Cooperative federalism is not license to re-write clear federal rules (Co. App.) Ruth Koehler sued the Department after it terminated her benefits under its Medicaid Home and Community Based Services for the Elderly, Blind and Disabled (HCBS) program. Ruth, an elderly disabled woman, received HCBS as an alternative to nursing home care. Her husband resided […]
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Hogberg v. State Dep’t of Soc. Servs., 2009 Conn. Super. LEXIS 50 (2009). Lynda Hogberg was admitted to a nursing home in September, 2004. Two years later, in September 2006, her husband, a community spouse, filed a Medicaid application. The application was denied in March, 2007. In April, 2007, he filed an appeal. On May […]
James v. Richman, 465 F. Supp. 2d 395 (M.D. Pa. 2006). Robert and Josephine James were married when Robert went to the nursing home. A resource assessment was done and Medicaid determined they had $278,343 in available resources. To reduce their resources, Josephine purchased a $250,000 single premium immediate irrevocable annuity from General Electric Assurance […]
The Deficit Reduction Act of 2005, Pub. L. No. 109-171 (Effective date February 8, 2006). The Deficit Reduction Act of 2005 (DRA) changed the Medicaid eligibility rules significantly. Most of the changes are (or will be) codified at 42 U.S.C. § 1396p. DRA lengthened the look-back from 36 to 60 months; changed the start date […]
Harris v. McRae, 448 U.S. 297 (1980). The Medicaid program created by Title XIX is a cooperative endeavor in which the Federal Government provides financial assistance to participating States to aid them in furnishing health care to needy persons. Under this system of “cooperative federalism,” King v. Smith, 392 U.S. 309, 316, if a State […]
CMS: Centers for Medicare and Medicaid Services. Community Spouse The spouse of an institutionalized spouse. 42 U.S.C. § 1396r-5(h)(2). CSMIA: Community Spouse Monthly Income Allowance. This is the amount of the institutionalized spouse’s income that is diverted, if necessary, to bring the community spouse’s income up to the MMMNA. CSRA: Community Spouse Resource Allowance. DRA: […]
Medicare Drug Coverage (Part D). Provides basic information about Medicare prescription drug coverage, benefits and costs, eligibility and enrollment, extra help, comparing and choosing plans, and coverage determinations and appeals Medicare and Medicaid Fraud and Abuse Prevention. Explains Medicare and Medicaid fraud, waste, and abuse prevention, detection, reporting, and recovery Medicare Rights and Protections. Explains […]
2021 Training Powerpoint. Explains the rules that govern the payers‘ responsibility when people have Medicare and certain other types of health and/or prescription drug coverage
