ACTION ALERT: ON JULY 1st, GOVERNOR WILL UNILATERALLY CUT HEALTHCARE FOR SENIORS, DISABLED AND THE POOR

Coalition to Stop Medicaid Cuts in New York

Contact: Enzo Pastore (NYFAHC)
646-442-4184
epastore@nyfahc.org
fax 212-254-5953

David Silva (Selfhelp)
212-971-7695
dsilva@selfhelp.net
fax 212-947-8737

On July 1, 2006, severe cuts will go into effect that will limit the ability of seniors and people with disabilities to obtain necessary health care services in the community. These Medicaid cuts were not enacted by the usual process. Although both the Assembly and Senate voted against the Governor's proposed cuts, the Governor decreed that he will not comply with the legislature's decision. The Governor plans to forge ahead with new restrictions on Medicaid eligibility for our most vulnerable residents. These cuts must be stopped.

New York's future does not have to look this way:

1. HURTING COUPLES AND FAMILIES STRUGGLING WITH A LOVED ONE WITH A DISABILITY.
   
   The cost of health care for the chronically ill and disabled will prevent loving couples from getting married or force them to get divorced. People with severe disabilities, including children, will be forced to live in nursing homes, or to go without any care, since Medicaid will refuse to pay for vital health care in the community unless their spouse or parents live in poverty.

   On July 1 the Governor will take away the right of a frail elderly person or younger person with a disability to receive Medicaid when his or her wife or husband is unable to pay the high cost of home care and other medical bills and hold the family together at the same time. This right is called "spousal or parental refusal."

   New York's Medicaid program expects couples to live in the community on only $900 per month income - 20% below the Federal Poverty Line. A husband or wife who is "well" will be forced to divorce or institutionalize their spouse - just when they need to be together the most. In an astonishing twist, if the disabled spouse is placed in a nursing home, Medicaid will allow a "well" spouse to keep more of his or her income and assets (up to $99,540 in their combined assets and $2,489 in monthly income) than if the family cares for the disabled spouse at home. If he or she stays home and needs home care, they can have only $5,400 in combined assets and $900 in monthly income. This disparity violates the U.S. Supreme Court's ruling in Olmstead, which requires state Medicaid programs to make long-term care services available in the community, rather than only in nursing homes.

   On July 1, many young children will be forced into institutions. These children with severe disabilities receive Medicaid nursing services and home care. (About a third of all Medicaid home nursing services are for children under 20 years old). Their parents may work and support them, but cannot pay all the costly medical and home care bills. After July 1st, many of these children will no longer qualify for Medicaid and will be forced into institutions. This will turn back the clock - to the bad old days when we put away kids with disabilities and erased them from our families.

   Ironically, Governor Pataki has made this cut at the same time that he is increasing payment rates to the nurses who provide the care, because of the shortage of nurses. But if children are not eligible for care, increased payment rates won't help.

2. Contributing to a grandchild's college education or to favorite charity - called a transfer - will deprive fragile grandmothers of long-term health care at home.

   On July 1, the Governor will deny care at home for seniors and young people with severe disabilities who, during the last three years, donated to a church, a favorite charity, gave a wedding gift or graduation gift to a family member. They may be disqualified for vital Medicaid home care or assisted living services for a "penalty period." Now, anyone with a disability or significant health need will have to anticipate that a gift of even a modest amount of money will prevent them from receiving vital home care services.

   The Governor claims this change will stop "Medicaid for Millionaires." This makes a good sound bite, but it has little to do with the reality. Most gifts are made not by millionaires but by lower or middle-income people who transfer relatively small amounts of money - often under $20,000 - and are not intended to circumvent the Medicaid system. Often the gift is used to pay rent or other expenses for the elderly or disabled Medicaid recipient who cannot afford to pay these expenses on the meager Medicaid allowance of $692 for singles and $900 for couples.

   The Governor will not even allow an elderly woman to transfer her home to her daughter who moved in with her and took care of her for two years before she applied for Medicaid. That transfer will disqualify her from receiving Medicaid home care or assisted living for three years. Yet if the same woman goes into a nursing home, Medicaid would allow her to transfer her home to this caregiver daughter, as an exception to the usual transfer penalty. Again, the Governor is taking away the choice to stay in the community, leaving nursing home care as the only option.

3. By ending the Medicaid wrap-around for Medicare Part D, New York State will grab medicine from the hands of the poorest people with disabilities and the frail elderly

   Ever since January, when dually-eligible Medicaid/Medicare recipients began receiving their drugs through Medicare Part D, New York has prevented coverage gaps for this vulnerable population by allowing Medicaid to "wrap around" Part D. This means that when a Medicare Part D plan will not cover a drug that should be covered, Medicaid covers it. The Legislature voted to continue the Medicaid wrap until January 14, 2007. Instead, on his own, the Governor will end the Medicaid wrap unless one is "lucky" enough to need one of four kinds of drugs (atypical anti-psychotics, anti-depressants, anti-retrovirals for HIV/AIDS, and anti-rejection drugs used for transplants).

   Again, the Governor is pushing needy people struggling with severe illnesses and disabilities into nursing homes. If a "dual eligible" goes into a nursing home, they have NO copayments for drugs, and the nursing home is obligated to pay for drugs that the Part D plan refuses to pay for.

4. Families scraping by will avoid seeing the doctor - until it is too late - because of higher Family Health Plus co-payments

   On July 1, the Governor will cut New York's safety-net for the uninsured, Family Health Plus, over the objections of both the Senate and the Assembly. The Governor is about to increase the co-payment for "inappropriate" use of emergency room services from $3 to $25. The Governor will also allow hospitals, pharmacists and other providers to deny services if an individual is unable to pay the required co-payment. The real damage is not only the $25 – it is the second-guessing of whether one can afford to check out the possible stroke, diabetic shock or heart attack.

You can help us by:

• Tell your story. Use the attached "story form" to let us know what would happen to you if the Governor's cuts are allowed to take effect. Send them to casestudies@hcanys.org or dsilva@selfhelp.net or fax them to 212-947-8737

• Tell Governor Pataki he must stop hurting elderly and disabled New Yorkers. Go to http://www.ltccc.org/ and click on "Take Action" or direct link is http://capwiz.com/nhccnys/issues/alert/?alertid=8786521&type=ML

• Write a letter (sample letter at http://onlineresources.wnylc.net/healthcare/
  docs/patakiletter.doc

• Ask your organization to sign-on to this coalition. A press conference will be held June 6th or 7th in Albany. All organizations signed on will be listed on the press release. Let us know at dsilva@selfhelp.net

Coalition to Stop Medicaid Cuts -- List in Formation:

AARP - New York State Office
Alzheimer's Association, NYC Chapter
Alzheimer's Association, Long Island Chapter
Alzheimer's Association, NYS Coalition of Alzheimer's Association Chapters
Burden Center for the Aging
Center for Independence of the Disabled of New York (CIDNY)
Coalition of Institutionalized Aged and Disabled
Coalition of Voluntary Mental Health Agencies Inc.
Consumer Directed Choices, Inc.
Disabled in Action of Metropolitan New York
Empire Justice Center
Federation of Protestant Welfare Agencies
Friends and Relatives of Institutionalized Aged (FRIA)
Independence Care System
Legal Services for the Elderly in Queens
Long Term Care Community Coalition of New York State
New York Association on Independent Living
New Yorkers for Accessible Health Coverage
National Multiple Sclerosis Society - Long Island Chapter
National Multiple Sclerosis Society - Southern NY Chapter
National Multiple Sclerosis Society - Upstate New York Chapter
New York Legal Assistance Group
New York Alliance for Retired Americans
New York StateWide Senior Action Council
Special Services for Senior Citizens
The 504 Democratic Club
The Legal Aid Society
Westchester Disabled On the Move Inc.