"The System"

A blog about government programs, with a focus on Medicaid.

[akochis-blog]

Long Term Care

Long Term care, also known as “Chronic Care” or “Nursing Home Care,” is an chartered territory for many people. In my experience, most people don’t know anything about this type of need - until the need becomes their own. Long term care can be scary in and of itself, despite having to worry with how to pay. It’s also very expensive, averaging over $30,000 per month in many states. In all cases, your loved one will need a pay-source (or pending pay-source, such as Medicaid), before they’ll even be considered by a facility.

Medicaid for Long Term Care doesn’t only pay for placement. It also helps to pay to keep people in their homes, safely, through home healthcare solutions.

It’s the overwhelming fear of the unknown, and ancient myths & rumors, that often make this process the most freighting. Families often resort to hiring an attorney for guidance. Unfortunately, in many cases, attorneys can be a bit of overkill. The reason I say this is because most people assume the state will just “take everything away” and that an attorney can somehow keep that from happening. In reality, there are very few cases where an attorney can actually make these little miracles happen. That being said, if you’re one of those families who truly needs an attorney... then you probably shouldn’t be considering Medicaid to begin with.

Info. to help you on your journey:

Resource limits and allowances are much different then community Medicaid; the two Medicaid programs are often confused.

If you’re married, your home is not a resource - as long as it’s your primary residence.

Your spouse will be have an allowance - money to live off, that is.

You will be allowed to have some money in the bank.

You are allowed to have life insurance.

You can own a pre-paid burial.

Your retirement, annuity, or other investment may qualify to be counted as income, rather than a resource.

Most importantly: the government does not take your things away. Despite all the rules and jargon, you still have some say in how your affairs are handled - including whether or not you want to receive Medicaid assistance.

I encourage any family who is going through this process to do their research online. There is a lot of information available - just go to your state’s website and search. Ask your assigned caseworker many questions - and don’t be afraid to ask for copies of the regulations that state the information/answers that your caseworker gives to you. 

Here is some more great info:

[akochis-blog]

Medicaid is BOOMING!

Since October, 3 million people have enrolled into Medicaid, according to Federal Data released earlier this month. The majority of this increase is seen in states that have expanded Medicaid: 

Oregon ------------ 34.8% West Virginia ---- 33.5% Vermont ---------- 32.2% Colorado --------- 22.8% Washington ----- 22.5%

Enrollment in states that have expanded Medicaid has increased an average of 8.2%, compared to 1.6% in other states. Despite these increases, the federal government exchange sites are suffering many glitches - one of the largest being timely transfer of data to states. So, if you’ve applied for Medicaid through the government website it may be several weeks before the state receives your information to process your case.

[akochis-blog]

We Have Fewer Uninsured Americans

Thanks to Obamacare??

Lots to consider here… as this is a highly debated conversation. Arguments aside, I think that we can all agree that the decrease in uninsured Americans is pretty phenomenal. It’s such a big deal that it’s been all over the news!

Since 2008, the percentage of uninsured Americans has droppedIn 2008, there were approximately 15% uninsured and today it’s estimated to be just under 12%. However, it’s important to note that the number of uninsured between 2008 & 2013 increased to as much as 18%. . In the first quarter in 2015, the number of uninsured has dropped 1% over fourth quarter 2014. So the decrease we’re seeing today is actually much more significant, based on those figures.

What’s even more interesting is that this overall decrease is weighted heavily on states that have expanded. In other words, if all states had expanded – it’s possible that the number of uninsured could be as low as 8-10%. According to the Huffington Post, an “analysis published by the department last month estimates that 16 million fewer Americans are uninsured because of the Obamacare coverage expansion, including the exchanges and Medicaid.” Note: the last part of that quote… “BECAUSE OF THE OBAMACARE COVERAGE EXPANSION, INCLUDING THE EXCHANGES AND MEDICAID.”

“Were more states to expand Medicaid under Obamacare, the uninsured rate would fall more sharply, as it did in Indiana earlier this year. Previous surveys showing state-by-state numbers illustrate that Obamacare's effect on the uninsured is diminished by states' refusal to expand Medicaid.” (Jeffrey Young)

http://www.huffingtonpost.com/2015/04/13/uninsured-rate-obamacare_n_7043534.html

[akochis-blog]

Medicaid Fraud

Medicaid fraudcomes in many shapes and sizes. One of the most common forms of Medicaid fraud comes directly from the recipient, who has given false (or misleading) information about themselves – in order to obtain Medicaid benefits. For this reason, there are many checks and balances in place, starting with using verifications like: homeland security, INS, IRS, Social Security, and MVA records (to name a few). These systems make it a little harder – yet not impossible – to fraudulently obtain Medicaid.

But… what about other types of Medicaid fraud?

I’m talking about providers who fraudulently bill for Medicaid services. There is a story in recent news about a scam in New York City – where, not one but, a ring of doctors and at least one clinic owner did just that. They targeted the homeless population by offering free shoes or boots in order to lure them to clinics to receive services. There, doctors saw these patients and allegedly misdiagnosed, ordered unnecessary tests and/or medical equipment, along with reoccurring medical visits.

This group of people have claimed thousands and thousands of dollars of Medicaid dollars, which (ultimately) affects everyone! Thankfully, one of the victims came forward to the district attorney after being misdiagnosed and told she needed a knee brace. When the patient refused the knee brace she was told she couldn’t have her “free shoes” unless she took the brace.

http://www.nytimes.com/2015/04/01/nyregion/9-new-york-doctors-indicted-in-medicaid-fraud-using-homeless-patients.html?ref=topics&_r=0\

[akochis-blog]

Are Tax Subsidies a Goner?

The Advanced Premium Tax Credit (APTC) is a federal subsidy used to assist qualifying individuals and families obtain health insurance by reducing the monthly premium amount in order to make health insurance affordable.

Currently, advanced premium tax credits are enabling countless Americans to afford health insurance, through government subsidies. However,  The law behind advanced premium tax credits is being challenged [King vs. Burwell], based on the wording of the law - which implies that the premium tax credits are only available to citizens who purchase insurance through exchanges established by the state. Key Words: exchanges established by the state.

If the courts rule in favor of the plaintiffs, millions of Americans will be effected. These people in federal exchange states will no longer qualify for subsidies and cost for mandated health insurance will rise!

Watch the story below for details.

[akochis-blog]

Are you Eligible?

Determining eligibility is a science and, when correctly done, is very precise. You don’t need to be a caseworker to figure it out; youjust need to understand how Medicaid works and where to get the updatedinformation. Each state has a website; and in most cases you can find forms and standard eligibility guidelines on the website.

Determining eligibility is, typically, done in a few steps.

Step 1: Category

Medicaid eligibility is determined for each person independently – even if they’re part of a family. Different people within the same family unit can be considered different categories, therefore making income & resource requirement different.

Categories are the same for every state, with the most common being:

single/childless couples,

children

adults with children

pregnant women

aged, blind & disabled

Step 2: Resources

Generally, resources are any asset, liquid or not, not including your primary residence and first car. Medicaid Expansion states no longer have resource requirements for regular Medicaid, therefore resources for these states does not need to be taken into account.

However, in states that opted out of expansion – you should check your State’s resource limits.

Note: In most states if you are over the resource limit on the first day of the month then you will not be eligible for that month.

Step 3: Countable Income

Gross Income – Disregards  = Countable Income

Countable income is the total gross income less “disregards” (certain money that is excluded from the total gross income). For the average household, in a Medicaid Expansion state, the standard disregard is 5%. In a state that didn’t expand, it’s approximately $90 per working income per month (or $20 per month for non-working income).

[Note: there are more efficient ways to determine your disregard – some of which may not be offered to you by your caseworker. Caseworkers use the standard disregard – unless you provide enough information for them to calculate your income with alternate disregards. *I will go more in-depth about this in one of my future blogs.]

Step 4: Deeming Eligible

Countable Income – Allowable Income = Excess Income

The allowable income (limit) can be found on your State’s website. If your excess income is more than $0 you are not eligible for Medicaid, unless you are eligible for a spenddown.

[akochis-blog]

The ACA... Oh Boy!

I've been in this business since long before the affordable care act was born. And, let me tell you, it sure does throw afew wrenches into the machine. What I mean is that people are more scared andconfused than ever before. Part of the expectation for each state is to haveoutreach programs. Typically these outreach programs fall on the state; however [often] due to lack of funding, the real burden is on non-profit designated organizations. In other words, the outreach may not be reaching quite as far as it need to. (The Heritage Foundation published http://www.heritage.org/research/reports/2013/07/public-outreach-on-obamacare-cost-of-educating-the-public-on-health-care-reform.)

Government programs are confusing enough; when I talk about the health exchange with my patients, the majority of the time they shut down. It has become so overwhelming, complex, and/or political [to them], that I could practically watch their blood pressure rise.

But, honestly - have you ever tried to navigate the system before? Even as an experienced advocate I still, occasionally, run into brick walls.

Last year I saw issues in almost half of the states that I work; the concerning part is that it wasn't just technical issues I encountered. Caseworkers were actually giving the wrong information to the public. People were being wrongfully denied and many people had no idea they'd have won on an appeal. I was utterly shocked how many left feet government workers were tripping over.

And, more than a year later, state/federal websites still aren't up to date & people are given the wrong information. Not all state exchanges are a failure, as a matter of fact I've worked with several states, including New York and Maryland who seem to be ahead of the game. But, to illustrate an example - watch what is transpiring in Oregon. Keep in mind that fox is infamous for being politically inclined, so you'll need to look past the political innuendos - to the heart of the story. 

In closing, here's a good laugh... this is the John Oliver video referenced above in the news cast. Warning - language.

[akochis-blog]

What the What is with Health Insurance?

Applying for health insurance, including Medicare& Medicaid is not a cookie-cutter process. Each person’s situation is entirely unique, and so each person will have a completely different experience. For many, the process will be simple – complete an application,submit documents needed, get a determination. For others, however, theirsituations are complicated by a disability or high medical bills, or otherfactor that complicates the process. My intention for this blog is to reach those people who need help understanding the complexities of their situation and how to best navigate the system, in order to get the health coverage they need.

I work with people, from all walks of life, every day. My job is to help the uninsured & under-insured find ways to pay their hospital bills or get coverage for their loved ones to find placement. I've been in this business a long, long time. In my experience, if you ask people why they don’t have healthcare, the majority are going to tell you it’s because they “can’t afford it.” Makes a lot of sense; most of my patients don’t have two nickels to rub together, let alone have money to pay a co-pay (or premiums). I’m sure there are a lot of opinions out there about this topic, but how people pay for health insurance and the politics behind it are not going to be addressed in this blog.

Disclaimer: Because I do this for a living I'm a little bias when it comes to knowing the facts about these types of government programs. It has absolutely NO reflection on my political beliefs what so ever - so don't go bashing me on politics. This is NOT a political blog (yuck!). 

To get started, here are a couple of videos to help clarify the differences between Medicare & Medicaid, as well as explain the affordable care act. These videos are, in my opinion, non-bias – which is crucial to this cause.

[akochis-blog]

About Me...

My name is Autumn and I live in Upstate New York. I am a mother of two, 14 & 7 year old boys, and go to school full time - pursuing a bachelor degree in computer science. This blog is a class assignment and I was inspired by the work I do.

I've been in the business of Medicaid advocacy for 7 years, working for a for-profit company. I currently manage a region in West Virginia, but have previously managed regions in New York, Pennsylvania, & Maryland. I also am in charge of my company's designation through the health exchange in all states, including certifying our patient advocates, nationwide, as certified application counselors. I am currently a certified application counselor in over 25 states.

Part of the biggest thing that sets my experience apart from non-profit agencies and county agencies is that my company is for profit. This means that it's my job to know the system better then the state workers do - so that I can help my uninsured patients be approved for Medicaid when they rightfully qualify. Most of my patients are not typically eligible and have been denied in the past; they have a new onset illness that qualifies them for a temporary disability and, in most cases, they need a spenddown because they're over income or resource limits. 

In many states this process also involves the Social Security Disability process - which can be confusing an overwhelming for many people. I have a great track record of success and have had applications approved in as little as two weeks. When most people apply on their own they're denied several times before being approved - if approved at all; and their applications can take over a year... sometimes up to three years.

In addition to all of this, my youngest son was born 4 months premature (Yes, my avatar is his foot and my father's thumb - when he was about 6-7 weeks old!); his medical bill from birth amounted to well over a million dollars. So, even with private insurance, I found myself in the same shoes as my patients. My husband and I needed help paying our co-pay that was almost $300,000. So my experience with these situation started before I became involved in advocacy and is the center of my motivation. 

Thanks for reading! Feedback welcome!