ElderWeb

The Medi-Cal Policy Institute has issed a new report, "Understanding Medi-Cal Long Term Care." It answers questions like:
- What is Medi-Cal?
- Who is eligible for Medi-Cal long-term care?
- How is long-term care funded and administered?
- Which services are covered by Medi-Cal?
- What policy issues lie ahead?

Governor Gray Davis announced a new initiative to pay premiums of approximately 40,000 elderly and disabled Californians who faced disruption of their health care when nine Medicare+Choice HMOs in California implemented price increases on January 1, 2001. Last fall, nine Medicare+Choice HMOs in California and others nationwide announced plans to increase premiums to cover rising costs of health services. These increases affected beneficiaries who are eligible for both the state's Medi-Cal program and the federal Medicare program. By ending enrollment in their plans these individuals would have returned to a fee-for-service health care plan. These plans are more costly to the beneficiaries and the state.

Under the new program, California will pay the premiums for these individuals, effective January 1. The state is paying the HMOs directly, eliminating the need for individuals to make a payment each month. The payments are comprised of 50 percent General Funds and 50 percent federal matching funds. Initial annual cost projections for the program are $8 million in the current fiscal year and $17 million in subsequent years.

The state of California has unveiled a new state website, and as a part of that new site they have posted an online directory to licensed nursing homes, residential care facilities, home and community based services, adult day care, and other services for older Californians. The searches provide names, addresses, phone numbers, and information about the licensure status of the facility.

The Sacramento Bee reported that the state of California is suing Susan Gollas for $120,000 to recoup the cost of caring for her father, Sadao Yorita. Susan placed him in a nursing home when she was no longer able to care for him at home. She found that he qualified for Medi-Cal, since he didn't have the resources to pay for his own care. However, Gollas said she wasn't aware that she would have to pay back the state when her father applied for Medi-Cal. She said she will be forced to sell the 20-acre family farm she inherited from him and now works with her husband, Mario, and their three children.

Many people are unaware that federal law requires states to pursue repayment of nursing home costs from the estates of Medicaid recipients. The program in California collected about $40 million last year from more than 2,400 estates. County welfare offices give Medi-Cal applicants for long-term care printed information explaining that the costs will eventually be recovered, but the regulations are complex and advocates say an estate planner or attorney may be needed to help some understand the consequences. Some of those who are surprised the most have very modest estates, and may not have the education or resources to get professional help.

One thing the article did not mention is that the Federal guidelines provide that states should not recover costs if they cause "undue hardship," for example in the event that the estate is the only income-producing asset for the surviving family. It specifically mentions family farms as an example. Hopefully, Ms. Gollas will retain professional help to protect her family farm, but this story illustrates the fact that many people are unaware of all the consequences of relying on Medicaid for nursing home costs.

Governor Gray Davis of California signed AB 1731, a bill which will increase nursing home oversight and enforcement. As a part of the bill, nursing home staffing requirements will also be increased. Existing law provides that the minimum number of actual nursing hours per patient required in a skilled nursing facility shall be 3.2 hours.

This bill would declare the intent of the Legislature to increase the minimum number of direct care nursing hours per patient day in skilled nursing facilities. The bill would require the department to determine the need, and provide recommendations, for any increase in the minimum number of nursing hours per patient day and perform designated analysis. The bill would require the department, on or before May 1, 2001, to prepare a report on its analysis and recommendations and submit the report to the Legislature.

California SB2111 has been passed by the legislature. It will add agents and company representatives to the working group responsible for helping state insurance regulators come up with the content and format for the state's annual LTC rate stability guide. The bill would also allow insurers to focus consumers' attention on rate increases affecting California LTC policies, rather than on increases affecting policies sold throughout the United States.

Current law requires insurers to report and the consumer guide to include summaries of coverage of any policy sold in any state for the last ten years. The bill's author, Senator Joseph Dunn, believes this voluminous amount of information is of little use to California consumers since they can only purchase those policies which are sold in California. Dunn believes the bill makes it clear that the rate guide is intended to have two sections: a rate comparison section of all policies sold in any state in the last ten years, and a policy comparison section comparing policies available for purchase in California.

The California Legislature has enrolled AB 2107, which requires that all insurers, brokers, agents, and others engaged in the business of insurance owe a policyholder or a prospective policyholder a duty of honesty, and a duty of good faith and fair dealing.

The bill stipulates that if a life agent offers to sell to an elder any life insurance or annuity product, they must advise the client writing that the sale or liquidation of financial assets to fund the purchase of this product may have tax consequences, early withdrawal penalties, or other costs or penalties as a result of the sale or liquidation, and that the elder or elder's agent may wish to consult independent legal or financial advice before selling or liquidating any assets and prior to the purchase of any new products.

A life agent who offers for sale or sells a financial product to an elder on the basis of the product's treatment under the Medi-Cal program may not negligently misrepresent the treatment of any asset under the statutes and rules and regulations of the Medi-Cal program, as it pertains to the determination of the elder's eligibility for any program of public assistance. A life agent who offers for sale or sells any financial product on the basis of its treatment under the Medi-Cal program shall provide, in writing, a specified disclosure that indicates it is not necessary to expend all of their savings before applying for Medi-Cal, and outlines the financial eligibility rules for Medi-Cal.

The bill also clarifies that "Financial abuse" of an elder or dependent adult occurs when a person or entity takes, secretes, appropriates, or retains, or assists in taking, secreting, appropriating, or retaining real or personal property of an elder or dependent adult to a wrongful use or with intent to defraud.

This bill underwent substantial revisions in response to concerns expressed by the insurance industry and other professionals. The original version of this bill would have forbidden lawyers to sell annuities to their clients, or to receive compensation for referring clients to insurance agents or brokers, and would have restricted agents? ability to recommend that older customers sell assets to pay for LTC arrangements. If the original version had been enacted, agents would be allowed to make LTC recommendations involving asset sales only if they held Series 7 licenses from the National Association of Securities Dealers and were certified financial planners or certified financial analysts, according to the bill text.

House members from the San Francisco Bay area of California -- Fortney Pete Stark, Anna G. Eshoo, Tom Lantos, Barbara Lee, Zoe Lofgren, George Miller, Nancy Pelosi, Ellen O. Tauscher, and Lynn C. Woolsey -- asked the minority staff of the Committee on Government Reform to investigate the conditions in nursing homes in the Bay Area. There are 288 nursing homes in the Bay Area that accept residents covered by Medicaid or Medicare. These homes serve approximately 22,000 residents. This is the first report to evaluate their compliance with federal nursing home standards.

The report found that there are serious deficiencies in many Bay Area nursing homes. Only 18 nursing homes in the Bay Area were in full or substantial compliance with federal standards during their most recent annual inspection. In contrast, 119 nursing homes in the Bay Area -- more than one out of every three -- had violations that caused actual harm to residents or placed them at risk of death or serious injury.

The California legislature has enacted a new law consolidating several previous law related to advanced healthcare directives. Advanced directives are used to allow people to influence decisions about how they will be cared for in the event they become unable to make their wishes known directly.

The new allows people to appoint another person to be their health care "agent." This person, called an "attorney-in-fact", will have legal authority to make decisions about their medical care if they become unable to make these decisions for themselves. The law also allows people to document their health care wishes in the Advance Health Care Directive form, for example, a desire not to receive treatment that only prolongs the dying process in the event of a terminal illness.

The Advance Health Care Directive is now the legally recognized format for a living will in California, replacing the Natural Death Act Declaration. The Advance Health Care Directive is more comprehensive than a living will, which only states a desire not to receive life-sustaining treatment if the person is terminally ill or permanently unconscious. The Advance Health Care Directive can be used to state the person's desires about their health care in any situation in which they are unable to make your own decisions.

The Advance Health Care Directive has also replaced the Durable Power of Attorney for Health Care (or "DPAHC") as the legally recognized document for appointing a health care agent in California. Previously executed Durable Powers of Attorney for Health Care or Natural Death Act Declarations will remain valid unless replaced with the new Advance Health Care Directive.