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View Diary: 300,000 Arizonans win, will get Medicaid (70 comments)

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  •  AHCCCS is more like health insurance (1+ / 0-)
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    AHCCCS makes monthly payments on your behalf, whether or not you actually use any medical care that month.

    Capitation Payments: The AHCCCS program is ba
    sed on cost containment through preventive
    care rather than emergency care. AHCCCS contracts with “program contractors” which in turn
    are responsible to ensure the delivery of all
    covered medical services to ALTCS members.
    AHCCCS pays program contractors a monthly “capitation” payment prospectively for each
    enrolled ALTCS member. This capitation concep
    t is patterned on the wa
    y many individuals pay
    for private health care insurance. AHCCCS pays
    the monthly capitation payment to the program
    contractors for each month the A
    LTCS member is enrolled, rega
    rdless of whether the ALTCS
    member received a medical service during the mont
    h. If the ALTCS member is on Medicare, the
    capitation payment amount for months of service
    on, or after, January 1,
    2010 that is subject to
    estate recovery will be the amount paid to th
    e program contractors ad
    justed to remove the
    actuarially determined amount of the
    Medicare cost sharing portion.
    The average contract year 2011
    monthly capitation payment
    to program contractors is
    approximately $3,340. It is approximatel
    y $3,020 without the Medicare benefit.
    It is important
    to be aware that capitation payments can
    exceed the actual costs of services provided
    during the month.
    Before enrolling in ALTCS, if an applicant or
    family member is concerned about AHCCCS’
    claim that will be filed against the estate, the ap
    plicant and/or family member should evaluate the
    financial benefits of enrolling the applicant in
    ALTCS. Because ALTCS payments made on the
    member’s behalf can exceed the actual costs of se
    rvices provided, and accrue even if no medical
    service is provided, it is
    very important that ALTCS applican
    ts (and family members) make an
    informed decision about enrolling in ALTCS.
    This is especially
    true for those ALTCS
    applicants who elect to remain in their ow
    n home and do not enter a nursing home.
    applicant and family member should review whethe
    r it is better financially and medically for the
    applicant to pay for his/her n
    eeded medical services out-of-pocket (what won’t be paid by
    Medicare and/or other insuranc
    e) rather than enrolling in A
    LTCS and incurring a claim against
    their estate. Individuals who do not require ma
    ny medical services may
    not wish to enroll in
    ALTCS because their estate w
    ill be responsible for payment to AHCCCS of all ALTCS
    payments that are listed in question 5 above

    When you're over age 55, they begin accumulating all the charges spent to support you, and that is claimed against your estate.

    •  more on this recovery for AZ (2+ / 0-)
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      paradise50, splashoil

      although this is dated, it verified the methodology AZ uses to recover record amounts of $ from medicaid outlays. In fact AZ is #1 in recovered money as of 2004 anyways.

      2004 High and Low State Collection Rates

          The three states that recouped the largest share of their nursing home spending are Arizona (10.4%),* Oregon (5.8%), and Idaho (4.5%).
          Five additional states recouped >2.0% of nursing home spending: Iowa (2.9%), Minnesota (2.8%), Wyoming (2.7%), Maine (2.5%), and Massachusetts (2.0%).
          Three states reported minimal recoveries (rounding out to 0%): Louisiana, New Mexico, and Utah.
          Four states did not report any estate recoveries: Alaska, Georgia, Michigan, and Texas.

      * Arizona's estate recovery collections, as a percentage of nursing home spending, are not comparable to any other state because comprehensive prepaid managed care contracts dominate that state's Medicaid program. Nursing home care provided under these contracts is not identified separately for reporting purposes.

      It appears to me that all age 55+ Medicaid coverage, not just nursing home, etc., is charged back to the estate after your death. And the states have the option to pursue moneys, etc., other than just the probate items.
      States can choose to implement the minimal estate recovery guidelines mandated by OBRA 93, or they can implement a variety of options permitted by federal law to expand their estate recovery activities to reach more people and include more types of assets (see Table 4, below). For example, they can: use liens to secure Medicaid's right to recover; recover from recipient assets that bypass probate; or recover Medicaid spending for additional services beyond the required minimum of long-term care and related services.
      •  ...yes, my mom was totally broke... (2+ / 0-)
        Recommended by:
        splashoil, BarkerSr

        ...she lived in Texas. She ended up in a nursing facility in the end for a few weeks. She was on Medicaid. Even though I had nothing to do with this situation and live in California (from Colorado...never lived in Texas)...both the nursing home and the state of Texas pressured me to pay them back for her Medicaid costs while in that nursing home. No matter what I did, they kept coming at me. My mom had estate...nothing. She was living in her brother's home.

        After consulting lawyers in California I finally decided just to pay off the state of Texas and that nursing home (in Longview, TX) as they were about to sue me and go after what I own. I doubt it would have worked, however, it would have costed me several $10's of thousand of dollars to defend myself.  It was simply less expensive to pay them off.

        This is a standard ploy...make it more expensive for you to defend yourself against what isn't really legal than to just pay they off. I must admit, it is a strategy that works!...

        Welcome from the DK Partners & Mentors Team. If you have any questions about how to participate here, you can learn more at the Knowledge Base or from the New Diarists Resources Diaries. Diaries labeled "Open Thread" are also great places to ask. We look forward to your contributions.

        Ignorance is bliss only for the ignorant. The rest of us must suffer the consequences.

        by paradise50 on Sun Jun 16, 2013 at 10:59:58 AM PDT

        [ Parent ]

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