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July 7, 2005
ANOTHER BAD DAY FOR SENIORS
I am sorry to report that the Community Spouse Resource Allowance (CSRA) and the Transfer of Assets (TOA) provisions were not accepted by the Conference Committee. The Conference Committee Budget omitted these provisions and a host of other items which were included in the Senate Budget but not in the House Budget. The rationale behind these omissions is the request by Speaker DiMasi that policy matters go through the Bill process rather than the Budget.
In a nutshell, the CSRA provision applies to married couples who need to place a spouse in a nursing home. The Medicaid (MassHealth) regulations currently allow them to keep one-half of their countable assets up to $95,100. The change that was requested in the Conference Committee would have allowed them to keep the first $95,100. Example: A family has $40,000, under the current rules they can only keep $20,000 (one-half of their assets). The change that was not accepted would have let them keep all their money. They would be entitled to keep the first $95,000 of their assets.
The Transfer of Asset (TOA) provisions were aimed at something called the Waiver. In August 2003 the Governor requested from the Federal Government a Waiver. If the Waiver were granted, Romney could then ignore Federal Law and make up his own rules for Medicaid. It has been almost two years since the Waiver was requested and still, no answer from the Federal Government. I think this is a good indication that there are some serious problems in what the Governor requested. Last month Governor Rell from Connecticut withdrew her request for a waiver that had been requested over three years ago. It was very similar to what Massachusetts requested.
Other elder issues approved by the Conference Committee, and now included in the budget, are retention of funding for the 10 day bedhold, retention of Score 3 nursing home admission criteria and increased funding for most elder home care programs.
The 10 day bedhold is a provision that allows a nursing home resident to leave the nursing home and still have MassHealth pay the nursing home as if the person was there. A Bill before the Conference Committee had requested that the bedhold be extended to 20 days, it remains at 10 days. This law is important because it allows a nursing home resident to be able to return to his same room if he had to go to the hospital for an operation. This would also allow a nursing home resident who is healthy enough, to be able to go away for a weekend with family to attend a grandson’s wedding. Without this provision, any absences from the nursing home would result in the person losing his room unless he privately paid the nursing home. Considering the fact that a nursing home resident is only allowed to keep $60 per month, private paying for anything is beyond their financial ability.
The Score 3 Criteria remains unchanged, and is used to determine whether Medicaid (MassHealth) will pay for an individual at a nursing home. This means that an individual must need assistance with at least 3 Activities of Daily Living (ADL). Activities of Daily Living include items such as eating, toileting, transferring (going from bed to a wheelchair), grooming and bathing. This is also known as a screening. Whenever a nursing home resident runs out of money and applies for MassHealth coverage the screening is done. House Bill #H2899 would change the time that a screening is done. It would be done prior to entering a nursing home instead of being done at the time of application for MassHealth benefits. Bill #H2899 might be able to help some elders who are not that ill, to remain at home, instead of being shipped off to the nursing home.
So where does that leave us? The initial process of making a new law has started at the hearing stage before the Committee on Elder Affairs and the Committee on Health Care Financing. The Committee on Elder Affairs had hearings on both the CSRA and TOA issues. The Committee on Health Care Financing had a hearing in June 22nd that covered 8 Bills from the House and one from the Senate. Don’t ask me why some hearings on Medicaid bills go to Elder Affairs and some go to Health Care Financing. I don’t know. Anyways, if these Committees make a favorable decision on these Bills, they will probably then move onto the Ways and Means Committee, where most bills that affect the financing of the Commonwealth end up. I will be monitoring these bills and will try to keep you up to date.
This article gives general information and not specific advice on individual matters. Persons wanting individualized advice on matters discussed should contact an advisor experienced in those matters. To the extent this article provides information on legal matters, it is based on law in effect in Massachusetts on the date of posting (laws in effect in other states are often quite different).
Ronald H. Surabian is a CPA and attorney who works at the Elder Law Center in Saugus, Massachusetts. He also holds Masters in accounting and a Masters in tax law. He currently serves on the board of directors of the Massachusetts Chapter of the National Academy of Elder Law Attorneys. If you have any questions please call me at the Elder Law Center, One Essex Street, Saugus, MA 01906 (781)233-4444. To view this or any prior article, please visit our web site at www.elderlawcenter.org