Many of you have seen me tweeting and posting on Facebook regarding the need to contact your legislators about the Medicaid Reform legislation that was happening this season in Florida. Luckily, for our seniors, two changes were put on hold (at least for now). The use of personal care contracts is still a viable tool in Florida (which is a good thing considering how they have cut reimbursement rates to nursing homes which means that nursing homes will not be able to spend as much time helping residents as they do now).
Additionally, the legislature did not restrict spousal refusal. Spousal refusal is especially important in second (or third or more) marriages where each spouse has their own assets and does not co-mingle them with the other spouse. Under spousal refusal, a person can go into the nursing home and apply for Medicaid (assuming they meet all the qualifications) and their spouse can refuse to use his or her assets to pay for the care (which gives the community spouse the ability to use their own assets to take care of themselves). In other states where spousal refusal is not allowed, couples are forced to divorce so that the community spouse can keep enough assets to be able to survive.
What are some things that are were not so good about Medicaid Reform? Well, assuming the federal government approves the program, HMO’s will begin receiving financial bonuses beginning next year for “transitioning” elderly nursing home residents back into the community or home-based care. And, by 2013, the HMO’s will receive 3% bonuses for “transitioning” elderly residents out of skilled nursing facilities. The goal is to reduce the overall nursing home population to 35% of the total number of folks eligible for skilled nursing care. Why is this bad? Because there is the potential that HMO’s will deny coverage to individuals telling them they need to be living at home or in assisted living when these people have lived in skilled nursing for years and need the 24/7 care that is provided.