GOP Targets Seniors' Long-Term Care

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GOP Targets Seniors' Long-Term Care

By Matt Pacenza, the Timesunion.com

March 8, 2004

To Gov. George Pataki and the state Senate leaders, Jane and Anthony DeSomma are model seniors.

They have health insurance, but just in case either needs nursing home care, or around-the-clock care at home, they took out extra coverage about five years ago.

"We pay a lot for it," said Jane DeSomma.

Indeed they do -about $8,000 a year for the two of them.

In an effort to rein in Medicaid spending that is threatening to overwhelm county and state budgets, the Senate and governor are targeting long-term care for seniors with limited resources.

Nursing home care costs an average of $5,000 a month in New York .

They allege that some seniors, more middle class than truly poor, do everything they can to qualify for Medicaid, like passing investments to their spouses and children.

"You've had a situation where affluent people preserve assets so that their even-more-affluent children can have an estate," claimed state Sen. Raymond Meier, R-Utica. "And we pay for their nursing home care."

So the governor's budget proposes making it tougher for seniors to use Medicaid for nursing homes or home care. What they hope is that by restricting eligibility, government will push seniors and baby boomers nearing retirement to plan ahead, like the DeSommas.

But to opponents of those proposals, like elder-law attorneys and advocates for seniors and the disabled, tightening Medicaid long-term care eligibility will keep vulnerable old people in the hospital, drive them to poverty -- or even to divorce.

They instead think that the state should focus on making prescription drugs cheaper, and on creating community alternatives to nursing homes, to cut Medicaid spending.

No one disagrees on one thing: Most seniors don't plan ahead specifically for long-term care.

Many don't realize that their health insurance, whether a government program like Medicare or from a private company, almost certainly won't pay for long-term care.

For example, 76-year-old Evelyn Timpanaro of Mechanicville has a husband who is ailing. They have Medicare, but so far they haven't worried about what they'll do if either or both needs long-term care.

"As far as a nursing home," Timpanaro said, getting ready to play cards on Thursday at the Shenendehowa Senior Center in Clifton Park , "he hasn't really thought about that."

Others are confident their children will be there for them.

"They'll take care of me, some way or another," said Nicholas Mospan, 88, of Clifton Park , who's been living with his daughter since his wife died three years ago. "They ain't going to throw me out in the street."

Seniors only get Medicaid for long-term care basically if they have nothing except for a few thousand dollars and a home, if their spouse lives there.

To keep seniors from "spending down" their assets at the last minute, authorities already try to distinguish between the poor and those seniors savvy enough to shed their assets to look poor.

By preventing this, the governor's office says, the state eventually will save more than $200 million a year.

When counties review long-term care applications, they look back three years to see if a senior has given away cash or assets. If he did, he must pay for his own care for a certain time, called the penalty period, proportionate to the amount he gave away.

The governor's budget would extend the "look back" period to five years. It also would change the penalty period to begin when a senior applies, instead of when he sheds his assets, and extend the penalty-period concept to Medicaid-funded home care for the first time. That change would effectively obligate a senior to pay his own nursing care bills for an even longer period of time, or to wait until he becomes eligible.

Also, the budget seeks to eliminate what's called spousal refusal, the right to decline to contribute toward a spouse's care.

The rules, both under the current and proposed systems, allow a spouse to hang on to a certain amount: for example, $75,000 in assets if the partner is in a nursing home, but just $5,700 if he is receiving home care.

Pataki's budget wants to prevent a spouse from keeping more than that by taking advantage of spousal refusal. If the proposal is adopted, it will drive couples to end their marriages, advocates for seniors claim.

"It will make it more desirable to break up a family through divorce," said Tracie Crandell, a policy analyst with the Center for Disability Rights.

Republican reformers dismiss such claims as scare tactics, arguing that their proposed changes are necessary not just because of budget deficits, but because some recipients simply don't need government help.

"It became obvious that this benefit had become a middle-class benefit," said Kemp Hannon, R-Long Island , chairman of the Senate Health Committee, who chaired a Senate Medicaid task force.

"If you talk to the nursing home industry," said Bob Hinckley, Pataki's senior deputy secretary for Health and Human Services, "as much as 15 percent or more are not really Medicaid-eligible."

The fact is, however, that no one knows if such estimates are accurate. Many dispute them, saying it's almost exclusively the needy who seek Medicaid.

"They want to deny care to people who need it the most," said Bill Ferris, legislative representative for AARP New York. "What are people supposed to do if they need 24-hour nursing care and can't pay for it?"

Lou Pierro knows where they'll end up. "Hospitals will be deluged with nursing home admissions," said Pierro, an Albany elder-law attorney. "If they pass all these proposals, it's a system crash."

The backers of tightening Medicaid say that they'll keep that from happening by making long-term care insurance cheaper, so that seniors will be able to pay less than the $8,000 a year the DeSommas pay, for example.

Some seniors are choosing a middle ground, taking out extra insurance to cover a short stay in a nursing home. Arthur Morrow, 73, of Halfmoon, and his wife are paying an extra $260 month to beef up their Medicare coverage, so that it includes, among other things, up to 80 days of free nursing home care.

"But hopefully we'll never need it," he said.