The End of Three Month Retroactive Coverage Puts Providers and Families At Risk according to the National Academy of Elder Law Attorneys.

Sec. 114(b) of the American Health Care Act would repeal retroactive coverage of Medicaid eligibility. This puts providers at risk of economic loss; strains family finances; and pits providers against family members for recoupment of expenses, potentially through litigation.

Family Caregivers Provide the Bulk of Care, Often until Exhaustion.

Many Americans take pride in caring for their families, including those that need long-term services and supports (LTSS). In economic terms, one study estimates that unpaid caregivers provide close to four times the amount of services than Medicaid LTSS.

Oftentimes, family members place themselves under extreme emotional, physical, and financial strain. Family caregivers often give up working full time to provide care, often foregoing saving for retirement, paying into Social Security, and resulting in economic insecurity over their life-times. Many families turn to public benefits only when they can no longer provide the care their loved one needs.

Current Law Allows for Up to Three Months of Retroactive Coverage.

As a condition of participating in the Medicaid program, states must provide retroactive Medicaid coverage up to three months prior to application, provided the individual with a disability could have qualified for benefits during that time frame. Sec. 114 of the American Health Care Act would end this retroactive coverage except for during the month of application.

Three Month Retroactive Coverage Protects Families and Providers Alike.

Often families hope to support their loved one with a disability as long as possible. They may have personally racked up significant expenses paying for that individual’s health and LTSS needs. Sometimes, admission to a nursing home happens suddenly after hospitalization. The individual may get directly discharged by the hospital to a nursing facility for rehabilitation. Medicaid eligibility rules are complex and the applications onerous.

By the time the adult child of the Medicaid beneficiary makes the application, it may be a month or so after admission to the nursing home. Yet, the nursing facility needs to ensure it gets compensated for providing services to that individual.

The adult child does not want to see his or her parent discharged because the parent lack funds. Retroactive coverage ensures the provider can collect payment for a beneficiary who meets the strict means-tested standards of Medicaid, but has not yet finalized the application process while receiving services.

Repeal of These Provisions Would Put Families at Risk of Lawsuits and Debt Collection.

Without retroactive coverage, from the perspective of the nursing home provider, they now have provided care without compensation. Depending on the contractual obligations of the family caregiver, the nursing facility could sue them by claiming they should have filed the Medicaid application more swiftly, holding them personally liable for payment of services.

This increase in litigation does not serve beneficiaries, their families, nor their providers. In the alternative, a nursing facility may require money paid in advance until Medicaid starts providing coverage.

This could put a tremendous financial strain on the families who may decide to hold off on admission, putting the beneficiary at risk for receiving care at the most appropriate setting.