Investigators at the U.S. Government Accountability Office (GAO) have found that state Medicaid programs are having troubling getting the consumer financial information they need to determine whether residents seeking Medicaid nursing home benefits really are poor enough to qualify for the benefits.
Carolyn Yocum, discusses the GAO’s findings in a report on state Medicaid long-term care (LTC) asset screening prepared for Sen. Orrin Hatch, R-Utah, and Sen. Tom Coburn, R-Okla., who is a medical doctor.
State Medicaid plans pay for acute health care for the poor. The plans also pay for nursing home care for patients who get through an eligibility screening process. State Medicaid programs accounted for about half of the $263 billion spent on nursing home care in the United States in 2010, Yocum says.
The drafters of the Deficit Reduction Act of 2005 (DRA) tried to hold down growth in Medicaid long-term care (LTC) spending — and respond to allegations that some consumers make themselves artificially poor to qualify for Medicaid nursing home benefits — by requiring each Medicaid plan to look back at how LTC applicants had managed their assets over the previous 60 months.
A DRA provision calls for each state and the District of Columbia to set up electronic asset verification systems to help with efforts to detect “Medicaid planning” efforts.
All states told the GAO that they do try to verify Medicaid LTC benefits applicants’ asset information, but no state actually had an electronic verification system in place when the GAO investigators did their research, Yocum says.