A recent comprehensive study by Joanna Bisgaier, M.S.W., and Karin V. Rhodes, M.D. found that children on Medicaid and state Children’s Health Insurance Programs (CHIP) must wait twice as long as their peers with private insurance for an appointment with a specialist even though Medicaid recipients are supposed to be able to access care on a similar basis as others. In fact, the study found many providers wouldn’t even treat Medicaid recipients. Although expecting to find some disparity, the authors were surprised by the magnitude reports Reuters Health on June 15, 2012[http://news.yahoo.com/s/nm/20110615/hl_nm/us_medicaid_children].

The authors attribute the disparity to health care providers’ reluctance to accept public benefits. This result shouldn’t be surprising because, as the study notes, Medicaid often pays considerably less than other insurers for the same treatment. Thus, the authors suggest that this issue be addressed as part of the larger debate over health care reform. Although it is too soon to tell, the move by some states (like New Jersey) to move Medicaid recipients to managed care plans may help broaden access even if states’ motivations are more to reign in Medicaid costs.

The study appears [http://healthpolicyandreform.nejm.org/?p=14707&query=home] in the June 16 2011 issue of the New England Journal of Medicine [http://www.nejm.org].

It’s difficult enough for many seniors to cope with the normal issues and changes that arise as people age, but it’s particular unfortunate when they also must contend with financial abuse. The National Committee for the Prevention of Elder Abuse reports that a recent study by MetLife Mature Market Institute in conjunction with NAPEA and others (available on NAPEA’s website at http://www.preventelderabuse.org) finds that financial abuse of seniors is on the rise and costs billions of dollars. While much of the fraud noted in the studies was by strangers, a substantial share of financial abuse resulted from exploitation by family, friends, and neighbors. The study found that women are more than twice as likely as men to be victims of financial exploitation and men are somewhat more likely than women to be perpetrators.

Elder law attorneys can make various tools available to reduce an elderly loved one’s risk of financial abuse. Most importantly, statements for savings, investments, credit cards, loans, and lines of credit should be reviewed regularly to guard against unusual financial activity. Giving power of attorney to a financially secure and trustworthy loved one can ensure a second pair of eyes is on the lookout for patterns of abuse. Another option is to place assets under professional management through a living trust or other legal mechanism. We often help clients retain geriatric care managers to facilitate care and appropriate services to vulnerable seniors and serve as an additional bulwark against financial abuse. Of course, a lawyer should review contracts before they are signed. In addition, our firm helps families develop individual plans to protect a loved one where abuse is a serious concern.

Financial elder abuse often is circumspect and easy for the casual observer to miss. That is just one reason, it’s best to be proactive and put powers of attorney and other mechanisms in place early. Hiding your head in the sand can prove costly to both the victim and family.

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A recent New York Supreme Court case, Wayne Health Care Demay Living Center v. Blair (N.Y. Sup. Court # 68514/2009, April 20, 2011), illustrates the pitfalls of do it yourself Medicaid and long term care planning. Mrs. Blair admitted her husband to a nursing home but apparently didn’t properly handle his Medicaid application. Because Mr. Blair was denied Medicaid, Mrs. Blair was held liable to the nursing home under the doctrine of necessities. New Jersey courts also recognize this doctrine. The shame is that knowledgeable Medicaid planning could have avoided or substantially limited Mrs. Blair’s need to fund personally her husband’s nursing home costs. The doctrine of necessities is just one of many traps for the unwary in Medicaid planning. For instance, couples in second marriages often are surprised to learn that one spouse’s assets can be tapped for the other spouse’s long term care even when spouses always keep their finances separate and have a pre-nuptial agreement. We typically find Medicaid planning very valuable whether a single or married person needs long term care. For further information on long term care options and Medicaid planning visit the elder law tab at specialneedsnj.com or contact FriedmanLaw at 908-704-1900.  The Wayne Health Care Demay Living Center v. Blair  decision is available at http://www.elderlawanswers.com/Resources/ArticleAtty.asp?id=9117&Section=9&state

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