by Jennifer B. Cona, Esq.
In a sweeping gesture on a hot-button topic, Governor Cuomo boldly announced the creation of a “Medicaid Redesign Team” in his State of the State address in January. While Medicaid cost-cutting initiatives are an easy sell and good politico-speak, the real fix to an overburdened system that cares for the frail elderly, disabled and most vulnerable members of our community will be no easier than the overhaul of our federal health care system. If it was easy, it would have been done by now.
There is no question that the Medicaid system needs an overhaul. As our demographic ages, more and more people need home health care services, rehabilitation and placement in long-term care facilities, such as nursing homes. Many people simply cannot afford such long-term care, or if they can initially, their funds are quickly exhausted as average costs can be upwards of ten thousand dollars per month.
While Governor Cuomo should be commended for establishing the Medicaid Redesign Team, the team is shockingly missing some critical players, namely Elder Law attorneys and nursing home owners and administrators.
Nursing home owners and administrators are on the front lines of the battle to provide quality care in the face of shrinking dollars. Facilities struggle everyday with ways to stretch their limited Medicaid reimbursement dollars without sacrificing patient care and staff-to-resident ratios. While hospitals are well represented on the Medicaid Redesign Team, nursing homes are not. Considering 90% of residents in nursing homes on
Long Island receive Medicaid benefits, who better to be heard in this cost-containment versus quality of care debate than the nursing home service providers.
Similarly, Elder Law attorneys struggle everyday with families in the financial-long term healthcare conundrum. We are called upon to find ways for the elderly and disabled to access necessary health care and receive assistance with daily living activities on behalf of families with widely varying asset levels. Elder Law attorneys’ collective voice is an important one in the Medicaid debate as we see first hand how this government benefit affects the care our clients and their families are able to secure.
Further, Elder Law attorneys and the New York State Bar Association have been instrumental in proposing an innovative cost-sharing solution to contain Medicaid costs known as the New York State Long Term Care Compact. The Compact is premised on the fact that neither individuals nor the public sector is capable of meeting the enormous costs of long term care indefinitely. The Compact proposes a cost-sharing methodology between individuals and the Medicaid coffers as follows: an individual pledges a dollar amount to contribute toward the cost of care, which can be, at a minimum, one-half of the assets or, at a maximum, the average cost of three years in a nursing facility. Once the pledged private-pay funds have been exhausted on the cost of care, Medicaid will then become the payor source.
Clearly, this burden-sharing plan which privatizes to a great extent the cost of care of the elderly and disabled is a plan whose time has come. Should not individuals with intimate knowledge of such programs and proposals be part of the discussion? And in case anyone was wondering, Elder Law attorneys want to be part of the solution, not part of the problem.
It is incomprehensible how these two very relevant, even critical, voices could be overlooked as members of the Medicaid Redesign Team. The union leaders, politicians and heads of various state agencies that currently compose the “team” will undoubtedly bring good ideas on cost-cutting, efficiency and coordination of care, but who will speak for the patients, residents and families that will bear the brunt of these cuts? If getting it right the first time around is the goal, the right team must be in place.
Jennifer B. Cona, Esq. is the managing partner of Cona Elder Law, an Elder Law firm based in Melville.