CMS Ruling May Pose Serious Problems for New York Seniors

Federal law protects married couples from having to choose between divorcing and becoming impoverished when one spouse needs expensive nursing home care. For 20 years, this law allowed the healthier spouse to retain income and assets while the sicker spouse is covered by Medicaid.

In New York State, the same benefit has been extended to people with illnesses like Alzheimer's disease or cancer who receive care at home, which is both less expensive and less disruptive to relationships.

That benefit may no longer be available to the spouses of those patients receiving care at home, according to The New York Times. Last fall, the Centers for Medicare and Medicaid Services sent a letter to New York health officials outlining a legal ruling declaring that couples in which both partners live at home are not entitled to the same protection as those couples where one spouse is in a nursing home.

According to the article,

"The change was originally supposed to go into effect in December, but the Paterson administration and the New York Congressional delegation have won a delay until March 1, and are hoping that President Obama will reverse the Bush administration’s ruling."

Federal Medicaid officials say that:

"[W]hen Congress gave the states the option to extend the so-called spousal impoverishment protections to home health care, it intended to protect only the neediest people, and that New York State is protecting people with too much retirement income."

So far, the ruling has been subject to several vocal opponents, including Senator Charles E. Schumer, a New York Democrat, who said:

“[The New York] policy makes imminent sense to ensure that seniors and the spouses who care for them do not fall in to poverty."

and

"The Bush administration is trying to pull the rug out from under thousands of seniors in New York who depend on this critical program year in and year out just to survive.”

The state Health Department estimates that 3,000 couples will be affected by this change, while advocates for the elderly say the number is closer to 4,000.

Several thousand couples may be faced with a difficult choice this March. If the federal protection ceases to apply to those patients who receive care at home, the inevitable choice for many couples will be to forego keeping their current home care with a Medicaid "spend-down" for the long-term care option protected by federal law.

Clearly, the shift of 4,000 patients to long-term care would increase overall cost; a burden that would have to be shouldered by the Medicaid program. Moreover, it raises concerns about the quality of care those patients going from home-based care to long-term care will receive.