Maryland Could Broaden Medicaid Eligibility Standards For Elder Care

Summaries of news aboutrecent Medicaid developments in Maryland and New York appear below.

Maryland

The Maryland Court of Special Appeals last month ruled that some Medicaideligibility standards used by the Department ofHealth and Mental Hygiene were stricter than federal laws allow, and advocates hope the broadstandards outlined in the case will be applied universally, the Baltimore Sun reports. The lawsuit was filed byDiane Byus on behalf of her mother, Ida Brown, after Brown was diagnosed withAlzheimer's disease and was unable to receive assistance through the OlderAdults Waiver Program, a Medicaid program designed to provide services such asnursing and adult day care.

Marylandlimits eligibility in the program to residents older than age 50 who haveincomes less than $1,869 a month and require daily care from licensed healthcare professionals. Although Brown, who also has several chronic conditions,requires daily monitoring, she does not require constant care from a physicianor nurse, the Sun reports. Attorneys from the Legal Aid Bureau and AARP argued in the case that state andfederal laws limit eligibility to residents who regularly require"health-related care and services," such as those that could beprovided in a nursing home, but not necessarily daily by a skilled nurse.

The state health department has not indicated whether it would appeal thedecision. State officials said that loosening eligibility requirements for theprogram would allow more people to receive benefits and could lead to denial ofcare for some of the neediest residents because of limited funding. The programcosts the state about $81 million annually.

Legal Aid attorneys are working on several similar cases. According to the Sun,lawsuits were filed against at least two other states that tried to limitcommunity- and home-based care services programs. Advocates in Kentucky succeeded in overturning restrictions, while Oregon's restrictionswere allowed to stand (Green, Baltimore Sun, 12/10).

New York

Two audits released onMonday by New York State Comptroller Thomas DiNapoli showed that the state made$5 million in Medicaid overpayments to 135 in-home health care, outpatient andlaboratory service providers across the state, Long Island Newsday reports. One of the audits, which spanned afive-year period through September 2006, showed that the state overpaid homehealth care providers $2.1 million for Medicaid claims of beneficiaries whowere living in nursing homes. The second audit, over a five-year period endingin February 2007, showed that the state overpaid $2.9 million in Medicaid tooutpatient and laboratory service providers for services that should have beenpaid by the facilities that ordered.

DiNapoli said, "Medicaid costs are already high," adding, "Thelast thing the state needs to do is pay for services not rendered or pay forthe same service twice. The state should take the steps necessary to recoupthese costs."

The audits said the overpayments are due to ineffective practices of the state Office of the Medicaid Inspector General and home health care providers whoeither ignored or misinterpreted Medicaid billing rules. The audits also notedthat the state does not have a proper Medicaidclaims handling system to identify cases of overpayments (Dowdy, Long Island Newsday, 12/11).

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