People often call a geriatric care manager when they are in crisis. Unfortunately, lack of information or faulty information about Medicaid often contributes to the crises.

For example, George’s 85-year-old father, Tom, who was healthy and living alone, was out shopping when he stumbled, fell and could not get back on his feet. A passerby called 911. An ambulance took Tom to the emergency room, where an X-ray revealed that he had a broken hip. He was admitted to the hospital. One of the ER workers called George in California. George caught a flight to New York and went directly to the hospital.

George and Tom, whose names were changed for privacy reasons, met with a hospital social worker, who told them that after surgery and a brief recuperative stay, the hospital would discharge Tom to a rehabilitation facility for physical therapy. However, after completing the rehabilitation, he would likely need daily home care for a number of months, perhaps longer.

Tom had a Medicare Advantage plan that would pay for his rehabilitation. But he would need a good deal more home care than the 12 hours a week for two weeks that his plan would cover. His doctor said that he would likely need at least six hours of home care a day for a number of months.

Tom’s income of $1,300 a month barely covered his monthly expenses. He also had about $20,000 in a savings account. He would very quickly run out of money if he had to pay for the additional home care he needed.

The hospital social worker told Tom and George that Tom had too much money to qualify for Medicaid. Perhaps Tom could move to California and live with George? George said that wouldn’t work. He lived with his wife and two children in a small home; they’d either have to get a larger, more expensive place, which they could not afford, or get Tom another apartment, which they also could not afford. Both George and his wife worked full-time; they didn’t have enough money to hire aides.

Tom firmly said that he would not agree to move to California. The social worker said that another alternative would be for Tom to stay in a nursing home until he was able to come home without home care.

“But that could be three months or more. He might lose his apartment. And then what would he do?” George said. The social worker remembered that she had the name of a geriatric care manager who knew a lot about Medicaid. Perhaps they should give him a call.
George called the geriatric care manager and arranged for him to come to the hospital to meet with him and Tom. The geriatric care manager told them that Tom did have assets and income over the Medicaid limits, but that he could still become eligible to apply for and receive full Medicaid benefits. With the help of the geriatric care manager, Tom:

• Put $6,000 of his assets into an irrevocable funeral plan, which brought his total assets to below the $14,250 Medicaid asset limit
• Applied for Medicaid

• Joined a pooled income trust and deposited the $500 of his income that was over the Medicaid limit into the trust each month. He had the trust use the $450 left after deducting the monthly administrative fee to pay his monthly bills for utilities, cable, telephone and food. Once Medicaid determined him to be disabled and recognized his deposits into the trust, they subtracted the $500 a month from their calculations of his income, which brought him down to the Medicaid income limit, providing him with full benefits.

• Received enough home care paid for by Medicare and Medicaid for him to return home and to remain there once he had finished a month of rehabilitation in a skilled nursing facility.
Roy Herndon Smith, Ph.D., is with Community Geriatric Care (communitygeriatriccare@gmail.com), a subsidiary of Foremost Home Care.

Photos Courtesy of Alissa Fleck

A number of groups and individuals met today in Foley Square to rally in support of SCOTUS upholding the Affordable Care Act (ACA). Health Care for All New York organized a “Rally to Respond” to the ruling, which was quickly retitled a “Rally to Celebrate,” announced Director Mark Hannay to the crowd. Hannay was among several speakers—doctors, advocates and elected officials—addressing the jubilant crowd of community supporters at the evening rally.

(by Alissa Fleck)

Hannay called the ruling a “milestone step forward in the history of justice,” pointing to the Declaration of Independence’s insistence on the right to life, liberty and the pursuit of happiness. Hannay said these rights cannot be met without affordable, accessible healthcare for all.

Hannay added SCOTUS making healthcare a right for all means America is finally moving toward other industrialized nations, though he said we are only “9/10ths of the way down the field” and must continue to politically support those who uphold affordable healthcare.

Other speakers laid out the main points of what the ruling would mean for Americans, and New Yorkers in particular, including a breakdown of what could be expected by 2014. State Assemblyman Richard Gottfried explained the ACA would help make health funding available for working families, encourage providers to communicate with one another and ensure senior citizens can afford necessary drugs among numerous other modifications. Preventive care will become more widely accessible, particularly pertinent to many women’s health issues.

Georgetown law student and women’s rights advocate Sandra Fluke took the stand to applaud the efforts of Americans who worked to support the SCOTUS decision as well as to remind crowd members the fight is not over.

“I don’t want to see ideologically-driven legislators work to repeal this decision so they can say they fought Obamacare,” said Fluke. “We want the implementation of the whole Affordable Health Care Act and we want it now.”

All the speakers agreed this decision, while important, is foundational and there are still hurdles from here, including building on decisions made in Washington to make laws in New York “even better” and make health care “a right, not a privilege.”

Speaker Quinn called what happened in Washington an “incredibly American act” and said the days of no options for many sick people and “whether you could get treatment [meaning] how big your paycheck was” are coming to an end.

“All have the right to get well, be well and stay well,” said Quinn. “Let’s make it even better.”

Myth: I cannot become eligible for Medicaid because my assets are too high.
Fact: Applicants for Community Medicaid in New York State must have less than $14,250 (for a single person) or $20,850 (combined assets for a married couple).
An applicant’s residence does not count as an asset if the market value of the home, minus the amount mortgaged, is less than $750,000.
Applicants with assets higher than the Medicaid limit can reduce them by spending them down to the limit or by transferring them to a trusted family member or an irrevocable trust. If you have significant assets, you should consult with an elder care attorney about how best to reduce them.
Once you have reduced your assets to under the limit, you are eligible to apply for Medicaid in the following month.

(By Roy Herndon Smith)

Myth: I cannot get Medicaid because my income is too high.

Fact: The Community Medicaid income limits are $792 a month for a single person and $1,159 for a married person.
You can still apply and qualify for Medicaid if you have income over these limits. Medicaid treats such “surplus” or “excess” income as a deductible. For instance, if you are a single person with an income of $1,292 a month, you have a surplus of $500. If you have $1,400 of medical expenses, including home care, in a month, Medicaid will only pay for $900 of those expenses; you will be billed for $500.
However, you can use a pooled income trust to protect your surplus income. Once Medicaid recognizes that you are disabled and are depositing your surplus into a pooled income trust, it will pay for all the covered medical expenses, including home care. You will not be billed for the surplus amount. You can have the trust use almost the entire surplus to pay for your regular bills, such as rent and utilities.

New York City’s Human Resources Administration can take a long time, sometimes over 3 months, to approve Medicaid and Medicaid home care. Applicants, especially when they have surplus income and are using a pooled income trust, often face delays and difficulties and need expert help to deal with them. For these reasons, if you foresee needing Medicaid to pay for home care in the future, you should start preparing to apply now by calling a knowledgeable geriatric care manager or social worker.

Roy Herndon Smith, Ph.D., is with Community Geriatric Care (communitygeriatriccare@gmail.com), a subsidiary of Foremost Home Care.

St. Luke’s-Roosevelt’s nationally renowned Center for Comprehensive Care (CCC) has just opened a new location on West 17th Street in Chelsea. This brand-new, state-of-the-art facility at 230 W. 17th St. joins the CCC’s other outstanding locations in New York City focused on HIV management.

“We have a beautiful space designed with the patient experience in mind,” said Dr. Victoria Sharp, director of CCC. “We are so excited to offer the community here a true medical ‘home,’ where they may access a multidisciplinary array of services that are coordinated, convenient and of the highest quality in a single location.”

The West 17th Street clinic aims to offer one-stop shopping for its patients’ health care needs. Primary and specialty medical care, including dermatology, gynecology and cardiology, dental services, behavioral health services, acupuncture, massage and other services can all be found under the same roof. This approach not only simplifies treatment for patients but creates more coordinated care between the different health care providers.

Best of all, the West 17th Street clinic is taking care of HIV-positive and HIV-negative people of all insurance types, be it subsidized APAP, Medicaid, or commercial insurance.

Much attention was paid to the architectural possibilities of health care, so much so that clinic adopted “Redesign,” an architectural model that mirrors CCC’s commitment to efficient and democratic care. A patient arrives at a reception area, not a waiting room, and moves to a room where all services, including physician visits, labs, blood work and immunization, take place.

“We’re really running a social experiment here. We’ve put a lot of thought into how architecture can affect behavior,” said Dr. Antonio Urbina, associate medical director of the West 17th Street clinic. “And sure enough, by treating all patients with equal respect and dignity, we’ve seen how behavior improves. Last week, I treated a homeless man in one room and a CEO in the room next door. Both of them were receiving the best possible care.”

The advent of the HIV drug cocktail in 1995 has transformed not only the life expectancy of HIV-positive people but also their quality of life—what was once a fatal disease is now a manageable chronic illness. “Thanks to the drug cocktails available, the lifespan for HIV-positive people has been increased by an additional 46 years. I even have an 87-year-old patient who is doing well.

“But those 46 additional years are not inexpensive; the cost is close to $1.5 million,” continued Urbina. “We have to find a way to keep those costs down. Preventive health care all under the same roof is a great way to do that. If we can keep people healthy, we can keep them out of the emergency room and the hospital, where so much of that cost is incurred.”

While the mortality rates of HIV patients may be on the decline, there are still 56,000 new infections every year in the United States.

“We haven’t done a great job with prevention. That’s where the challenge is,” confessed Urbina. “In all risk groups, rates of infection have dropped, except in one key group. We’ve seen a 40 percent increase in infection in young, gay African-American men, aged 13 to 29. We’re seeing very young, newly infected people; I diagnosed a 16-year-old last week.”

While African-American men are disproportionately affected, there is no evidence to suggest that the group sees any increased drug usage or more sexual partners than any other risk groups.

New HIV prevention strategies must be incorporated to encourage protected sex at all times, as current methods seem to be ineffective. “I guess young people aren’t so afraid of HIV anymore. They’ve grown up in an era when a couple of friends weren’t dying every year from it,” Urbina said. “They have seen Magic Johnson on TV and they know he’s still alive. But despite the advances, it’s still a disease that causes inflammation, premature aging and all sorts of bodily decline. Prevention needs to be taken seriously.”

The team at the West 17th Street clinic is dedicated to compassion—not just toward patients but toward one another. “We’re exploring the possibility of building a community, and accountability to community, in both patients and health care providers. This is the future of health care.”

Members of the medical team at the recently opened St. Luke’s-Roosevelt’s Center for Comprehensive Care on West 17th Street. Photo courtesy of CCC.