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Life Health > Long-Term Care Planning

LTCI Watch: Maine

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The Maine Health Care Association has hired the Center for Long-Term Care Reform to figure out how much money the Maine Medicaid program could save if the state made nursing home benefits eligibility rules as strict as federal law seems to permit.

Maine is a state with a governor, Paul LePage, who hates the Patient Protection and Affordable Care Act (PPACA).

Maine is suing the U.S. Department of Health and Human Services (HHS)  for the right to cut Medicaid spending by $20 million, by removing 33,000 of what it says are the least needy enrollees from the program, according to the LTC reform center.

HHS says a PPACA “maintenance of effort” provision lets it take existing Medicaid funding away from a state that fails to keep Medicaid program eligibility levels at least as generous as they were back in March 2010, when PPACA was signed into law.

Maine is arguing that the same Supreme Court decision that stopped HHS from taking existing Medicaid funding away from states that fail to meet new PPACA goals should also keep HHS from taking funding away from states that fail to meet the PPACA “maintenance of effort” requirements.

The LTC reform center is supposed to help the Maine Health Care Association, a long-term care (LTC) provider group, figure out how much Maine would save if, in effect, it made nursing benefit eligibility rules as tight as they could have been under the laws that are in place in February 2010, before PPACA took effect.

The LTC reform center gives home equity as an example of what it thinks is wrong with Maine Medicaid nursing home benefits eligibility rules.

Medicaid is supposed to be a program for poor people.

Today, Maine lets a Medicaid nursing home benefit user keep $786,000 in home equity, according to the LTC reform center. The state wants to cut that to $525,000, the federal minimum, the LTC reform center says.

“There are many other examples of measures Maine could take that would target scarce Medicaid resources to people most in need while at the same time demonstrating the importance for others, who have the time and financial wherewithal to plan for LTC, to do so,” the center says.

What rational, independent person can really object to that idea?

A budget-conscious conservative shouldn’t want Medicaid to be spending any more nursing home care than it absolutely has to — if it spends anything on nursing home care at all.

A liberal who thinks the government should try to help the poor might think the government should use its money to help sick, elderly and disabled people who are genuinely poor, as opposed to people who do have serious health problems but also have $786,000 in home equity.

I think the secret here is that, aside from individual families that want to help Grandma stay in a nice nursing home and also keep Grandma’s house, the people who think Grandma should be able to keep $786,000 in home equity and still qualify for a program for poor people are people who are thinking with their kind, fuzzy hearts and not with their cold, rational heads.

I know, for example, a woman (let’s change all of the details to protect the identity of people whose stories I might be misconstruing) who inherited a house in Maryland with her sister. This woman has a lousy work history. She is poor herself, more because she has done a rotten job than because of the state of the economy. Her mom went into a nursing home, somehow qualified for Medicaid, and was able to pass a nice  house on to the Maryland woman. Because the woman inherited the house, she has a place to live, which is great. I’m so happy that she has that house. Who knows where she’d live if she didn’t have that house.

If I were an elder care planning lawyer who had members of that family as clients, of course I’d feel like going to Washington to defend the right of that family to keep the house and keep the daughter off the sidewalk. 

And, of course, there are other families in which the adult kids can all earn a real living, but Grandma’s house is a beloved treasure trove. How can we make families sell treasure troves full of memories just to hold down Medicaid spending?

And, of course, this problem is much harder for Kathleen Sebelius, the secretary of Health and Human Services, for other administration officials and for members of Congress.

When they are the gatekeepers, how can they say “no” to all of those feckless adult children who have trouble holding down a job and to all of those responsible adult children who can’t quite pay for 5 years of nursing home care, who didn’t think to buy private long-term care insurance early enough, and who want to keep their childhood tree house in the family?

How on earth can members of Congress and the workers who handle their constituent services slam the door in the face of voters who are just trying to hang on to a tree house?

The answer, of course, is that needs are endless, resources are limited, and we voters have to somehow get ourselves to be responsible and make it clear that we support efforts by government officials to say no. 

When we say we want our bread and circuses without being willing to pay a dime more in taxes, then we get the government we deserve. It’s fine to debate when we cut costs and when we raise taxes, but, somehow, whatever choice we make, we have to get real about the math, or there is no way our public servants will be able to do so.


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