Though some people are unaware that you can use Medicaid to pay for extended care expenses such as nursing homes or assisted living facilities, even those that are aware often have various misconceptions about Medicaid and its requirements. If you are considering using Medicaid to pay for nursing home expenses, you should always speak to your estate planning attorney first, so you can have any questions answered in detail. In the meantime, let’s take a look at a few of the common misperceptions about Medicaid that many people have.

Myth 1: I have to sell everything to qualify for Medicaid.

This is not true. Medicaid allows you to keep specific assets and still qualify for the program. In particular, Medicaid allows you to keep your personal home. Additionally, Medicaid allows you to keep up to $2,000 of additional assets, and also allows your spouse to keep additional assets if he or she is not applying for Medicaid.

Myth 2: I can give away my assets and still qualify.

This is partially true. Medicaid only looks at the assets you own either individually or jointly with someone else. If you give away your assets to someone else Medicaid cannot count these. However, you must do so outside of five years of applying for Medicaid. This means that if you give away assets in excess of the Medicaid requirements within five years of applying you are not eligible for a certain waiting  period. This five-year “look back” period is often why people come to estate planning attorneys to begin a comprehensive Medicaid plan.

Byrd : Garrett, PLLC is a member of the American Academy of Estate Planning Attorneys.

After the Supreme Court issued its decision on the Patient Protection and Affordable Care Act, each state is now having to decide whether or not it will implement the Medicaid expansion provisions under the law. Opponents of expansion sometimes cite the prospect that Medicaid patients will clog hospital emergency rooms and use them as their primary care facility. However, a new study shows that Medicaid patients do not visit hospital emergency rooms for routine care more significantly than those with private or employer-paid health insurance.

Researchers with the Center for Studying Health Systems, a nonpartisan organization dedicated to researching health care, recently released a study that showed that while Medicaid patients do visit emergency rooms more often than others, they do not use these facilities for primary care.

The study showed that about one in 10 Medicaid recipients used hospital emergency rooms or other emergency care facilities for nonemergency uses. Those on insurer paid or private healthcare insurance programs use the same facilities for non-emergency care needs at a rate of about one out of every 14 patients.

Medicaid is provided primarily to low income people, but is also used by the elderly, children, and those with disabilities. Medicaid recipients were more likely to visit emergency rooms in any previous year, with about 46 out of every 100 doing so in 2008. This is compared to about 24 out of every 100 privately insured patients who visited emergency care facilities during the same year.

The study looked at data acquired by the centers for disease control and prevention’s national Center for health statistics from 2008, the year of the most recently available data.

Byrd : Garrett, PLLC is a member of the American Academy of Estate Planning Attorneys.

In a 5-4 vote, the Supreme Court of the United States issued a ruling that upheld the Patient Protection and Affordable Care Act health reform law. As part of the ruling, the court declared that the individual insurance mandate the law required is constitutional and can go ahead as part of the law. However, the court also stated that the Medicaid expansion portion of the law is unconstitutional as written.

In its decision, seven of the nine justices decided that the federal government cannot compel the states to adopt the expanded Medicaid provisions that the law provides for,  while threatening to remove Medicaid funding if the states do not comply. (The federal government pays for about 10 percent of state Medicaid costs, and removal would leave states with a significant loss of funds to pay for the program.)

The court ruled that the federal government can offer funds to the states and impose conditions with which they must comply if they choose to accept the funds, but it cannot remove existing funds if a state refuses to comply.

Experts have estimated that if all 50 states implement the expanded Medicaid program, an additional 16 million Americans would be covered under the joint federal and state healthcare insurance program. With the court ruling that the federal government cannot require states to participate in the Medicaid expansion, it’s unclear how many of those will not be able to participate, or which, if any, states will choose not to expand Medicaid coverage.

Byrd : Garrett, PLLC is a member of the American Academy of Estate Planning Attorneys.

Though Medicaid fraud accounts for approximately 8% of all the money that the federal and state government spends on the program, a recent audit program designed to curtail fraudulent payments has resulted in more expenses than it uncovered.

According to a recent report issued by the Government Accountability Office, Congress’s nonpartisan investigative body, and audit program begun in 2008 has resulted in about $102 million in auditing expenses even though it only identified about $20 million in fraud or Medicaid overpayments.

The program was managed by the Medicaid Integrity Group, a government organization that hired 10 private companies to conduct various Medicaid audits. Five of the companies were tasked with analyzing state records to identify potential health providers for audits, while the other five companies performed the individual audits. The program lasted between 2008 and February of 2011, conducting 1,550 audits of state records in that time.

The report recently released by the Government Accountability Office stated that about two thirds of the more than 1,500 audits were unproductive, having identified about $7.4 million in Medicaid overpayments. Audits that states conducted in partnership with the federal government found an additional $4.4 million, while 26 audits of individual healthcare providers revealed another $8.1 million in overpayments.

Medicaid fraud continues to account for approximately $60 billion a year in wasted money, and program managers stated that they plan on focusing on joint state and federal audits to help identify fraudulent payments.

Byrd : Garrett, PLLC is a member of the American Academy of Estate Planning Attorneys.

The millions of Americans who’ve lost their jobs in the recession turned to Medicaid at a significantly increased rate, causing states to spend much more money than they had budgeted for. A new study released by the Kaiser Foundation nonprofit group showed that the recent recession increased government spending on Medicaid by about $70 billion between 2007 and 2010.

The Medicaid spending increase represents an average annual increase of about 6.6 percent, far more than the 1.3 percent annual increase states experienced between 2005 and 2006. The Medicaid increase coincided with a sharp decline in state revenues, and is now leading to states making drastic cuts in their Medicaid system.

The economic stimulus package passed by Congress in 2009 provided states with some additional funds to deal with increased costs, but the stimulus funds are no longer available and states are considering new methods for addressing the rampant Medicaid spending. Medicaid already takes up about one-third of the state budget in some states, in almost all states devote at least one-fifth of their budget to the program.

Currently, least 10 states are currently over budget on Medicaid expenditures this year, and 20 others have made significant cuts in their health care spending.

The increase in Medicaid expenditures comes almost exclusively from the rise in the number of people who have applied for Medicaid assistance. This should come as no surprise, as Medicaid is primarily designed to provide healthcare to the poor, and job losses experienced during the recession contributed to the number of people filing for Medicaid assistance. It’s estimated that about 8 million people joined Medicaid from 2007 to 2010.

Byrd : Garrett, PLLC is a member of the American Academy of Estate Planning Attorneys.

A South Carolina state employee has apparently stolen the personal information of about 228,000 South Carolina Medicaid beneficiaries, according to state officials. Christopher Lykes Jr., a former project manager with the South Carolina Department of Health and Human Services, allegedly collected the information, e-mailed it to himself, and sent it to at least one other person. The breach was discovered on April 10th, and the investigation surrounding the problem is still ongoing.

South Carolina officials have sent letters notifying affected patients of the loss of information. The data stolen includes vital personal information such as names, dates of birth, Social Security numbers, addresses, and Medicaid identification numbers. The information is more than enough for someone fraudulently to open a financial account in the person’s name. However, there is as yet no word on whether the information was used in this manner.

Mr. Lykes has been charged with six criminal counts and, if convicted, faces up to 10 years in prison. South Carolina state officials have also begun an investigation into the security protocols surrounding state workers and their access to confidential patient information. This data breach is somewhat similar to a recent security breach that occurred in Utah, wherein the personal information of nearly 1,000,000 Medicaid recipients with stolen by computer hackers located in Eastern Europe.

Byrd : Garrett, PLLC is a member of the American Academy of Estate Planning Attorneys.

Hackers breached a computer server in Utah and stole the personal information of over 780,000  patients in late March. According to the Utah Department of Health, the victims include were primarily Medicaid recipients and patients receiving care under a state program for low-income children. A total of 24,000 files were compromised after Eastern European hackers breached a server when they exploited a computer worker’s weak password.

Originally it was thought that only 24,000 people were affected because the hackers downloaded about 24,000 files. However, that number was greatly expanded after the Utah Department of Health learned that each of those files contained up to hundreds of patient names and associated information.

Information security experts say that there is little the individual patient could have done to prevent this breach of information because the data was stolen from a state server. This type of breach mirrors other security problems where large databases hold information on numerous people. Another such breach occurred after hackers stole credit card information from Global Payments, and Atlanta payment processing service. The hackers stole security information on more than 1 million credit card accounts, and there was nothing in individual card user could have done about it.

Utah Medicaid patients affected by the security breach will receive one year of free credit monitoring to protect against potential identify theft.

Byrd : Garrett, PLLC is a member of the American Academy of Estate Planning Attorneys.

As the Supreme Court weighs the arguments for and against the challenge to the Affordable Care Act, states are weighing what will happen if the court decides to overturn some, or all, of the law. In particular, the court’s ruling on the expansion of Medicaid may have far reaching consequences that include more than just health care protections.

According to a recent story on National Public Radio, Medicaid currently provides healthcare coverage to 1 out of every 3 children. However, the program is still limited in that it is not generally available to people only if they are poor. A Medicaid recipient must also be older than 65, a child, a person with a disability or a pregnant woman.

The proposed expansion of Medicaid under the Affordable Care Act changes this requirement and expands coverage to anyone who meets poverty guidelines.

This is where the court’s decision comes into the equation. The states challenging the health care law say that if they don’t agree to the new provisions the federal government will no longer provide Medicaid funding. Medicaid is an optional program that states do not have to participate in. But, the Supreme Court may decide that programs that provide funds with conditions, such as Medicaid, highway funding, educational programs and child-welfare programs, are coercive. If so, it may change a fundamental way the states interact with the federal government.

Byrd : Garrett, PLLC is a member of the American Academy of Estate Planning Attorneys.

Though it is still almost 2 years away, one key provision of the Affordable Care Act will extend Medicaid coverage to millions more Americans. Under the healthcare reform law passed in 2010, approximately 16,000,000 more Americans will be eligible for the Medicaid safety net on January 1st, 2014.

The expansion allows people with low income to receive Medicaid coverage. Previously, Medicaid was typically restricted to low income parents and children, people with disabilities and the elderly. Under the terms of the new law, anyone that meets household income requirements is eligible for coverage. The requirements state that a person or household must earn no more than 133% of the federally established poverty level.

Currently, that means that an individual who makes about $14,850 per year, or a family of four that earns about $30,650 per year, will become eligible for Medicaid coverage come 2014.

However, the Supreme Court of the United States is hearing oral arguments on a challenge to the constitutional basis of the Affordable Care Act. Experts say that the court will likely issue its final ruling sometime in the summer of 2012.

Even though the constitutional basis is being challenged, several states have adopted the expansion requirements already. Washington, New Jersey, Minnesota, Connecticut, and California, as well as the District of Columbia, have all begun the expanded Medicaid coverage program. The state of Illinois is also set to expand its coverage before the 2014 federally mandated deadline.

Byrd : Garrett, PLLC is a member of the American Academy of Estate Planning Attorneys.

The federal government provides medical coverage to Americans through two programs: Medicaid and Medicare. These programs, although both initiated by the federal government are different in many ways.

Medicaid

Medicaid covers medical expenses for low income individuals of any age. This includes those over 65 who may also be receiving Medicare. In this case, Medicaid can help pay for Medicare costs.

Medicaid, although a federal program, is run by individual states. To be eligible you must be below the income level set by your state. Because Medicaid is intended for poverty level people, coverage is very comprehensive. It can even cover some costs left over from Medicare such as prescriptions and eyeglasses. Medicaid recipients pay little or no co-pays for services received.

Medicare

Medicare is medical insurance for Americans over the age of 65. This program was created by the federal government to help the elderly deal with the high cost of medical care at a time in their life when they use health services the most. You can apply for Medicare, which is federally administered, at your local social security office.

Medicare is withheld from your paycheck and for that reason you are eligible to receive it once you reach 65. Individuals who receive Social Security disability benefits, even if they are under age 65, may also receive Medicare.

There are four types of Medicare: Part A which is basic Medicare, part B which is a little more comprehensive, part C which can be a more costly supplement to part A and B and covers additional services, and part D for prescription drug coverage. Premiums and deductibles are necessary for Medicare depending upon which type you receive. Part A and Part B both require yearly deductibles as well as large copays for extensive treatment. You do not have to pay a monthly premium for Part A but you must for Parts B, C and D.

Byrd : Garrett, PLLC is a member of the American Academy of Estate Planning Attorneys.