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The Affordable Care Act and Medicaid by David A. Cutner, Esq. he Affordable Care Act (commonly referred to as “Obamacare”) has been much in the news these days. The legislation itself is very long (over 2,000 pages) and unwieldy, and many of the implementing rules and regulations remain to be determined. Putting aside issues relating to the exchanges and the so-called “individual mandate,” many features of the Act will have an impact on seniors and individuals with disabilities. In particular, those who qualify for both Medicare and Medicaid — so called “dual eligibles” — will see significant changes in the way healthcare and longterm care is provided. Traditionally, long-term care providers licensed by Medicaid were paid on a “fee for service” basis, at rates that were negotiated between Medicaid and the provider. The provider billed Medicaid for the specific services rendered to each patient, and Medicaid paid for these services. Recently, in an effort to control the costs of this hugely expensive program, there has been a shift to managed care, under which providers are paid a “capitated” rate. This means that Medicaid pays a flat amount for each person enrolled in the managed care plan. New York State has entered into a Federal-State
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partnership that mandates the integration of Medicare and Medicaid under the umbrella of one plan. “Dual eligibles” will have all of their medical, health, and long-term care needs covered and coordinated in one all-inclusive plan. This new Federal-State partnership is called the Fully Integrated Dual Advantage demonstration project, or FIDA. Those who are “FIDA eligible” will have to choose a FIDA plan, or they will be passively enrolled if they don’t make a selection. FIDA is mandated for most “dual eligibles” who reside in Queens, the Bronx, Kings, New York, Richmond, Nassau, Suffolk and Westchester counties and who are receiving long-term care. The FIDA plans will be phased in during 2014. Individuals who are not eligible for Medicare, but who have low incomes, may be able to qualify for Medicaid under a simplified procedure until they are 65 years of age. Under the Affordable Care Act, Medicaid eligibility is based on modified adjusted gross income (“MAGI”) as determined under IRS rules. Those who earn less than 138 percent of the federal poverty level will be eligible for Medicaid under a simplified application procedure. Seniors 65 years of age and above will remain subject to Medicaid’s resource and income limits, and the fiveyear “look back” and “penalty period” in nursing home cases. Those who seek Medicaid benefits must continue to comply with the full application process, including all forms and documentation previously required. As the implementation of the Affordable Care Act is likely to be a shifting landscape for some time, it’s best to check with an elder law firm for the current status and requirements of these programs and services – and how to protect your money, income, and property when applying for Medicaid benefits. David Cutner is a founding partner of Lamson & Cutner. He focuses his practice on developing reliable and cost-effective solutions for clients who need long-term care, and who want to protect their assets and income.
REHAB with RESULTS
Page 7 QUEENS CHRONICLE, Thursday, March 20, 2014
LAMSON & CUTNER, P.C.
P & P MEDICAID CONSULTING, INC. Located in Massapequa Park: serving Queens, Nassau, Suffolk, & the entire state of New York.
Shabbos Hospitality Apartment for visiting family members located only a block away Eruv connecting our facility to Kew Gardens Hills, Jamaica Estates/ Holliswood, Hillcrest/ Fresh Meadows & Briarwood
www.tietzjewish.com
718-298-7829
For the latestLIVING news GUIDE visit qchron.com SENIOR • Spring 2014
Centrally located near the Queens communities of Kew Gardens Hills, Hillcrest & Jamaica Estates. Only 20 minutes from Brooklyn, Manhattan & the Five Towns.
Shabbos Elevator
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164-11 Chapin Parkway Jamaica Hills, NY 11432
Daily & Shabbos Minyanim
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We are proud to provide the Jewish Community with high quality Subacute Rehabilitation and Long-Term Care in a newly renovated & completely Kosher setting.
State-of-the-art separate Meat & all Cholov Yisroel Dairy Kitchens under the Vaad Harabonim of Queens
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Our team of therapists utilize the most advanced technology and proven techniques to achieve optimal outcomes.
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social worker/Medicaid liaison. Ann (along with the remainder of the P & P staff) dedicate their time to helping applicants obtain the necessary documentation for completion of their Medicaid process. P & P offers reasonable rates and personalized service for all of our clients. We are available 24/7 for free advice and will handle all of the necessary paperwork in the comfort of your home, or if the client prefers, at our office at: 5071 Merrick Road, Massapequa Park, New York, 11762. Our 24/7 phone numbers are: (516) 541-4770 and (516) 641-7014. P & P Medicaid is dedicated to making the Medicaid process as painless as possible. Many times when a Medicaid application is necessary, prior to visiting us, our clients are under a great deal of stress, so our service is dedicated to easing the stress of the application process. P & P Medicaid Consulting’s fees are reasonable and very affordable. Our fees are normally priced at a fraction of what other establishments would charge for the same service. We have a great working relationship with the Department of Social Services (Medicaid), and most of the nursing home facilities and the home healthcare agencies throughout our service area. Our mission at P & P is to provide quality service at an affordable price; and we pride ourselves on organization, perfection, satisfaction, dedication and professionalism from application through approval and through the process of helping with the services needed.
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P & P Medicaid Consulting, Inc. was established in response to a need by a person or family that required assistance in obtaining Medicaid eligibility for Home Care Services and/or Nursing Home Care & Placement; and at a lower, reasonable rate, which families could afford. P & P Medicaid has rapidly grown, and besides the Medicaid applications, we now also handle: Geriatric Care Management, “Social Security Disability” applications, and “P.R.I. screenings” for nursing home admissions. In addition, P & P Medicaid also completes the documentation process for “NYSARC Pooled Income Trusts,” which allow qualifying applicants to “keep” their “full income,” while becoming “eligible” for “home care” or “community” Medicaid. The staff at P & P has over “thirty” years of experience in the Medicaid/healthcare industry. The office is located in Massapequa, but the staff will happily visit any client at home, or at a medical facility. Paul D. Mertz, who is the President of P & P Medicaid, is responsible for all aspects of the Medicaid application process. On staff, we have a geriatric care manager (Lois Koppleman-Lange), who handles all of our families’ care needs; a registered nurse, B.S.N. (Ann Marie Campbell, who is certified for P.R.I. screenings); Debbie Imperio, who is our friendly and always courteous office manager, and who handles all of our client’s questions and concerns on a daily basis. Ann Doyle is our fully-experienced
At Margaret Tietz Nursing & Rehabilitation Center our goal is to get you back home as quickly as possible.