SOME ELDER ISSUES FOR THE 2005 MASS STATE LEGISLATURE

The following are bills in front of the Mass State Legislature in 2005 which may impact elders and elder mental health.







1. Community Spouse Resource Allowance

Key sponsors and current numbers
House – Rep Smizik – HD. 2629
Senate – Senator Montingy – SD. 1150


Background
Federal Law allows the community spouse of a nursing home resident who is on Medicaid to retain some portion their combined assets. Each State picks an amount which is within a range set by the Federal government. The State of Mass has generally allowed the maximum($ 90, 760). Recently the State reduced the amount to the minimum($ 18, 552).


Change
This bill restores the maximum amount for the community spouse.


2. Assets First

Key sponsors and current bill numbers
House – Rep Petersen – HD 3687
Senate – Senator Montigny – SD 1148


Background
Under Federal Law each State is allowed to identify a formula which will determine how much the community spouse may retain when the other spouse is in a nursing facility under Medicaid. Until recently the State of Mass used a formula which allowed the community spouse to retain more of their combined assets. This is especially important when the community spouse has a low income(pension, social security,) and needs their assets to meet her expenses.This was called Assets First.
Mass has moved to a formula which means that even a community spouse with a low monthly income can only use a smaller amount of their combined assets. This is called Income First.


• Change
This bill restores Assets First.



3. Transfer of Assets


Key sponsors and current bill numbers
House – Rep Hynes – HD 3609
Senate – Senator Creedon – SD 1369


Background

Current Federal law(and still in Mass) provides strict rules about the transfer of assets by an individual who applies for nursing home care under Medicaid. If certain transfers are made a penalty period of ineligibility for nursing home care under Medicaid is applied beginning at the date of the transfer. In many circumstances the penalty applies if the transfer is made within three years (look back period) of nursing home admission.

The State of Mass has gone to the Federal Government to ask permission (technically a “waiver”) to modify the rules. The State wants to extend the look back period to five years in some cases, to ten in others, and to begin the penalty period(of ineligibility for nursing home care) at a later time(admission date to the nursing home or application for Medicaid whichever is later). This new rule(if allowed) would effectively prohibit frail elders from entering a nursing home and place an additional burden on their family members.


• Change
This bill would require Mass to comply with current Federal Law.

4. Safe Nursing Home Discharges

  • Key Sponsors and Current Bill Numbers
    House – Rep Khan – HD 2307
    Senate – Senator Montigny – SD 1153
  • Background


Current regulations identify the reasons for which a resident may be discharged from a nursing home and require that a notice with information about the discharge be given to the resident. However, regulations by Medicaid do not speak to the adequacy of the placement(for example is it safe or will it provide appropriate services for this specific resident, etc.).

  • Change
    This bill will tell Medicaid to develop new regulations which requires facilities to ensure safe and orderly transfer or discharge from the facility to another appropriate setting.


5. Personal Needs Allowance

  • Key Sponsors and Current Bill Numbers
    House – Rep. Paulsen- HD 2207
    Senate- Senator Panagiotakos – SD 1997
  • Background
    Nursing and Rest Home Residents who are on Medicaid are allowed to retain $ 60.00 of their own money to pay for their personal needs. These are expenses such as clothing, shoes, hairdresser, telephone, ordinary dental and podiatry care, etc. for which Medicaid does not pay. This amount has not been raised in over a decade. Unfortunately, at that time, the amount was set at
    $ 72.80 a month and then decreased to its present level. Since then its dollar value has decreased to under $ 40.00 a month
    .
  • Change
    This bill will raise the PNA back to $ 72.80 a month and add an annual cost of living increase.


6. Long Term Care Insurance

  • Key Sponsors and Current Bill Numbers
    House –Rep Teahan –
  • Background
    When a Mass resident purchases long term care insurance which has at least a two year benefit period the State will not engage in estate recovery if that individual goes into a nursing home under Medicaid. However, the State has used estate recovery when these policies have been used for community based long term care for a portion of the two years which has then resulted in less than two years coverage in a nursing home.
  • Change
    This bill will ensure that an individual’s home is protected(i.e.- no estate recovery) if long term care insurance is purchased even if that insurance is used for community based long term care during the two year period.


7. Home Care

  • Key Sponsors
    -(Money Follows the Person)
    House - Barbara L'Italien
    Senate - Susan Tucker

    -(Pre-Admission Counseling)
    House -Mike Festa
    Senate - Stanley Rosenberg

    - (Choice)
    House - Barbara L'Italien
    Senate - Susan Tucker
  • Background
    Funding for home and community based care has been anemic. These are
    cost-effective services for frail elders who want to remain in the community.
    The Commonwealth has consistently under funded these programs. The care needs of
    seniors may change over time and they should have a variety of appropriate
    sevices on the long term care spectrum(ex.- home care, day care, nursing home
    care, etc.) available and accessible for them. That is not the case today

 

  • .Change
    These bills will all serve to address this problem. They are all for
    frail elders who are nursing home eligible. They will provide the opportunity to
    examine the various options available in addition to nursing home care. Monies
    which may have funded an individual's nursing home care can then be used to
    acccess care in the community or in a nursing home which ever is more
    appropriate.
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