Mississippi not talking about the wealthy people on Medicaid – Jackson Clarion Ledger

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Disability advocates staged what they called a ‘die in’ outside Senate Majority Leader Mitch McConnell’s office Thursday to protest the GOP health care plan and proposed cuts to Medicaid. Police arrested a number of them, some in wheelchairs. (June 22)
AP

Clinton attorney Ronald Morton helps the elderly protect their stuff — sometimes so they can use Medicaid to pay for long-term, end-of-life health care as opposed to spending their savings.

“We can create a trust and do so in a way that the money, by and large, still stays with the (person),” he said. “But we’re transferring it to a place that it is protected. It is out of the reach of Medicaid.”

While Mississippi lawmakers discuss cracking down on the state’s growing Medicaid rolls by vetting applicants more closely, this is not a scenario that enters the conversation.

“Since I’ve been chairman, we’ve never talked about it at all,” said Senate Medicaid Chairman Brice Wiggins, R-Pascagoula, who’s held the seat since 2015.

In Mississippi, three out of four nursing home residents receive Medicaid benefits. That’s 13 percent more than the national average. But it is difficult for Medicaid officials to determine how much of an impact “Medicaid planning” has on the state.

More: The who, what and how much of Mississippi Medicaid

Morton, just one of many attorneys who provide Medicaid planning services, said the impact is not what you might picture. He doesn’t help make millionaires appear poor to get government benefits. Instead, he says, most of his clients are middle class.

“We have some very wealthy individuals (as clients), but for the most part we’re not helping millionaires get on Medicaid. That’s a misnomer that may make interesting headlines, but it’s simply not true,” Morton said. “Who we’re helping is middle class … these are individuals that worked hard their whole life. Their primary asset is a house and a little bit of savings. The husband and wife have worked, they’re looking forward to enjoying retirement, and boom, they get a diagnosis of Alzheimer’s in one of them.”

Morton points out that the practice is completely legal.

“Largely what we do is help protect the nest egg this couple worked their entire lives so that this spouse that’s at home can enjoy the fruits of that,” he said.

When former Florence attorney and Rankin County Chancery Judge Roger Clapp practiced law, people would come to him and ask for help getting on Medicaid. He turned them away.

“I believe it is morally wrong,” Clapp said. “It is taking from the taxpayers what you yourself could afford to pay for.

“They believe it’s wrong for them to have to spend their own assets to take care of themselves. They believe it’s wrong. That’s what’s happened to our society … How did that ever come to be the American way?” Clapp asked.

More: Frank conversations about planning for the final years

Congress established Medicaid in 1965 as a safety net for folks who couldn’t afford health care. In the ’90s, Congress made it a crime to transfer assets for the purpose of becoming eligible for Medicaid, a law referred to as the “Granny Goes to Jail Act.”

The law lasted one year before officials replaced it with a statute that only made it illegal for an attorney to advise someone on how to do so. In 1998, then-U.S. Attorney General Janet Reno said the new law was unconstitutional and declared that the Justice Department would not enforce it.

In 2006, after a national conversation about the issue, Congress increased the “look back” period — the amount of time a person must wait after transferring assets to be eligible for Medicaid — to five years.

“Medicaid planning,” then, is when a person, anticipating the possible need for long-term, end-of-life care, transfers assets ahead of time, leaving enough money to pay for their care until the five-year, look-back period concludes. The practice essentially requires an attorney’s assistance to ensure all the laws are followed.

“By placing it into this type of trust, we can start the clock running on protecting those assets for those Medicaid purposes,” Morton said.

Sam R. Hall: Allow me to shatter some Medicaid myths

Of 72.3 million Medicaid recipients nationally in 2017, 5.8 million, or roughly 7 percent, are elderly, according to the U.S. Centers for Medicare and Medicaid Services. In Mississippi, that number is 70,631 or 9 percent of the state’s Medicaid population.

Yet, long-term care and nursing home costs make up 42 percent of all Medicaid spending nationwide, 48 percent in Mississippi.

Rep. Jarvis Dortch, D-Jackson, said he’s in favor of options for elderly citizens to protect their assets ”instead of losing everything they work for.” 

Still, Dortch, former program manager for the Mississippi Health Advocacy Program, recognizes the irony of state lawmakers “attacking everyone else for trying to get health care” while being silent about wealthier people on the program.

Dortch opposed a law passed in the last legislative session called the HOPE Act, which was designed to root out “welfare fraud,” in part by requiring more rigorous eligibility auditing of Medicaid recipients.

“It’s almost, you treat some people like they’re not worthy of health care and ignore where the real money goes and how people are qualifying for it,” Dortch said.

There’s little research indicating the prevalence of Medicaid planning or how much money is legally shielded from the Medicaid program by planners.

Attorney Richard Young of Flowood’s The Elder Law Firm, which lists Medicaid planning as a service on its website, said the percentage of elderly on Medicaid who could be paying for care with their own assets is unknown.

“I’m not sure it contributes that much because not that many people know to do it,” Young said.

Young also said the majority of people who seek Medicaid planning services from his firm have less than $1 million in assets.

“(It’s) not a lot of money when you really look at it,” he said.

The Mississippi Division of Medicaid is responsible for enforcing the look-back period to make sure people aren’t shielding assets right before enrolling in Medicaid. The division asks for bank statements, deeds and property agreements and any other ownership documentation to verify candidates meet its requirements.

Medicaid spokeswoman Erin Barham said the division ensures recipients are following the look-back period. While some people are penalized because of asset transfers, Barham said, the division doesn’t have readily available data on how often it occurs.

“Medicaid is for the most vulnerable people in the state, so hopefully the people who are getting it are the ones who need it most,” Barham said.

But because it is legal under federal law, Sen. Wiggins said the state has little control over limiting the practice.

“Congress could fix it, but they don’t,” Wiggins said.

Contact Anna Wolfe at 601-961-7326 or awolfe@gannett.com. Follow her on Twitter.

Qualifying for long-term care under Medicaid

Mississippians over 65 needing long-term care in a nursing home are eligible for Medicaid if their income does not exceed:

  • $2,205 a month for individuals
  • $3,309 for couples 

Those amounts are set at 300 percent of the federal Supplemental Security Income benefit rate.

To be eligible, a person’s other resources — assets and property, excluding homes — cannot exceed $4,000. Other exclusions include:

  • Up to two cars 
  • Household goods
  • Personal property with value less than $5,000
  • Life insurance policies less than $10,000.

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