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Guildnet Closes Its Doors

On August 21, 2018, Guildnet CEO, Alan R. Morse, notified employees that the company will be closing its doors as of December 1, 2018, leaving New Yorkers in need of managed long-term care (MLTC) services at a disadvantage. The Guildnet program was designed to offer therapeutic/medical care, home healthcare services, case management, and medical equipment to those who qualify and will be in need of the provided services for a minimum of 120 days. Guildnet announced that by January 1st of 2019, all medical services to their 8,211 managed long-term care members will be terminated. United Healthcare, who until recently offered a partial MLTC plan, will also be pulling out of several counties in up-state New York by February of 2019, affecting nearly 1,500 enrollees who are said to be notified of these changes by November.
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Fair Hearings – Medicaid

Applying for Medicaid or any other government benefits can be challenging. If an application for Medicaid or other government benefits is denied, it is important to understand that you have the right to appeal the denial to the State in an administrative proceeding called a Fair Hearing. (NOTE_- You must also request an internal appeal of an adverse decision with your healthcare provider in addition to requesting a NYS Fair Hearing)
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Determining Medicaid Eligibility

Medicaid is a joint federal and state public assistance program that provides health insurance to low-income Americans, regardless of age, and is based on financial need and hardship. This program is publicly funded through taxes that are collected from each working individual.
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Expect to Pay More for Home Health and Assisted Living Costs

According to the most recent data from the U.S. Census Bureau, there were 2,797,589 people in New York who were aged 65 and over in 2016 which is 14.6% of the state’s population. Compare that number to 2015, when 2,724,135 seniors lived in New York State (14.3% of the population), and 2014 (2,655,913 people ages 65 and over, 14.0% of the population). Continue reading “Expect to Pay More for Home Health and Assisted Living Costs”

How Joint Accounts and Gifting Affect Medicaid Eligibility

As individuals begin to age, long-term care services and how to finance them become major concerns. Many turn to Medicaid to pay for their long-term care needs. Medicaid is a joint Federal and State funded program that provides medical insurance and long-term care payments on behalf of middle- to low-income individuals, including those who are elderly and disabled. However, since Medicaid eligibility is determined by the combined value of income and assets, gifting money and joint accounts may impede a person’s ability to secure Medicaid benefits.

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What is Medicaid Fraud?

There are several types of Medicaid fraud, such as those who receive Medicaid fraudulently. Medicaid recipient fraud may include an applicant falsifying information on the application and certification failure to disclose information about income and assets owned, and the failure to disclose income earned by a spouse or other household member. Other activities that can be deemed as fraud are loaning another person their Medicaid identification card, changing or creating a falsified order or prescription, using more than one Medicaid identification card, deliberately receiving excess, duplicative or conflicting medical service and/or supplies, and selling Medicaid-provided supplies to others.

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Elderly Misuse of Antipsychotics: A Disturbing National Trend

A recent National Public Radio (NPR) investigation revealed that nearly 20 percent of senior nursing home residents receive some form of antipsychotic medications.

Similar reports, drawing from the NPR investigation, found significantly higher rates of antipsychotic drug usage concentrated in the Western New York area.  In the Rochester region, data revealed that antipsychotic drug usage rates reached up to 30 percent.*

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Nursing Homes Attempt to Lure in More Medicare Patients to Increase Profit

A recent exposé by the New York Times revealed that as nursing homes revamp their facilities to include luxury living quarters, the disparity between the lavish amenities of short term accommodations, and the quality of care can be drastic.  Although nursing homes are attempting to lure in patients whose short stays will be funded by Medicare dollars, in lieu of Medicaid, many patients are being discharged from the facilities before they have been rehabilitated.  Or worse yet- they leave with more medical issues than they had upon admittance.

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Medicare Prescription Drug Abuse on the Rise

A recent examination of federal data conducted by USA Today has recently revealed that the number of U.S. senior citizens receiving narcotic painkillers and anti-anxiety medications under Medicare’s prescription drug program is sharply rising. Recreational drug use can still be classified under medication-related problems (MRPs).  Caregivers can play a key role in identifying and managing substance abuse issues, however, they may also be held liable if they fail to notice the signs of substance abuse.

According to the data collected between, 2007-2012, the number of senior patients receiving Medicare prescriptions for opioid-based pain medications has increased by more than 30 percent to upward of 8.5 million beneficiaries.

Specifically, the use of the most commonly abused painkillers, like hydrocodone and oxycodone, rose by more than 50 percent. The data also showed a significant increase of the personal supply of each narcotic provided to the average recipient rose about 15 percent over approximately three months. Continue reading “Medicare Prescription Drug Abuse on the Rise”

Special Needs Trust Can Provide Effective Financial Relief for the Disabled Elderly.

Federal and State law provides a number of programs to help a person with disabilities.  Such programs include. Security Income and Medicaid. Supplemental Security Income, or SSI, is a federal program that provides monthly cash payments to people in need. SSI is for individuals who are 65 or older, as well as for blind or disabled people of any age, including children.

However, to qualify for SSI and Medicaid an applicant must own less than $2,000 in assets. The value of your home does not count if you live in it. Usually, the value of your car does not count and the value of certain other resources, such as personal items or a burial plot, may not count either. Continue reading “Special Needs Trust Can Provide Effective Financial Relief for the Disabled Elderly.”