Friday, January 24, 2014

Medicaid extension with Obamacare could lead states to come after heirs, even seize homes; unintended consequence of Obamacare provision?

A new wrinkle has occurred in the Obamacare debacle. 
In states that accepted the Medicaid expansion (as federally funded), elderly (but still under 65) persons who sign up for it as a result of the way they buy individual policies under the Affordable Care Act could put their estates at risk of losing their homes after their passing.  In some cases, states could pursue heirs for the deceased person who had used the program.  If an heir was living in the house, he or she could possibly be evicted (after foreclosure) and become suddenly homeless.
The risk is probably mitigated in practice by “look back” rules that prevent people from giving away assets to qualify for Medicaid rules, although that situation is seen more commonly with nursing home stays that conventional medical care.
It could also be complicated in some states (particularly like Pennsylvania) if these states try to enforce their filial responsibility laws (or “poor laws”) against adult children for indigent parents’ bills. 
The problem is covered in a front page story in the Washington Post on Friday January 24, 2014, by Sandhya Somashekhar, link here

In my own case, there was never any use of Medicaid for my mother’s care.  

Wednesday, January 22, 2014

Self-employed people should use retirement products for designed for them

Here's a guide for self-employed people for setting up their own retirement.

It may be a little better for people who actually have employees.

The main options are a Solo 401(k) if you have no employees, a SEP IRA (Simplified Employee Pension), usually if you have no employees, and a SIMPLE IRA, a Savings Incentive Match for Employees of Small Employers.

The link for this report is on "Next Avenue", here.

There is a last piece of advise: don't count on selling your business to retire.

Remember. most taxi drivers are self-employed.  

Thursday, January 16, 2014

NBC's medical reporter Snyderman talks about caregiving her own parents

NBC's medical editor Dr. Nancy Snyderman covered her increasing role for her two living parents, who appear to have moved in to her home in Princeton NJ from Indiana.

The mother is taking care of the ailing father, but now they both need attention.
The family talked about a living will, and the father did not want tube, ventilators, and the like.

The link for the story at NBC is here.

This family seems to have its caregiving well in hand.  And now Nancy has responsible people staying in her home when she works and travels, so that's a plus.  It's better to be a caregiver in your own home than in your parents'.  

Tuesday, January 14, 2014

Virginia will tighten rules on notifications of third-party designees for long term care insurance

Virginia is considering tightening the law controlling how third-party designees on long-term care policies are notified about any changes in policies, especially cancellations.  The new law would require notification by certified mail.   
The AARP reports on a case where John Hancock cancelled a policy after the “father” mistakenly stopped automated payments on the wrong policy, as in this article in the Jan-Feb issue here. The story appears on p. 36 in the printed AARP Bulletin.

The third party designations can be important in states that have filial responsibility laws, as does Virginia.  However, in the particular case reported, the state taxpayers picked up the tab through Medicaid.  Some states, like Pennsylvania, might be stricter in enforcing these laws (May 24, 2012) and so such notification could become even more critical.    

Monday, January 13, 2014

AARP wanrs that Congress could let multi-employer pension funds cut payments even to current beneficiaries

Barry Rand (CEO of the AARP) has an important op-ed on p. 34 of the January-February 2014 AARP Bulletin, “Protect our Earned Pensions”, link here
Rand warns that Congress is reviewing the solvency of multi-employer pension plans, which cover over 10 million Americans.  He warns that Congress is considering allowing these plans to lower payments to existing and current retirees as well as future retirees.  This would be like lowering Social Security Benefits.

Avik Roy had an article in Forbes, “Obama to labor unions with multi-employer pension plans: drop dead”, link here

I’ll have to look for specific legislation in Congress.  Does somebody know the HR number?

Thursday, January 09, 2014

Medicare trips up inpatients with "under observation" classification, forcing copays, denying rehab

Medicare patients admitted to hospitals need to make sure that Medicare classifies them as truly “inpatient” (Part A) and not “under observation”, the two hidden dirty words.  If patients are classified at admission as “observation”, they could be billed for charges (at least for the copays under Part B, for outpatient), sometimes even years later, and might not qualify for skilled nursing care (SNF).
My own mother had two periods of SNF care at facilities in Arlington, VA, once in 1999 after coronary bypass surgery, and in 2009 after a stroke.  Both were fully covered.  But based on this report, I wonder if I could hear about this again.  She passed away at the end of 2010 at age 97, and I am in charge of the estate.
Medicare Supplemental policies have help alleviate this risk.  It’s not clear how Medicare Advantage plans might respond.
The Wall Street Journal had reported on the problem Oct. 19 with an article by Anne Tergesen, here
NBC News reported on this problem tonight.

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Friday, January 03, 2014

Obamacare may help transition from nursing home back to family in Medicaid-supplemented states

States that decided to accept the Medicaid extension with the Affordable Care Act may find it easier to move elderly in nursing homes back into the homes of willing family members, according to a front page story in the Washington Post Friday January 3, 2014 by Tara Bahrampour, “Elderly making transition to elder care at home”, link here.  
The annual average cost throughout the nation of a nursing home stay is about $75000, but it is $110000 in Washington DC.  
My mother spent about $88000 on in-home care during the last year of her life in 2010.
The program for those ineligible for regular Medicaid is called Money Follows the Person.
The article explains that depending on nursing homes to take care of the wave of Alzheimers that is developing will be economically unsustainable.