Medicaid benefits increase January 1

A number of important Medicaid figures will increase as of January 1, 2012.

Most of the changes are figures that are typically adjusted every January. (Others change July 1, October 1, or at a lesser interval.)

Many reflect a 3.6% cost-of-living increase, the first since 2009.

One change is Pennsylvania’s penalty divisor, which will now be $8,112.13/month or $266.70/day. The penalty divisor is a figure used to calculate how long a Medicaid applicant will be ineligible for making a gift made during the look-back period. It is based on the state’s calculation of the average cost of nursing home care in Pennsylvania.

Figures for the community spouse resource allowance (CSRA) also increased. The new minimum is $22,728 and the new maximum is $113,640.

The monthly maintenance needs allowance (MMNA) has a new maximum figure of $2,841/month. The minimum MMNA gets adjusted in July.

Other new figures affect aspects of Medicaid that are more technical, and are mainly of interest to caseworkers, elder law attorneys, and others who work with Medicaid cases regularly:

Home maintenance deduction:  $720.10 (6 month limit)

Income figure to determine resource limit ($2,400 or $8,000):  $2,094/month

Excess home equity limit: $525,000

All these figures have been added to our complete list of current Medicaid figures, which you can always find on our website.

Are kids liable for Mom & Dad’s nursing home bill?

You may be surprised to learn that Pennsylvania law provides that the spouse, parent, or child of an indigent person has “the responsibility to care for and maintain or financially assist” that person, and that this responsibility applies “regardless of whether the indigent person is a public charge.”

(There are two exceptions. A child is not liable for support of a parent who abandoned the child for 10 years while the child was a minor. No person is liable under this law if there is a financial inability to pay support.)

Before you panic, though, keep in mind that the state of Pennsylvania does not generally bring support actions against family members whose relatives have run out of money and qualify for benefits. (Whether the law would even be enforceable for that purpose is questionable.) Medicaid, veterans benefits, and other public benefits regularly assist in paying for long term care for seniors who lack the ability to pay.

But Pennsylvania’s support law has been used by nursing homes and assisted living facilities to hold family members responsible for the cost of care in certain circumstances.

One important factor is whether Mom or Dad reside in a nursing facility that is certified to receive Medicare or Medicaid reimbursement. Under the federal Nursing Home Reform Act, such a facility may not require someone other than the resident (such as a family member) to guarantee payment. A facility may require someone who has access to the resident’s income or resources to sign a contract to make payment from the resident’s assets, but such a person incurs no personal financial liability.

Facilities that are not certified for Medicare or Medicaid, such as personal care or assisted living facilities, have successfully sought payment from family members. In 2009, for example, Allegheny County Judge Stanton Wettick allowed an assisted living facility to bring a lawsuit against a son of one of its residents for payment under Pennsylvania’s support law. (To read opinion, click here and find page 284.)

Another important factor is whether a family member has signed any kind of agreement to be a “responsible party” (or some similar term) for payment. Such agreements are not always enforced by the courts, but facilities sometimes use them to insist on payment from the signer.

When helping a relative with admission to a long term care facility, be sure you understand your possible liability to help make payments. An elder law attorney can help you review admission contracts and discuss the financial responsibility you may incur.

“Assisted living” in Pennsylvania: terminology confusion ahead

What does “assisted living” mean in Pennsylvania now?

It’s getting harder for consumers to know.

When I have visited assisted living facilities in the past year, I have been struck by the wide variation in the services offered. One place may offer a narrow range of services and expect its residents to be nearly independent, while another may keep residents who require help with most activities of daily living.

New regulations that took effect in the state in January appeared, at first, to offer a solution. Licensed “assisted living” facilities would have to offer certain core services. Facilities would also have to provide, or arrange for, certain “supplemental health care services” which would be “packaged, contracted and priced separately from the resident agreement.” Thus, consumers could compare facilities and prices more transparently.

A licensed facility would also have to meet certain requirements in its physical site, staffing, and training. So if you moved into a licensed assisted living facility, you would generally know what you were going to get.

But the regulations would only apply to a facility that chose to use the term “assisted living” in its name or written materials.

Regulators expected hundreds of facilities to apply but few have, according to a news report. Gary Rotstein of the Pittsburgh Post-Gazette has reported that state officials predicted there would be at least 150 assisted living residences licensed by now, but there are only 10 (with only one in Western Pennsylvania). Since facilities fall under the new regulations only if they describe themselves to consumers using the term “assisted living,” it seems many are choosing to avoid that term and thereby escape the regulatory requirements, the article said.

These developments are a sure-fire recipe for confusion.

Consumers know the well-branded term “assisted living” as a place where a person can receive help with activities of daily living in a home-like setting, instead of going to a nursing home. But where can a person find that service? The 10 licensed facilities cannot possibly serve the demand in Pennsylvania. People will be unsure if what used to be called the XYZ Assisted Living Residence is providing the same service now that it’s called the XYZ Personal Care Residence. Terms like “personal care” are so vague that many consumers may not know what services the facility offers.

When the regulations went into effect in January, it was hoped they would give meaning to the term “assisted living” and help consumers find the services they need. Now it appears the use of that term may become increasingly rare and consumers will be left to wonder what services are offered at which facilities, and where they can find the right mix of help they need.