Monday, June 27, 2011

Bill would protect Pennsylvania Seniors Prescription Drug benefits

Update: HB 463 was signed into law as Act 21 of 2011 on June 30, 2011

Seniors who were receiving benefits from Pennsylvania’s PACE or PACENET prescription drug programs on December 31, 2010 would not be bumped off their program in 2012 and 2013 due to increased income from Social Security cost-of-living adjustments if House Bill 463 is enacted.  It is projected that Social Security payments will increase 1.2 percent in 2012. 

The Department of Aging estimates nearly 22,000 seniors would be forced from PACE to PACENET if the bill does not become law. More than 9,000 would lose their coverage entirely. If enacted, the legislation would take effect immediately and expire Dec. 31, 2013.

To be eligible for PACE or PACENET, Pennsylvania residents must be at least 65 and cannot have prescription coverage through Medicaid. Eligibility is determined based on the applicant’s previous calendar year income. 

For PACE, a single person cannot make more than $14,500. For a married couple, the combined income limit is $17,700. Co-payment for a 30-day supply of medication is $6 for generics and $9 for brand name prescriptions. 

For PACENET, the income limits is between $14,500-$23,500 for a single person and $17,700-$31,500 for couples. The co-pay is $8 for generics and $15 for brand name prescriptions. PACENET has a monthly premium of between $20 and $30.

HB 463 passed the House by unanimous vote on June 6, 2011 and is now in the Senate.

Sunday, June 26, 2011


While policy makers in Washington debate whether to make fundamental changes to our Social Security system, the program goes on making its own significant adjustments each year.  Here are some of the important modifications that have already occurred this year - 2011.

Social Security taxes reduced for workers. As a result of the Tax Relief Act, the amount that workers pay into the Social Security trust fund has been reduced from 6.2 percent (of taxable wages up to $106,800 annually) to 4.2 percent. This one time temporary change is effective in 2011 only. Employers will continue to pay 6.2 percent of wages into the entitlement program. 

For self-employed workers, the Social Security tax rate is reduced from 12.4 percent to 10.4 percent in 2011.See the social Security Information Fact Sheet at

“Free loan” option eliminated. Retirees are no longer able to get an interest-free loan from the Social Security trust fund. The Social Security Administration announced in December 2010 that individuals are not able to begin payments at age 62, then pay back all the benefits received at age 70 without interest and reclaim at a higher rate of benefits due to delayed claiming. Under the new rules, Social Security beneficiaries may withdraw an application for retirement benefits only within 12 months of their first Social Security payment and are limited to one withdrawal per lifetime. 

Retroactive benefit suspensions discontinued. In the past retirees were able to temporarily suspend their benefits, and then restart them later – resulting in a bigger social security check because of the time in which the payment wasn’t received. This is still allowed under the new rules.  It can be an especially important planning option for some married couples because spousal benefits can be taken only after the primary worker files for benefits.  (For example, upon reaching full retirement age a worker can file for and then suspend his benefit but thereby allowing his spouse to claim spousal benefits. However, social security recipients are no longer able to retroactively suspend their benefits, and pay back money already received in exchange for higher payments going forward. They can only suspend benefits for months when they didn’t receive payments or for future payments, beginning the month after the request is made.

Goodbye Paper checks. Effective May 1, 2011, new applicants filing for all federal payments including Social Security, Supplemental Security Income (SSI), veterans benefits and wages will receive their payments electronically, unless they qualify for one of a very few exemptions. This means retirees who first apply for Social Security benefits on or after May 1 will no longer have the option of receiving a paper check in the mail. Seniors can have their entitlement payments directly deposited into a bank or credit union account or loaded onto a prepaid debit card. Benefit recipients can sign up for direct deposit at, by calling the U.S. Treasury Electronic Payment Solution Center at (800) 333-1795, or by speaking with a bank or credit union representative. 

If recipients do not provide information to the federal payment agency regarding a bank account or prepaid card into which they want their payments electronically deposited, they will be provided the federal government-issued Direct Express card. Direct Express cards have considerable protections for recipients, including limits on fees, legal protection against unauthorized charges, and requirements for free access to funds. They are likely to be substantially less expensive than other prepaid cards. 

Recipients who were receiving their benefits prior to May 1, 2011 have until March 1, 2013 to choose an electronic payment option. After that date, no payments will be issued via check, unless the recipient qualifies and is approved for an exemption. To continue receiving paper checks, recipients must be approved by the US Treasury for one of the following exemptions:

·       Aged 90 years or older, as of May 1, 2011 (no waiver required)
·       Mentally impaired
·        Live in a remote geographic area lacking the capability to support an electronic financial transaction

"This important change will provide significant savings to American taxpayers who will no longer incur the annual $120 million price tag associated with paper checks and will save Social Security $1 billion over the next 10 years," said Richard Gregg, Treasury Fiscal Assistant Secretary.

Goodbye Annual Statements. In the past, approximately three months before their birthday each year, Social Security would mail workers age 25 and over who are not already receiving benefits a personal statement that estimated their future Social Security benefits. However, in order to save money, beginning in April 2011 the Social Security Administration (SSA) stopped the mailing of these annual statements. SSA plans to eventually resume mailing statements to people age 60 and over.
SSA does provide individuals with the ability to obtain some limited information online at The online tool does not provide all the information that appeared in the written statement, such as estimates of disability and survivor’s benefits and the worker’s complete earnings record.

Saturday, June 25, 2011


Pennsylvania’s annual Seniors Farmers Market NutritionProgram was kicked off in June for income-eligible older adults. The program focuses on assisting older adults in eating a healthy diet. The program provides income-eligible individuals with four coupons or checks totaling $20 that can be exchanged for fruits and vegetables. Vouchers can be used at participating local farm markets and roadside farm stands.

To qualify for the program, individuals must be 60 or older by Dec. 31, 2011. Income eligibility is basis on 185% of the federal poverty income guidelines ($27,214 annual income for a family of two in 2011). 

Interested older adults should contact their local Area Agency on Aging. For more information on the program visit:

Saturday, June 18, 2011

Increased Medicaid FMAP ends this month

Medicaid is a federal-state matching program. States receive federal matching funds to help them pay the costs of basic health care and long-term care for their low-income residents.  These matching funds are available on an open-ended basis: the more a state spends on covered benefits for eligible individuals, the more matching funds it receives from the federal government.

The federal government matches state Medicaid expenditures based upon a percentage, called the Federal Medical Assistance Percentage (or FMAP), which varies depending on the state’s per capita income. This federal funding is open-ended. If a state decides to provide services permitted under the program, the state expenditures are matched by an uncapped federal matching grant. For example, in Pennsylvania, the FMAP was 57.71 percent in 2004. This meant that for every $1.00 in state funds that Pennsylvania paid out in 2004, it received $1.36 more from the federal government.

This open-ended federal financing system encourages states to provide health care to the elderly and other covered groups, and to broaden the scope of that coverage. The federal government will absorb more than half of the additional costs when a state expands the numbers of individuals and services covered under Medicaid.

The federal matching funds system helps protect state Medicaid spending in times of budget cuts. The matching grant structure makes it less desirable for states to cut Medicaid than other programs, since when Medicaid is cut, most of the dollars saved just flow back to the federal government. And, if Medicaid is cut, health-care providers and other businesses in the state that are dependent on Medicaid revenues will be required to cut jobs. Thus, Medicaid cuts magnify as they ripple through the state’s economy.

In response to the recent "Great Recession," the 2009 American Recovery and Reinvestment Act increased the Medicaid federal matching percentages (FMAPs) received by states through Dec. 31, 2010. A separate Medicaid assistance measure (Pub. L. No. 111-226), which was signed in August 2010, extended the match through June 30, 2011. The ARRA upped every state's FMAP by at least 6.2%.  It is estimated that the ARRA increase in the FMAP will have increased federal Medicaid payments to states by well over $100 billion dollars during its 11 quarter run (period October 2008 through June 30, 2011).

The ending of the increased FMAP means that Pennsylvania and other states will now have to pay a larger proportion of the costs of their Medicaid programs from state generated funds.

For more on the FMAP see Medicaid: The Federal Medical Assistance Percentage (FMAP), Congressional Research Service (September 24, 2011)

Note that more recently enacted Affordable Care Act (aka “health reform”) also contains a number of provisions that affect FMAPs. Most notably, the Affordable Care Act provides FMAPs of up to 100% for certain newly eligible individuals. It also provides increased FMAPs for primary care, specified preventive services and immunizations, smoking cessation services for pregnant women, specified home and community-based services, and health home services for certain people with chronic conditions.

Thursday, June 16, 2011

Recent PA DPW Medicaid Long Term Care Policy Clarifications

In Pennsylvania, Department of Public Welfare (DPW) County Assistance Office (CAO) income maintenance caseworkers review applications for Medical Assistance long term care benefits and make eligibility determinations. To help these CAO caseworkers, DPW’s Bureau of Policy provides interpretive guidelines in its Long Term Care Handbook

DPW also transmits various policy clarifications, program directives, and memoranda to the local CAOs, and provides ongoing trainings for local caseworkers where policies regarding eligibility determinations are discussed. DPW makes its policy clarifications and other program directives and memoranda intermittently available on the Department’s website.  Recent policy clarifications have included the following: 

PMN15801468: Revised Spousal Maintenance Allowance Effective 7/1/11 (June 3, 2011)

PMN15762403 : Managed Care Organization (MCO) Disenrollment for an Active Medical Assistance (MA) Recipient entering a Long Term Care (LTC) Facility (May 25, 2011)

Treatment of Income from Participating in Clinical Trials for Rare Diseases and Conditions (May 24, 2011)

PMN15789440: Transfer of Assets to a Disabled Child (May 18, 2011)

PMN15777389: Eligibility for Home and Community Based Services (HCBS) in Spend-down Category of Medical Assistance (MA)(May 5, 2011)

PMN15737468: Deduction Limitation for Guardian Fees, Including Costs to Establish Guardianship (April 10, 2011)

PMN15573440: Establishing the Penalty Period for a Recipient of Long Term Care (LTC) Facility Services or Home and Community Based Services (HCBS) (December 8, 2010)

PMN15565389: Procedures for HCBS Waiver Programs under the Office of Long Term Living (Revised January 13, 2011) 

PMN15421440: Resources for Home and Community Based Services (Aug 5, 2010)

Wednesday, June 15, 2011

CMS letter delivers guidance to state Medicaid agencies on financial protections for same-sex couples

The federal government has announced that it will permit states to extend Medicaid’s spousal long-term care protections to same-sex domestic partners. 

The Department of Health and Human Services website notes: 

“HHS will continue to evaluate ways its programs can ensure equal treatment of LGBT families. For example, HHS will advise states and tribes that federal law allows them to treat LGBT couples similarly to non-LGBT couples with respect to human services benefit programs such as Temporary Assistance for Needy Families and child care. The Centers for Medicare & Medicaid Services [CMS] will also notify states of their ability to provide same-sex domestic partners of long-term care Medicaid beneficiaries the same treatment as opposite-sex spouses in the contexts of estate recovery, imposition of liens, and transfer of assets. This includes not seizing or imposing a lien on the home of a deceased beneficiary if the same-sex domestic partner still resides in the home. It also includes allowing Medicaid beneficiaries needing long-term care to transfer the title of a home to a same-sex domestic partner, allowing the partner to remain in the home." ”

On June 10th CMS issued a letter to State Medicaid Agencies which clarifies that states can extend these protections when the same-sex spouse or domestic partner of the Medicaid enrollee continues to reside in their home.  The letter also outlines how states can apply other protections to same-sex spouses or domestic partners, for example, by allowing individuals needing institutional care to transfer ownership of their homes without financial penalties. View the letter at

The new HHS policy permits states to extend these protections to same-sex domestic partners, but it does not require states to do so. It is unclear whether any state will decide to expand Medicaid spousal protections in this manner. Of course in many cases it would be advantageous for same-sex couples to be treated as not-married to avoid Medicaid’s provisions for deeming of resources. 

Saturday, June 11, 2011

Community Spouse Minimum Income Allowance to Increase to $1,839 on July 1, 2011

If a married nursing home resident receives Medicaid long-term care benefits, his or her community spouse is entitled to retain a certain minimum level of income called the Monthly Maintenance Needs Allowance (MMNA).  If the community spouse's own income is insufficient to provide this allowance, income is diverted to the community spouse from the institutionalized spouse.

The MMNA is set at 150% of the federal poverty level for a family of two plus an excess shelter allowance, if applicable. The Pennsylvania MMNA is adjusted on July 1st of each year to keep up with inflation. 

As of July 1, 2011 the minimum MMNA is being increased to $1,839 per month. The actual MMNA can be higher than the minimum if the community spouse has high housing cost and is entitled to an excess shelter allowance.  

A standard monthly shelter allowance of $552 a month will be built into the minimum MMNA effective July 1. If certain housing-related expenses of the community spouse exceed this standard allowance the MMNA is increased by the amount of these excess shelter costs.  This is the called the "excess shelter allowance."   

These minimum income allowance rules are part of the federally mandated “spousal impoverishment” protections that were enacted in 1988 to avoid the total impoverishment of spouses of nursing home residents. These protections could be lost if a Medicaid Block Grant proposal were to be enacted at the national or state level.