Retirement News : Seniors : Medicaid nursing home rules may change

Medicaid nursing home rules may change

Date Added: 14-04-2005

CONCORD — A House committee yesterday endorsed a bill that changes rules for seniors who want to rely on Medicaid to pay for nursing home care.

House Bill 691 went through several procedural votes before winning a 13-9 Finance Committee vote. At one point yesterday, it was sent back for another year of work before Republicans pulled it back onto the table for a second vote.

The bill extends the state's look-back period on assets transfers by seniors. The current three years would go to five years on a sale of assets to family members and from five years to 10 years on transfers to trusts.

It also tightens state law that defines who is eligible for Medicaid care in a nursing home so that only the most medically needy are covered.

The bill stems from a Medicaid reform plan Health and Human Services Commissioner John Stephen calls GraniteCare. His wide-ranging plan was to start cutting into the rapid rise of Medicaid costs, which eat up an increasing share of the state budget. At the same time, the federal government has cut Medicaid payments to the state.

The bill will go before the full House next week during a session when it needs to make other major decisions, on school funding and a two-year budget. The first time through the House, the Medicaid bill passed by five votes.

The bill has been stripped of references to the controversial GraniteCare plan. What is left is primarily a means of judging whether a senior has options besides a nursing home, and the more stringent financial review of Medicaid clients.

Before the state can extend its look-back period, it has to obtain a waiver from the federal government. Some states have been waiting more than two years for similar waivers. It also ends the assessment process in two years unless the Legislature acts to continue it.

Rep. Peter Batula, R-Merrimack, Health and Human Services chairman, said the two years give the House time to judge whether the program is working.

"This is meant to save Medicaid for those who need it most, those it was intended to help," Batula said.

The bill is designed to steer people toward home-based and community-based care, and less toward nursing homes. The main tool is a detailed assessment process for all seniors who plan to enter a nursing home. It judges a person's ability to handle daily living activities such as cooking, cleaning, even getting out of bed.

Rep. Neal Kurk, R-Weare, who sponsored the bill, said the assessment will to help seniors make informed decisions about whether to choose a nursing home or a home health care.

"They will be offered options in a face-to-face assessment. We believe that will help seniors make decision more in accord with their wishes," he said.

The Finance Committee raised payments to home and community care providers to help spur more services, he said. "The easiest way to generate services is to pay for them," he said.

The most recent estimates by HHS are that the bill will cut into nursing home admissions next year by 1 percent, about 48 beds. The next year, the reduction would be about 2 percent, or about 96 beds.

Opponents of the bill say there are no clear savings to the state.

Rep. Mary Jane Wallner, D-Concord, said, "We still have no idea of what this will save. Aren't we the Finance Committee?"

Rep. Terie Norelli, D-Portsmouth, argued that the bill hits the middle class, leaving the poor with Medicaid coverage and the rich an option to avoid asset seizure by purchasing long-term care insurance, they argue.

The bill specifies that the state cannot seek reimbursement of Medicaid expenses from a spouse, minor child or a disabled adult child.

For More Information: http://www.theunionleader.com/articles_showa.html?article=53277