The California version of Medicaid, called Medi-Cal, will mandate the enrollment of about 400,000 of its patients in a state-sponsored managed-care plan over the next year.
The plan, designed to help the state cope with rising Medicaid costs, will effect Medi-Cal patients in San Francisco and fifteen other counties. California obtained a waiver from the U.S. Department of Health and Human Services in November 2010 to make the move, which local officials say will save the state approximately $365 million a year.
Other States Consider Managed Care
John Graham, director of health care policy studies at the Pacific Research Institute, said managed care in Medicaid is one method states are considering in order to save costs while increasing access.
“It’s a good idea. Traditional Medicaid fee for service is ineffective, because rates are too low, and the government bureaucrats—federal, state, and county—are not capable of determining the correct price or fee to pay for service,” Graham said. “So we are seeing decreasing access to doctors and medical services for Medicaid recipients.”
Graham says managed care solves some problems within Medicaid, but hardly all of them.
“The advantage to managed care is that the government gets out of price-fixing. Now the devil is in the details, so states are going to have to be sure they have a contract with a managed care provider in a transparent way so that the taxpayers can see who bears what degree of risk in that contract,” Graham said.
Could Improve Care
Managed care could hold promise for improving Medicaid’s outcomes, which lag far behind those of Medicare and private insurance. Research conducted by the American Action Forum’s Michael Ramlet and Carey Laferty found California’s limited experience with managed care in the past decreased hospital admissions for Medicaid enrollees with asthma, and increased the number of diabetics obtaining recommended eye exams over a five-year period.
Graham suggests more consumer-focused solutions could improve these outcomes even further.
“One thing we’re not seeing enough of in Medicaid managed care is consumer-directed care. There are no grounds to say that we should not have a managed care piece for chronically ill people, but you should also have a consumer-directed piece by which the consumer controls some of his own money, and decides how and where to spend that money,” Graham said.
“Medicaid managed care is not a panacea, but if you can get the contract negotiated so the risk-bearing is fair, and if you give some money to the individual, then you can get some leverage,” he added.
By: Loren Heal
Judd Matsunaga of Elder Law Services is a qualified attorney who has helped hundreds of California residents with Medi-Cal Planning. Mr. Matsunaga can be reached for a free consultation by calling 1-800 403-6078.
Nursing homes, ambulance companies, doctors, hospitals, home health care workers and about 100,000 consumers may see their world tilt on Friday when the Medi-Cal insurance system for low-income people transforms into a locally run HMO.
In the works since a 2005 state mandate, the change means a state-conducted system becomes a locally run network with an annual budget of about $300 million. It means as many as about 50,000 Medi-Cal members who haven’t chosen their doctors will be assigned to primary care physicians who will coordinate their care.
Many health care providers worry the change could mean less money and more problems in getting it. But leaders of the transformation say pairing each patient with a clinic or doctor’s office that serves as a medical home means people will be guided to the care they need rather than struggling to find doctors on their own or delaying care until they need an emergency room. State officials said the managed care system will eventually cost as much as 10 percent less than the current system.
“Ultimately, it will improve access to care and outcomes of care and it will reduce the taxpayers’ burden,” said Earl Greenia, CEO of the new system, the Gold Coast Health Plan.
The switch will be thrown Friday. People who qualify for Medi-Cal for doctors appointments, prescription drugs, home health care and other services will be covered by the new plan. Their complaints and concerns will be answered by a 42-person call center in Lexington, Ky.
As of last Friday, about 15,000 people on Medi-Cal had sent in their paperwork choosing a primary care doctor. As many as 30,000 people covered by both Medi-Cal and the federal Medicare program don’t have to submit a new choice.
That means about 55,000 people need to make the selection or they will be assigned to a physician.
“Fifty-five thousand is a big number,” said Dr. Robert Gonzalez, director of the Ventura County, Calif., Health Care Agency, noting people will still be able to choose doctors after Friday. “I believe there’s going to be a lot of settling out over the first two or three months of the program.”
Some observers predict varying levels of chaos with people showing up at the wrong doctor’s office or being told their specialists are no longer covered by the plan. They worry low reimbursement rates mean relatively few patients will see private doctors, meaning more pressure on facilities designed to serve low-income patients.
“When the dust settles it will actually be beneficial for the patients mainly because it will force them to have coordinated care,” said Dr. William Goldie, a pediatric neurologist at Ventura County Medical Center. “Getting to that level is going to be painful and chaotic.”
Gold Coast Health Plan leaders say they expect challenges, not chaos. They say a two-month grace period should mean patients won’t be turned away even if they show up at the wrong doctor. Providers say the same thing.
“We’ll take care of patients and hope that things get sorted out equitably after the fact,” said Mike Lurie, vice president of planning and managed care at Community Memorial Health System in Ventura.
With a few exceptions like group homes for the developmentally disabled, the new plan affects every aspect of health care received by people in Medi-Cal. That means it impacts ambulance companies, hospice care, nursing homes, home health care, outpatient centers and X-ray imaging sites.
“I’m totally confused at this point. Oh, man,” said Dave Merkley, nursing home administrator at Glenwood Care Center in Oxnard, Calif., a few hours after a Thursday conference call designed to end his confusion. He worries a new system could mean delays in the approvals needed for a nursing home to accept new patients. Gold Coast administrators say they hope to deliver the authorizations within one day.
Others expressed little angst.
“I don’t think it’s really going to change anything,” said Wynne Schumacher, director of business development at LifeLine Medical Transport ambulance company in Ventura. “The only thing that will change is where we send our claims.”
By TOM KISKEN
(Tom Kisen is a reporter fort the Ventura County Star in California.)
Judd Matsunaga of Elder Law Services is a qualified attorney who has helped hundreds of California residents with Medi-Cal Planning. Mr. Matsunaga can be reached for a free consultation by calling 1-800 403-6078.
Q: What is Medi-Cal Planning?
A: Medi-Cal Planning is the systematic approach of helping you protect your home and preserve your assets while still qualifying for Medi-Cal benefits. Medi-Cal Planning is especially important to married couples who are unable to qualify for long-term care insurance or who are unable to pay the high premiums. Medi-Cal eligibility is determined by formulas based on the amount of income and resources available to the applicant. Medi-Cal planning involves the purchasing, transferring, conversion and/or liquidation of assets to enable you or your loved one to qualify under Medi-Cal’s test of income and resources.
Due to changes in federal laws enacted in 1996, almost anyone can qualify under Medi-Cal’s eligibility tests by working within the complex rules and regulations of Medi-Cal. Depending on the individual’s specific circumstances and objectives, the details of Medi-Cal Planning may be different from one individual to the next.
The Department of Health Services (DHS) also requires that a Medi-Cal applicant sign a declaration stating that they are aware of the possibility of a “Notice of Spend down”.
The rules which govern Medi-Cal eligibility are complex and change each year. Consulting a qualified Elder Law Attorney before transferring assets is the best course of action to avoid an improper transfer which may result in a period of ineligibility for up to 5 years.
Q: Is our property protected against Medi-Cal claims if all our assets are in a Living Trust?
A: No. A Living Trust does not protect you from Medi-Cal claims. Any non-exempt property owned by your living Trust is subject to Medi-Cal eligibility rules and recovery claims.
Q: How can I protect my assets and still qualify for Medi-Cal?
A: Since a married applicant who requires long-term care is only allowed to keep $2,000, most Medi-Cal plans would involve taking his or her name off of all community property accounts and/or transferring his or her separate accounts to the spouse who is ‘well’. Any excess resources above $2,000 for an individual, or $109,560 for a married couple, may be spent down by purchasing exempt or unavailable assets. Your home can be transferred to anyone of your choosing, not just your spouse, as long as it is an exempt asset at the time of transfer. This should be done as a step-transaction to avoid having the new owners pay unnecessary taxes along and capital gains. It is also possible to transfer income (i.e. pension benefits) to the well spouse.
Q: What is a Durable Power of Attorney?
A: The Durable Power of Attorney is the single most important document for Medi-Cal planning. This document will enable your agent to act on your behalf by implementing Medi-Cal strategies should you or your spouse require long-term nursing care.
Q: If I already have Medicare are my nursing home costs covered?
A: No. Medicare will only pay for skilled nursing care, not “custodial” care. Even then, Medicare usually only pays for the first 20 days. From days 21 through 100, you pay the largest portion of the bill, and after that Medicare stops paying all together.
Q: What assets can I keep while still qualifying for Medi-Cal?
A: You are allowed to keep your home, a car, and all exempt and unavailable assets.
Q: Can I transfer my assets to my family members in order to qualify for Medi-Cal?
A: Assets can be protected, but only in a special way. Medi-Cal has strict rules against improper transfers which result in a period of ineligibility of up to 5 years. Medi-Cal conducts a “look back” to different time periods to determine if any improper transfers have been made. Consult an experienced Medi-Cal Planning Attorney before attempting to transfer assets.
Q: Who can assist me in transferring or passing my assets to my heirs?
A: You should contact an Elder Law Attorney who understands the latest complex Medi-Cal rules and who can help you to both protect and preserve assets while still qualifying for Medi-Cal.
Q: Don’t we have to be living at the poverty level to qualify for Medi-Cal reimbursement of nursing home costs?
A: No. It’s a very common misperception that Medi-Cal is only available to low-income applicants. California residents with substantial assets can qualify for Medi-Cal and have their nursing home paid for by the state if they know how.
Q: Will I have to sell our family home to qualify for Medi-Cal?
A: Your family home is exempt for Medi-Cal eligibility purposes. However, it is most important to know that certain steps must be taken to prevent Medi-Cal from asserting an estate recovery claim against your home to later recover the amount of nursing home bills it paid on your (or your spouse’s) behalf.
Elder Law Services of California has an extensive background in Medi-Cal Planning, Estate Planning and Real Estate Law. They routinely assists those in need of creating or updating their wills, trusts, powers of attorney and other estate planning legal documents. The firm actively keeps their website up-to-date with the latest information and free resources pertaining to Medi-Cal Qualification and Medi-Cal Planning.
Los Angeles, California – May 17, 2010 – Governor Arnold Schwarzenegger unveiled plans last Friday to plug California’s budget deficit by slashing billions of dollars worth of funding for services designed to help the state’s poor.
Schwarzenegger’s budget proposals would see spending cuts of 12.4 billion dollars including the elimination of California’s welfare-to-work program and virtually all child care for low income families. However, thousands of California’s elderly currently in long-term care facilities across the State will not be affected.
Attorney Judd Matsunaga of Elder Law Services of California states that there is still a “window of opportunity” for California residents with long-term care needs qualify for Medi-Cal benefits while preserving their assets and protecting the family home.
Elder Law Services of California has an extensive background in Medi-Cal Planning, Estate Planning and Real Estate Law. They routinely assists those in need of creating or updating their wills, trusts, powers of attorney and other estate planning legal documents. The firm actively keeps their website up-to-date with the latest information and free resources pertaining to Medi-Cal Qualification and Medi-Cal Planning.
Media Contact: Robin Montano, 1-800 403-6078, Robin@ElderLawCalifornia.com
RELATED LINKS
http://www.elderlawcalifornia.com
http://www.juddmatsunaga.com
California residents requiring long-term care or other expensive medical care can get help paying for their healthcare by qualifying for Medi-Cal. Through Medi-Cal Planning with Elder Law Services of California, a person will be able to maintain their accustomed quality of life while preserving their assets, including the family home. Judd Matsunaga of www.ElderLawCalifornia.com is available for a free consultation to discuss your needs and and answer questions about Medi-Cal and Asset Preservation. Call Judd at 1-800 403-6078
The interest of your heirs can be protected through the use of wills and trusts which when properly drafted can also help reduce taxes and probate fees. As an experienced estate planning attorney for more than ten years, Judd Matsunaga of Elder Law Servicies of California can help with the proper legal drafting of wills and trusts.
Listed below are four important aspects of estate planning that can help to preserve the value of your estate and ensure the efficient administration and disposition of your estate’s assets.
1. A will is the begininng of an estate plan and deals with all matters pertaining to the final distribution of your estate’s assets. A will is a legal document that speaks on your behalf upon your demise. Without a will the courts will decide the manner in which your estate’s assets will be distributed – which may not be in accordance with your wishes.
2. A trust is a legal document that can be designed to address any unique situation that you may have in regard to the distribution of your estate assets. For example, a spendthrift trust can be set up to protect the interests of a beneficiary who is not good at handling money. A trust can be set up for the protection and administration of assets for minor children, a spouse or for any other beneficiary.
3. Your estate’s executor will need to know the location of all of your assets and vital documents. A complete and proper record of your assets and vital documents will eliminate the possibility of assets being lost.
4. It is important to understand that most estates are illiquid, meaning that most of the estate’s assets are not readily convertible into cash. For example, real estate, long term financial investments, business interests, rental properties and such might not be easily and quickly sold for cash.
This means that proper funding arrangements need to be made in advance to avoid the possibility that your estate’s valuable assets would have to be liquidated at fire sale prices in order to pay taxes and other estate settlement expenses. These expenses can easily add up to thousands and even millions of dollars for larger estates. A qualified estate planning attorney like Judd Matsunaga can help you plan accordingly to avoid such a situation.
By implementing the above estate planning strategies you can ensure that all your affairs are properly organized and depending on the size of your estate, you could potentially save thousands if not millions of dollars. Your heirs will be relieved that you made all the proper arrangements and that all your affairs were left in order. To learn more on how estate planning can benefit you and your heirs call Judd Matsunaga with Elder Law Servicies of California at 1-800 403-6078 for a free consulation.
“Judd Matsunaga has a gift. He explains complex tax and legal issues clearly. He designed a tax strategy custom-tailored to fit our unique estate planning situation. I’d recommend Judd to anyone with complex estate planning needs.”
J. Beardsley
Judd Matsunaga is an outstanding attorney! He really knows his ‘stuff’. All my questions and fears were answered. Judd is very understanding. He was willing to explain things about Asset Protection that I didn’t understand and he was kind and empathetic. I’m recommending Judd without reservation!
We were tremendously impressed by the way Judd Matsunaga welcomed us and very patiently explained all of the detailed stipulations of a well prepared estate plan. He is very knowledgeable with all the details of the laws in California. We are so grateful for his expert opinions and professional approach in preparing our wills and living trusts, and power of attorney documents.
J. Nolen
I absolutely HATE having to deal with things I don’t understand like taxes and estate planning and that is why it is so important for me to have a professional like Judd Matsunaga to depend on. Judd is a competent and well informed estate planning attorney in Los Angeles, and I have to believe that his knowledge of estate planning law is unsurpassed. Judd is also fun to work with!
E. Nichols