Medicaid

The lawyers of Phillips & Mille Co., L.P.A. have seen an increasing need for dependable legal advice that addresses the interests of two groups that continue to grow in size: the elderly and their middle-aged adult children. As people age, they become aware of the need to anticipate and plan for asset protection, long-term care, and medical emergencies for themselves and their elderly parents. Many retired people can benefit as well from advice about Medicaid planning, powers of attorney and living wills.

Many middle-class families face the potential for problems with eligibility for Medicaid. As a needs-based program, Medicaid limits the value of assets that an individual or family can own before benefits are awarded. Our lawyers will work with you to assess your current and projected eligibility for Medicaid benefits. We'll also suggest ways to maximize the value of your exemptions so that you won't have to spend down more assets than absolutely necessary to protect your assets from Medicaid in the event of long-term needs. Additionally, we can advise you about arranging and financing in-home assistance or residential care as useful alternatives to conventional nursing home care, which is generally a choice of last resort.

We encourage our clients to plan for medical emergencies and extended disability through powers of attorney and living wills. These instruments appoint trusted persons to handle your medical treatment, financial affairs, and even difficult life support decisions under defined conditions of incapacity, coma or terminal illness.



Health Care Reform Web Portal Goes Live July 1st
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The federal government “web portal” called for in the Affordable Care Act which will enable consumers to do one-stop shopping for insurance plans is scheduled to go live on July 1.  The URL will be
http://www.healthcare.gov.  

Obama Administration Announces New Patient’s Bill of Rights
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On June 22, the Obama Administration released a “Patient’s Bill of Rights,” designed to communicate the consumer protections offered by four new regulations issued that day in order to implement the Affordable Care Act.  The new regulations relate to ending pre-existing condition exclusions for children, preventing limitations on choice of doctor, and ending lifetime limits on care.  View a copy of the document here:
http://www.healthreform.gov/newsroom/new_patients_bill_of_rights.html.

 
Poverty Levels Affect Eligibility-2010 Guidelines

 

Federal poverty level (FPL) guidelines for 2009 were re-published January 22, 2010, to remain in effect until at least March 1, 2010. 75 FR 3734 (January 22, 2010). The brief continuation of 2009 guidelines was authorized by the Department of Defense Appropriations Act 2010 (Pub. L. 111-118).  The guidelines affect eligibility levels for many public benefits, including health benefits for older people and people with disabilities. See, e.g., 74 FR 4199, (January 23, 2009).  

The published poverty levels merely state a dollar figure for different-sized family units.  They do not address issues of what income is included, what deductions from income are allowed, who is included in a family unit or other use issues.  These questions are addressed by the individual programs relying on the poverty guidelines.  The amounts given below apply to the 48 contiguous states and Washington, DC.  Rates for Alaska and Hawaii are slightly higher.  A complete list of FPLs is available at http://aspe.hhs.gov/poverty/09poverty.shtml.

Federal health programs affecting older people and people with disabilities that rely on federal poverty guidelines:

People with Full Medicaid:

Poverty Level Aged and Disabled (PLAD):  States can choose to provide full Medicaid benefits to aged and disabled individuals with incomes up to 100% of the federal poverty level (FPL).  For states choosing 100% FPL as their ceiling, eligibility levels for early 2010 will continue to be $902.50/month ($10,830/year) for an individual; to $1214.17/month ($14,570/year) for a couple.

Amounts protected for the at-home spouse of a Medicaid nursing facility resident:  Medicaid law allows for certain levels of income and resources to be protected for the community spouse of a nursing facility resident whose care is paid for by Medicaid and who otherwise would have to pay most of her/his income to the facility.  The minimum amount of income protected is 150% FPL for two people ($1,821.25/month. Other protected amounts for 2010, not linked to FPL, are maximum monthly protected income, $2,739; minimum resource allowance, $21,912; and maximum resource allowance, $109,560.

People in Medicare Savings Programs:

Qualified Medicare Beneficiaries (QMBs):  States must be responsible for all Medicare cost-sharing for Medicare beneficiaries with incomes up to 100% FPL and limited resources.  For this group, the 2009/early 2010 level is  $902.50/month ($10,830/year) for an individual; to $1214.17/month ($14,570/year) for a couple.

Specified Low-income Medicare Beneficiaries (SLMBs):  States must pay the Medicare Part B premium for Medicare beneficiaries with incomes between 100% FPL and 120% FPL and limited resources. The limit for this group continues to be $1,083/month ($12,996/year) for an individual; $1,457/month ($17,484/year) for a couple.

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Additional Resources - Medicaid

Health Law

  • Health Law: an Overview - Wex

    Improvements in technology and medical care have increased life expectancy by a considerable amount. Alongside these improvements, health care costs have risen dramatically. Because the health of the people in a nation reflects the health of the nation itself, health care law is vital for the stability of the United States.

  • Health Law: Resources

    This page is for those interested in health care law. Primarily, this page is intended as a resource for health care practitioners, professionals or anyone interested in learning more about the dynamic field of health care law, and more specifically, the regulatory and transactional aspects of health care law practice.

  • Health Maintenance Organization Act of 1973

    Today, many people receive health care through health maintenance organizations (HMO's). Managed care essentially creates a triangle relationship between physician, patient, and payer. Because of the importance of the industry, HMO's are heavily regulated. On the federal level the Health Maintenance Organization Act of 1973 governs.

  • Medicaid Law: an Overview

    Medicaid is a medical assitance program jointly financed by state and federal governments for low income individuals. It was first enacted in 1965 as an amendment to the Social Security Act of 1935. Today, Medicaid is a major social welfare program and is administered by the Centers for Medicare and Medicaid Services, formerly known as the Health Care Financing Administration.

  • Medicare Law: an Overview

    Medicare was enacted in 1965 as one of President Lyndon B. Johnson's Great Society programs. The Medicare system was originally administered by the Social Security Administration, but in 1977 management was transferred to the Health Care Financing Administration.

  • National Health Law Program

    The National Health Law Program is a national public interest law firm that seeks to improve health care for America's working and unemployed poor, minorities, the elderly and people with disabilities. NHeLP serves legal services programs, community-based organizations, the private bar, providers and individuals who work to preserve a health care safety net for the millions of uninsured or underinsured low-income people.

  • Quiet Revolution: Law as an Agent of Health System Change

    This paper considers law’s impact on health system change. Federal courts and state regulators have remade the rules of the medical marketplace, restricting the methods available to managed care organizations to control costs. Legal conflict, however, has had a larger effect through its influence on market actors’ perceptions and expectations. In anticipation of adverse legal outcomes and in response to consumers’ and investors’ anxiety, health plans changed business strategies, backing away from aggressive cost management. We conclude with four lessons about law’s role in the health sphere—lessons that stress the power of legal conflict to shape perceptions and to thereby change behavior before legal change occurs.

  • Section of Health Law - ABA

    The Health Law Section is one of the 27 Sections, Divisions and Forum of the ABA. We are governed by a Council which includes the Officers. We have four dedicated staff. The Section has the Divisions: Administrative, Member Services, Policy, Program and Publications. The Section has twelve Interest Groups which are listed below. Each Section member can join Interest Groups at no charge.

  • U.S. Food and Drug Legislation

    Code of Federal Regulations, Food and Drug Administration, Department Of Health And Human Services.

  • U.S. States' Health Law

    Health law - state statutes, by Wex.