Medicaid Long-Term Care

Monday, August 3, 2020

Funding Home Care for Elderly and Disabled

Tuesday, August 4th, is call-in day to push for dedicated funding of home and community-based services (HCBS) in the new COVID-19 relief legislation that is being negotiated in the U.S. Senate.  This is desperately needed in Texas, where HCBS funding has been greatly reduced during the pandemic, resulting in long delays for individuals waiting on the Interest List for an opportunity to apply for HCBS-Star Plus Waiver benefits.

As recently discussed on this blog, Medicaid requires states to provide nursing facility services, but does not mandate home and community-based care for elderly and disabled beneficiaries.

Read more . . .

Tuesday, February 4, 2020

The Long-Term Care Path from Medicare to Medicaid

Although Congress enacted Medicaid in the 1960s to provide health care coverage for the poor, Medicaid has become the primary pay source for nursing home and long-term care for the vulnerable elderly population.  The majority of nursing home residents, or 80%, are age 65 or older and 62% of residents are covered by Medicaid, which is available to beneficiaries with limited income and assets. 

Medicare – the national health insurance program for seniors and the disabled who work a sufficient number of quarters and pay Social Security and Medicare taxes – covers nearly 60 million people, mostly seniors, however Medicare provides very limited coverage of long-term nursing home care, just 100 days of rehabilitation in a facility after a 3-day hospital stay.  This and other Medicare coverage gaps, premiums, and copayments help explain why Medicare beneficiaries spend a larger share of income on health care costs than non-Medicare beneficiaries, according to the Kaiser Family Foundation.  Few can afford long-term care insurance or the annual cost of nursing home care, which was $82 thousand in 2016, more than three times the annual income of most seniors, according to KFF.

Read more . . .

Wednesday, July 17, 2019

List of Poor-Performing Nursing Homes

The Centers for Medicare and Medicaid Services (CMS) has released a list of under-performing nursing homes, including over thirty facilities in Texas. 

Read more . . .

Tuesday, September 19, 2017

New Bill Guts Healthcare, Medicaid


A new healthcare bill in the U.S. Senate would cap Medicaid spending per beneficiary, which means the program would no longer be an open-ended entitlement that covers everyone who qualifies for benefits.  Medicaid provides crucial funding of costly long-term care services for low-income elderly and disabled beneficiaries - services that Medicare does not cover.  The Graham-Cassidy bill would also "repeal and replace" key ACA provisions which ensure individuals, particularly those with a pre-existing condition, have access to adequate, affordable medical care.

Read more . . .

Tuesday, November 15, 2016

Will Trump Dump Medicaid on the States?

How will elder care be affected when Donald Trump becomes president and a Republican-controlled Congress convenes in January?  We should prepare for potentially severe budget cuts in Medicaid and other programs affecting seniors and people with disabilities, according to news sources, experts, and advocates

Read more . . .

Thursday, April 10, 2014

Fewer Physicians Accepting Medicaid Patients

It’s often thought that the battle of Medicaid ends after being accepted – once admitted into the program, low income families should be able to receive the health care they need. Unfortunately, in certain areas of the U.S., families aren’t being accepted by the physicians in their zone, leading some ill patients to travel further distances, or to forego not receiving the preventive care they need.

Depending on where a Medicaid beneficiary lives, it can become extremely difficult to be accepted by a primary care physician. Even in areas where there is a large concentration of physicians, some doctors aren’t willing to accept Medicaid patients because Medicaid reimburses physicians at a lower rate than Medicare and private insurance.  Access to preventive health care by Medicaid beneficiaries can be even more challenging in rural areas. 

Attempting to find out how challenging it can be to obtain an appointment in a poor area of Mississippi, researchers posed as patients (half covered under Medicaid, half covered under private insurance) and called different practices. Researchers found that 47 percent of the new Medicaid patients were accepted by the doctors, whereas about 75 percent of new patients with private insurance were accepted. These margins alone exemplify the difficulty one can face as a Medicaid patient. 

People who need Medicaid coverage tend to be sicker and to need the care of physicians most.  Without being able to receive the care they need, most Medicaid beneficiaries members put off symptoms, and ignore the obvious signs. This can lead to worsening conditions. For example, patients with diabetes who don’t get treated can go into a diabetic coma, which requires emergency care and , if receiving the appropriate care, could have been is completely preventable with appropriate medical care.

SImilarly, in the Medicaid nursing home program, Medicaid reimburses facilities at a lower rate than Medicare and private insurance.  Consequently, nursing homes limit the number of Medicaid patients they will admit, making it difficult for a patient to find a facility.  Nursing homes often have waiting lists for the limited number of Medicaid beds in the facility.  The process of finding a Medicaid facility and securing a Medicaid bed can be very stressful for the spouse or family of a patient who requires 24-hour nursing care and cannot be cared for safely at home.

The Stone Law Firm supports patients' families by helping them find quality nursing homes and available Medicaid beds.  We handle all aspects of Medicaid planning and applying for Medicaid coverage of long-term care, including in-home services.

Monday, March 10, 2014

Problems in Medicaid Managed Care

Pitfalls Seen in a Turn to Privately Run Long-Term Care,” published in the New York Times March 6, 2014, is timely as Texas prepares to shift administration of Medicaid nursing home services from state government to private insurance companies as early as September, 2014.  

Across the county, Medicaid long-term care has been privatized rapidly by state leaders to curb rising Medicaid costs as the elderly population expands, life expectancy increases, and the incidence of chronic, disabling conditions grows.  On average, Medicaid spends five times more on long-term care for an aged and disabled beneficiary as it does on a beneficiary in children’s Medicaid; aged and disabled beneficiaries comprise 6% of the Medicaid population yet consume one-third of Medicaid spending, according to the New York Times.  At least 26 states have implemented programs in which publicly funded Medicaid long-term care is managed by private, for-profit insurance companies. 

In the managed care model, Medicaid pays a flat monthly rate per beneficiary to a private insurance plan to cover and coordinate the beneficiary’s care.  The goal is to provide the most appropriate care in the least restrictive setting at the most reasonable cost.  Managed care plans achieve cost-savings by substituting Medicaid home care services, where appropriate, for care in a high-priced nursing facility.  The savings achieved by expanded use of home care is intended to save taxpayer dollars and counterbalance the higher care costs of beneficiaries who require nursing facility services.

Previously, there was little Medicaid funding available to provide less expensive home and community-based care.  The Medicaid managed care model offers an opportunity to end the bias toward facility care in Medicaid, to make in-home care more accessible, and to enable elderly and disabled Medicaid beneficiaries to remain at home in the community for as long as possible. 

Insurance companies, however, must also deliver profits to investors.  As the New York Times documents, managed long-term care plans have denied care to Medicaid beneficiaries who required more expensive nursing home care or more intensive home care services.  Managed long-term care plans have cherry-picked healthier seniors, including hundreds of beneficiaries who were not impaired enough to be eligible, while denying access to the most impaired.  Furthermore, the involvement of private insurance companies may not result in cost-savings for taxpayers.  In Minnesota, a 2011 audit found the state had overpaid insurers $207 million for expenses that included high executive salaries and a luxury box at a sports stadium.

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Attorney Nancy Stone assists clients with Elder Law, Medicaid Planning, and Estate Planning throughout Harris County, TX. I am now based in Sugar Land and serve all of Houston, Harris County, Bellaire, Jersey Village, Cypress, West University, The Heights, Pearland, Alvin, Sugar Land, Missouri City, Kingwood, Humble, The Woodlands, Spring, Tomball, Richmond, Rosenberg Pasadena, Baytown, La Porte, Clear Lake, Texas City, Katy, Friendswood, Stafford, as well as Fort Bend County, Brazoria County, Montgomery County, Galveston County, Liberty County, Chambers County, Waller County and throughout Southeast TX.

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