution

http://www.ajc.com/news/content/business/stories/0312bizestate.html

 

March 12, 2006

 

Medicaid will go after assets
Homes may be sold to reimburse the state

 

Mary Brandenburg has lived in a Monroe nursing home for seven years, paid for by Georgia's Medicaid program. But unless her family removes her from the facility or finds another way to pay for it by April 14, the cost of her care since August 2001 will be collected from her estate after she dies.

 

That could amount to more than $50,000 — more than her home, her only asset, is worth, her son Pat Brandenburg says.

 

Mary, 85, who has Alzheimer's, is among 40,000 Georgians who have received letters from the state telling them it will launch the asset collection program, called estate recovery, in May.

The program affects Georgians who receive long-term care paid by Medicaid. Those people must quit the program or have part or all of their assets go to the state when they die to reimburse the government for these services.

 

The most controversial piece of the new program is the state's decision to apply the rules retroactively to people receiving services now. Families of nursing home residents say they and their loved ones weren't told their homes would be targeted when they were admitted into the facilities.

 

"An awful lot of people have applied for Medicaid not knowing they'll lose their estates,'' said Becky Kurtz, the state's long-term care ombudsman.

 

Medicare is the main federal health insurance program for the elderly, but it provides only limited coverage for nursing home care. That job often falls to Medicaid, which covers the poor and disabled who fall under certain limits on income and resources. With nursing home expenses averaging about $0,000 a year nationally, savings can be depleted fast, and a person can eventually become eligible for Medicaid and its long-term care coverage.

 

Medicaid covers about 80 percent of Georgians in nursing homes.

Congress in 1993 required the states to recover the assets of Medicaid patients after their deaths, as part of an effort to cut soaring costs. But some states have been slow to comply. Georgia and Michigan are the last to do so.

 

States have leeway on how to implement recovery. For example, when Texas launched its program last year, it applied recovery to new patients but exempted those already in the system. Florida, on the other hand, did not exempt people already getting long-term care when it began recoveries in 1994.

 

Fred Watson, president of the Georgia Health Care Association, which represents nursing homes, said neither current nursing home residents nor their families were warned about the potential impact on their homes.

 

In 1998, the state proposed collecting estate money but quickly retreated, fearing a public outcry. Then, in 2004, the state's Medicaid agency approved the program being launched in May.

About 40,000 Georgians on Medicaid receive nursing home care in a typical year.

 

"We are following the law,'' said Julie Kerlin, spokeswoman with the state Department of Community Health. "This is federally mandated. Any lack of compliance with federal regulations jeopardizes [federal] matching funds.''……

 

Nursing home care paid by Georgia Medicaid costs an average of $6,000 a year, so the cost of Brandenburg's care since 2001 would exceed the $25,000 value of the home where her husband, Marshall, still lives, Pat Brandenburg says.

 

So when Mary and Marshall both pass away, under the new rules, Georgia Medicaid would collect the proceeds from the sale of the home to cover Mary's nursing home care — effectively wiping out any inheritance for their family.

 

"Mom and Dad worked a combined 90 years,'' said Pat Brandenburg, a retired police officer. If the state collects the proceeds from their home, he says, "everything they worked for will be gone. They were lower middle-income people.''……

 

Rules debated

 

Consumer advocates and elder law attorneys say Georgia's rules are too harsh.

Ira Leff, another elder law attorney, predicted that some families will choose to take their loved ones out of their nursing homes. "Those patients probably won't get the care they need,'' he said.

 

But Jeff Anderson, chairman of the Department of Community Health, said at a board meeting Thursday that with estate recovery, "We're trying to use Medicaid dollars for those who truly need it.''

 

Georgia's estate recovery program also applies to patients in facilities for the mentally retarded, and to people 55 and older receiving community and home-based services.

 

Going after community care money will discourage people seeking that option, which is less expensive than nursing home care, says Ken Mitchell, AARP Georgia's state director.


5-5-06 Governor signs new Medicaid Estate Recovery Law- $00,000 exemptions for estates

 

The Gwinnett Daily Post

http://www.gwinnettdailypost.com/

 

May 5, 2006

 

Perdue signs bill easing estate recovery

 

By Dave Williams

LAWRENCEVILLE - Gov. Sonny Perdue signed legislation this week aimed at reducing the impact of a new state initiative to recover what taxpayers spend on nursing home patients from their estates after they die.


But whether those changes to Georgia's estate recovery program ever take effect will be up to the federal government.


On May 1, Georgia became the 49th state to put in place an estate recovery plan since Congress passed a law in 1993 requiring states to seek reimbursement for the costs of caring for elderly Medicaid recipients from the estates of deceased nursing home patients.


Rules adopted by the Georgia Board of Community Health last year exempted from recovery the first $5,000 of the value of an estate and made the program retroactive to patients who entered nursing homes in 2001 or later.


But the General Assembly intervened in March by overwhelmingly passing a bill increasing the exemption to $00,000 and getting rid of the retroactivity requirement. Rep. Jeff Brown, R-LaGrange, chairman of the House budget subcommittee with jurisdiction over health care, argued that seniors who entered nursing homes before the state began developing an estate recovery plan shouldn't be subject to it.


"There's an issue of fairness in it,'' Brown said Thursday.


Brown was less enthusiastic over raising the exemption to $00,000. In fact, when the bill was debated on the House floor, he briefly floated a proposal to reduce the exemption to $0,000 before withdrawing it.


House Democrats, however, said they were glad to see the $00,000 figure stay in the bill.
"Those who had loved ones in nursing homes can now have some piece of mind that we have increased the amount or property shielded from confiscation," Rep. Calvin Smyre, of Columbus, chairman of the House Democratic Caucus, said Thursday.


Several advocates for seniors appeared before the community health board three weeks ago to urge Perdue to sign the bill without delay, before the May 1 implementation date kicked in.


But Community Health Commissioner Rhonda Medows said at the time that the federal Centers for Medicare and Medicaid Services probably would not approve a $00,000 exemption even if the governor signed the legislation.


Ann Williams, legislative chairman for the Georgia Council on Aging, said the uncertainty over the bill's fate contributed to many families deciding to pull their elderly relatives out of nursing homes late last month so that they wouldn't fall under estate recovery.


"We were hoping the governor would sign it and get it into the hopper with the federal people, so they could start determining whether the $00,000 (exemption) would be allowed,'' she said.


Julie Kerlin, spokeswoman for the state Department of Community Health, said the agency didn't wait until Perdue signed the bill on Wednesday before submitting the proposed changes to the federal CMS. She said the request went out last week, with the permission of the governor's office.


Perdue spokeswoman Heather Hedrick said the governor is optimistic that the feds at least will approve eliminating the retroactivity requirement. If that happens, she said Georgia's estate recovery program would not apply to any Medicaid expenses incurred before Wednesday.


5-6-06 State Medicaid and Homesteads -Perdue signs estate recovery bill

 

The Georgia Report

http://www.ciprg.com/

 

May 4, 2006

 

Perdue signs estate recovery bill

 

By Tom Crawford

 

Gov. Sonny Perdue gave in to the requests of legislative Democrats and signed legislation (SB 572) that grants a larger exemption to nursing home patients whose property could be seized to pay back the state for Medicaid benefits they receive.

 

SB 572 will increase from $5,000 to $00,000 the value of property – typically a house or farm land that would be passed on to a nursing home patient’s survivors – that would be protected from seizure under the Department of Community Health’s (DCH) estate recovery program.

 

The estate recovery program is a federal requirement and Georgia is one of the last states to implement its version, which went into effect May 1. Democratic legislators attached the $00,000 estate recovery exemption to another Medicaid bill late in the General Assembly session and passed the bill with the support of Republican lawmakers.

 

Ever since the session ended March 30, Democrats had been urging Perdue to sign SB 572 so that senior citizens on Medicaid could pass along more of their estate to their survivors. It was one of the last bills Perdue acted upon prior to the May 9 deadline for signing or vetoing legislation.

 

“People should not have to choose between giving up their homes or giving up Medicaid,” said House Minority Leader DuBose Porter (D-Dublin). “Georgia can do better for our citizens and it was right to increase the amount of property shielded from the Medicaid Estate Recovery Program from $5,000 to $00,000, which is a reasonable approach.”

 

“This was one of the best bills passed all year and I am glad to see the governor sign it into law,” said Rep. Calvin Smyre (D-Columbus). “Those who had loved ones in nursing homes can now have some piece of mind that we have increased the amount or property shielded from confiscation.”

 

The federal government will have to sign off on the increased exemption, and DCH officials have said they do not expect Georgia to get this federal approval.

 

SB 572 also requires the governor to get legislative approval before applying for a Medicaid waiver from the federal government, as Perdue has indicated he will do.


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