New York Times Examines Debate Between Federal, New York Officials Over Interpretation Of Medicaid Coverage For Long-Term Care

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Public Health
Article Date: 27 Jan 2009 - 4:00 PDT

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The New York Times on Saturday examined a debate between federal health officials and New York state health officials over the state's application of a federal law intended to protect spouses of people who need long-term care from falling into poverty. In 1988, Congress enacted a law aimed at allowing healthy spouses with lower incomes and fewer independent assets from being forced into poverty by their financially better-off spouse's need for long-term care. The law allows the spouse who needs care to enroll in Medicaid without taking into account all the couple's income and assets. In 2009, federal guidelines allow couples to keep up to $2,739 monthly in combined income and $109,560 in combined assets, excluding a home or car, and still qualify for Medicaid coverage of nursing home care.

According to the Times, "New York state has routinely extended the same benefits to people with illnesses like Alzheimer's disease or cancer who receive care at home, which is both less expensive and less disruptive to relationships." However, in fall of 2008, CMS sent a letter to New York state health officials "outlining a legal ruling that declares that couples in which both partners live at home are not entitled to the same protection," the Times reports. The change was scheduled to go into effect in December 2008, but New York Gov. David Paterson's (D) administration and the state congressional delegation won a delay until March 1, with the hopes that the Obama administration will reverse the Bush administration's ruling.

Federal officials say that Congress intended to protect only the neediest of residents when it gave states the option to expand impoverishment protection guidelines to home health care and that New York is taking the exemption too far. Opponents of the federal interpretation say it "makes little sense," according to the Times. Valerie Bogart, a lawyer representing the elderly, said, "The root of their interpretation is that Congress wanted to give states the option of extending these protections, but only to those whose incomes are so low that they would have no income to share with their spouse," adding, "It would be so absurd that no one would ever qualify." The Times reports that federal officials admit "that it is hard to know with certainty how far above certain minimum levels is too much" and "have offered to work with New York to figure out what those levels are."

According to the New York State Department of Health, approximately 3,000 couples of the 30,000 people in the long-term home care program would be affected by the change. Advocates for the elderly say the number is closer to 4,000. Mark Kissinger, deputy commissioner of long-term care for the state health department, said, "They're saying if you put your spouse in a nursing home, you're going to get to keep more income than if you keep your spouse out of a nursing home," adding, "That's completely opposite to public policy and research of the last 10 years" (Hartocollis, New York Times, 1/24).

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