Michigan Medicaid Benefits Change Affecting Nursing Homes
By - A Michigan law firm has raised concerns that a change in the way the state’s Medicaid benefits are applied could potentially affect nursing home residents. Michigan is now counting Solely for Benefit Of trusts (SBOs) as assets when determining a person’s eligibility for Medicaid.
According to Lisa Beatty, an elder law attorney with the Nawrocki Center for Elder Law, Special Needs & Disability Planning, the SBOs allow individuals to create an income stream that pays out a monthly stipend for a person whose spouse is a nursing home resident. However, with the change, there have been several denials of Medicaid benefits, Beatty told the Livingston Daily, and that many nursing home residents feel blindsided.
DHS spokesman Bob Wheaton explained that the state’s actions did not require special notification. Wheaton told the news source that federal laws addressing the counting of assets are designed to ensure that tax dollars go to these intended beneficiaries.
“The Michigan Department of Human Services and Michigan Department of Community Health determined that existing federal law and Medicaid policy requires solely for benefit of trust assets to be counted for purposes of determining Medicaid eligibility,” Wheaton said. “Once it was determined that federal law required these trust assets to be counted, DHS and MDCH decided to apply existing policy consistent with this law.”
Additionally, Wheaton said that providing notice and knowingly refraining from applying federal law for some period of time was not a viable option because state compliance with federal law is mandatory.
Michigan will likely not return to counting SOBs as assets, Beatty said.
“The best (outcome) would be they need to go back and give us a future effective date,” Beatty explained. “They have the right to change the policy, but you shouldn’t change policy in midstream without notifying anyone about it.”
Last month, more than 400,000 Michigan residents signed up for the state’s expanded Medicaid program, which was nearly the number that was expected to enroll over several years, reported the Detroit News. The Healthy Michigan Plan launched on April 1, with the state surpassing its first-year enrollment goal of 323,000 on July 10. The total estimated enrollment for the program wasn’t expected to reach 477,000 for several years.
Just earlier this week, the Centers for Medicare and Medicaid Services (CMS) announced a Medicare quality improvement initiative meant to improve nursing home care. While it did not affect how an individual would be approved for Medicaid, the CMS initiative will expand and strengthen its Five Star Quality Rating System.
Moreover, CMS plans to improve survey inspections, payroll-based staffing reporting, additional quality measures, timely and complete inspection data, and the scoring methodology.
“Nursing homes are working to improve their quality, and we are improving how we measure that quality,” Patrick Conway, M.D., deputy administrator for innovation and quality and CMS chief medical officer, said in a statement. “We believe the improvements we are making to the Five Star system will add confidence that the reported improvements are genuine, are sustained, and are benefiting residents.”
