Ideas for Reforming NYS Medicaid

[wnyerlaughs]

Agreed, all waste needs to be eliminated. That being said, however, no one has suggested stopping providing needed services or even cutting the rates at which hospitals/doctors are paid. If needed services are being provided, I don't see why hospitals will be closing. If they are providing unneeded services, well then.....

unneeded services still get paid for, and it's $$ to the hospitals and other facilities, which means job security for healthcare workers.

if you cut down on unneeded services, the people providing those unneeded services (like EMT cab rides ando dozens of other examples) will soon have to look for other work, and since there is no viable private sector here, they'll either get a govvy job, leave the area, or , best solution: fight to maintain the staus quo and job security. It's all a big shhhhhhhhh with, ultimately, taxpayers footing the bill. you just don't see the gun at your forehead each day, or the hands in your wallet siphoning it to albany, redistributing it in a way that keeps the entrenched interests holding onto their piece of the pot o' gold that you're paying for.

[nogods]

They don't do business in NYS... what's your point?

My point is the medicaid fraud that adds up to real numbers isn't coming from the bum who abuses the benefits, but instead is coming from the well off and very rich who are stealing 100's of millions through false accounting systems.

[mikenold]

My point is the medicaid fraud that adds up to real numbers isn't coming from the bum who abuses the benefits, but instead is coming from the well off and very rich who are stealing 100's of millions through false accounting systems.

Man, it's never the bums, is it?

[Dougles]

My point is the medicaid fraud that adds up to real numbers isn't coming from the bum who abuses the benefits, but instead is coming from the well off and very rich who are stealing 100's of millions through false accounting systems.

Isn't that the SEC's job to sniff it out?? Like the did with Madoff?

[NBuffaloResident]

Man, it's never the bums, is it?

Hardly ever, in reality. They don't have the time, nor the lawyers, to figure out how to fleece the system.

[wnyerlaughs]

Hardly ever, in reality. They don't have the time, nor the lawyers, to figure out how to fleece the system.

wow. i actually agree with NBRes on this one. for the most part anyway. True that they don't have -- nor need -- the organization or infrastructre necessary to orchestrate a scheme but, as individual consumers, they DO - in aggregate - represent the demand that the medicaid system delivers "supply" to. The overall scam is built into the supply side of the medicaid system.

the old saying "familiarity breeds contempt" holds true. For those that are so inclined to exploit the system, each individual "bum" (no i dont like the word or label but ill use ot for the example), each bum finds his or her unique way(s) to take advantage of the system for personal benefit, but certainly not in an organized way like the NYS legislature and their conspirators do on a regular basis. THAT is institutionalized fleecing where, once again, familiarity breeds contempt for the taxpayers

[BorderBob]

For a chronic caller like Alardo -- who phones 911 four or five times a week -- the annual medical bill can be as high as $300,000. Over 13 years, the length of time he has been abusing the emergency room, he has cost the medical system an estimated $3.9 million.

I've never understood this. What costs $300,000 in a year? Supplies? Gas for the ambulance? I'm not disputing the argument, "bums" using the system like this is unexcusable. I'm just wondering sometimes where we get these numbers from. Aren't the EMT's working already? The Hospital staff.

It isn't just medical expenses, it comes up in other things too like police protection. Granted if an officer is on overtime, that is outside the scope of his normal duties, but lots of times they call these "costs" when there are no extra expenses involved.



b.b.

[mnb811]

Here is the best idea! Cut NYS by Utica and make everything west of it the new state of West New York. Let down state destroy their own territory and let upstate change their destiny. Only when we get rid of that albatross called the "Big Rotten Apple" will upstate ever change for the better.

[nogods]

Here is the best idea! Cut NYS by Utica and make everything west of it the new state of West New York. Let down state destroy their own territory and let upstate change their destiny. Only when we get rid of that albatross called the "Big Rotten Apple" will upstate ever change for the better.

cut off at Utica? Do you have access to goggle maps?

[leftWNYbecauseofBS]

cut off at Utica? Do you have access to goggle maps?

What are goggle maps?

What is the problem with setting Utica as a cutoff?

[Genoobie]

Isn't that the SEC's job to sniff it out?? Like the did with Madoff?

Well here's an interesting point. Think of this for a minute. Madoff was making gobs of money, and people who invested with Madoff throught they were making gobs of money. Most likely, some were honest investors who thought they could make a quick buck. They also probably paid taxes on the money they *thought* they were making. So there's a conflict of interest, right? What's the incentive for the government to investigate if they too benefit from fraud like Madoff. More than likely what drove the investigation was that Madoff wasn't paying taxes and the govt. wasn't getting their cut of the game.

I think NBR's point is that armed with lawyers and accountants, when cuts roll through the bums are going to get the shaft, while the status quo still feeds at the trough. Is there any way to ensure that both get removed from the payroll? Doesn't really seem so in the present system. The people who are fleecing the system at the high end require the abuses at the low end.

[mikenold]

I've never understood this. What costs $300,000 in a year? Supplies? Gas for the ambulance? I'm not disputing the argument, "bums" using the system like this is unexcusable. I'm just wondering sometimes where we get these numbers from. Aren't the EMT's working already? The Hospital staff.

It isn't just medical expenses, it comes up in other things too like police protection. Granted if an officer is on overtime, that is outside the scope of his normal duties, but lots of times they call these "costs" when there are no extra expenses involved.
b.b.

Have you ever known anyone that got a ride in an ambulance? Try going to the emergency room by way of ambulance. Tell them that you would rather pay cash than use your insurance. You will quickly find out that the expense will prohibit you from ever doing that again!

[mikenold]

What are goggle maps?

What is the problem with setting Utica as a cutoff?

Utica is where the Mob lives!

[Linda_D]

Well, to bring this thread back on topic: another major cost to the NYS Medicaid program is long-term nursing home care, especially for the elderly.

The current law allows Medicaid eligibility based on income/assets within 2 years of application. Here are some examples of how this is a problem.

Assumptions:

• single elderly individual without spouse or other dependent
• diagnosed with Alzheimers or other age-onset dementia
• paid-for house worth $110,000 (net $100,000)
• $20,000 in savings
• SS/pension worth $ 1,000 a month after various deductions for Medicare & whatever
• Nursing home care $5,000 a month
• Patient lives 5 years after entering nurshing home

Example 1:
Grandpa goes into a nursing home. His $1,000 a month in income leaves $4,000 a month that eats up his savings in 5 months. His 3 daughters sell his home, and use to pay for their father's care for another 25 months. The taxpayers' unreimbursed cost: $120,000.

Example 2:
A year before Grandpa goes into a nursing home, he gives his 3 daughters his savings and his house and moves in with them on a rotating basis. He's not eligible for Medicaid for his nursing home expenses for another year, so the daughters have to pay (as opposed to taking care of him), which costs them $48,000. The daughters get to keep $ 72,000 from their father. The taxpayers' unreimbursed cost: $ 192,000.

Example 3:
Two years and 1 month before Grandpa goes into a nursing home, he gives his 3 daughters his savings and his house and moves in with them on a rotating basis. They keep him at their homes for 25 months before putting him in a nursing home, so they get to keep his entire $ 120,000. The taxpayers' unreimbursed cost: $ 240,000.

Example 4:
Years before, Grandpa purchased long-term care insurance that guarantees payment up to $5000 a month for 5 years. When Grandpa can no longer live at home, he goes into a nursing home. The insurance pays for his nursing home for 5 years. His three daughters get to keep his entire $ 120,000 estate. The taxpayers' unreimbursed cost: $ 0.

These are very simplistic examples, but you can see that it would be in the best interests of NYS taxpayers as well as many families if more elderly people got long-term care insurance. At present, with only a 2 year window, many elderly and their families are willing to take the chance that it won't happen to them. Lengthening that window for disposing of assets to 5 or 7 years would make many more elderly, especially the very well off, much more inclined to buy LTC insurance.

Should somebody who has a net worth approaching $1 million dollars be eligible for taxpayer support simply because his/her heirs disposed of his/her assets 2 years before applying for Medicaid? Medicaid is for the poor, not for the well-off who hide their assets. Before you complain so loudly about bums taking advantage of "the system", maybe you look at the upper and middle class people who do the same -- for considerably more.

[Dougles]

Well, to bring this thread back on topic: another major cost to the NYS Medicaid program is long-term nursing home care, especially for the elderly.

From what i've read this is the SINGLE largest cost of NYS's added medicaid program...


My question to all of those that back this "add on", how do the elderly in the other 49 states survive without it?