A new Medicaid regulation gives states “unprecedented flexibility” in configuring their Medicaid programs. Exempted from the rule are nursing home residents, Medicare beneficiaries and medically frail individuals who have freedom of choice in participating in coverage offerings.
The rule, which was issued by the Centers for Medicare & Medicaid Services Wednesday, allows states to place Medicaid beneficiaries in alternative benefit packages called “benchmark plans.” These plans are models states can use in designing their programs. They could carry benefits of a standard Blue Cross/Blue Shield provider plan under the Federal Employees Health Benefit Plan, or state employee coverage, as two examples.
The final rule incorporates some comments that the American Health Care Association made following the release of the proposed rule last February, according to Janice Zalen, senior director of special programs for the American Health Care Association. It states more explicitly that enrollment in a benchmark plan is optional for exempt individuals and they may opt out at any time, she said. AHCA was concerned that two states, which received approval to offer benchmark benefits, did not properly inform elderly people that inclusion was optional.

Many consumers are ill-informed about Medicare and Medicaid’s role in long-term care, and greater planning could help reduce the danger of soaring Medicaid costs, according to a new report from America’s Health Insurance Plans.

Over the next 20 years, federal and state governments are expected to spend $3.7 trillion on long-term care expenses, the report said. Between 2008 and 2027, annual Medicaid long-term care expenditures are projected to grow by 124% from $51.5 billion to $115.6 billion. AHIP represents most of the nation’s commercial insurers. Researchers at Strategic Affairs Forecasting and Paul A. London Associates conducted the report.

Too many people believe that Medicare will help pay for long-term care expenses, when actually it will provide only a limited amount of rehabilitative care, according to report authors. Up to two-thirds underestimate their potential need for long-term care, they note.

The Senate is likely to adopt a House version of an economic stimulus package that would infuse $14.7 billion into state Medicaid programs. 

While the House Friday passed its $60.8 billion stimulus bill, the Senate on Friday failed to pass its iteration, which would have given $19.6 billion in additional funds to state Medicaid programs. Still, even if the Senate approves the House bill, it may not pass. President Bush has vowed to veto the bills, saying they would do nothing to spur the economy and would only increase government spending.

Meanwhile, as of press time, the House failed to pass a $700 billion bailout package for the crippled financial sector. The House stimulus bill could actually become a “bargaining chip” between Congress and the president in negotiations over the bailout package, according to The New York Times.

Medicaid is known as the government health-care program for the poor, but it pays for more than two-thirds of long-term nursing-home stays. That means many middle-income Americans with savings will need the program. Ultimately, medicaid will cover nursing-home care for nearly everyone who needs it but can’t afford to pay on their own.

All Medicaid beneficiaries fit into one of several qualifying categories  of the program - 65 years of age or older, blind or disabled, for example. You must also submit financials that take into account both your income , assets as well as those of your spouse if you are married. The final category is  the people eligible to receive Supplemental Security Income from the Social Security Administration.