Latest DPW figures bring bad news

June 10, 2012

The Department of Public Welfare’s latest statistics for April were just released and they continue to paint a sad, even alarming picture. Total enrollment of kids in Medicaid and CHIP is down again, by 4,128 children. That’s more than an entire high school of kids who won’t be able to see a doctor for a broken bone, a pair of glasses or an immunization. Remember when we had a bipartisan consensus to cover all kids? What happened? So far no explanation.

Remember when the goal of welfare was to move people to work and self-sufficiency? The latest DPW data shows that the Administration is doing a very poor job of training people and helping them find work. Only 5.3% of TANF families have any earnings from work, down from 7.6% in the month that the Corbett Administration took office. TANF case closures based on earnings are also far below that of the previous Administration – only 1610 cases were closed last month because the family got a job that paid enough to move them off assistance. Some might say reducing the welfare to work budget by 40% might have contributed to this trend, but the Administration has turned more and more to punishing people for perceived shortcomings. Disqualification for failure to abide by the byzantine rules of the new system (a process known as sanctioning) has increased markedly – 807 families were newly sanctioned last month, bringing the total number of sanctioned families in April to 1907. Even more disturbing, 863 families, including the children, were denied all cash assistance. Not satisfied with “only” punishing 863 families, DPW is rumored to be seeking authority to cut off all the children in all families.

In short, Pennsylvania has moved away from helping families find work, to punishing entire families when parents are unable navigate the system. We changed from “welfare to work” to “welfare to nothing.”


Federal audit finds Pennsylvania Medicaid error rate less than half of national rate

December 22, 2010

On November 15, the U.S. Department of Health and Human Services released findings from its audit [pdf] of the Pennsylvania Medical Assistance program.  The audit found that Pennsylvania’s Medical Assistance, or Medicaid, error rate was 4.07%, less than half of the overall national Medicaid error rate of 8.98%.

Ever better news can be found in the details of the report.  Nationally, the error rate for eligibility determinations (i.e., whether the recipient is actually eligible for Medicaid) is 7.60%.  But Pennsylvania’s eligibility determination error rate is a low 1.97%.  That means that less than 2% of Medical Assistance recipients may not have been eligible for the assistance they received.  (The other errors were found in the fee-for-service or managed care programs that had insufficient documentation or provided incorrect diagnosis codes.)

Pennsylvania’s lowest-income families, children, the elderly, and disabled rely on Medical Assistance.  The Department of Public Welfare is to be applauded for administering this critical program so efficiently.

This federal audit contrasts with Auditor General Jack Wagner’s report last year that the Department of Public Welfare had a much higher error rate in the Medical Assistance program.  Why the difference?

Auditor General Wagner’s audit confused administrative errors with intentional fraud.  The Auditor General asserted that the Department of Public Welfare made errors in eligibility determinations for Medical Assistance applicants that countenanced fraud.  In truth, many of the errors had no bearing on applicants’ eligibility: they were eligible for the program but simply didn’t provide (or the Department of Public Welfare couldn’t produce) the requested paperwork.

The Department of Public Welfare should continue to modernize its operations to further reduce its low error rates.  But to do so may require additional budget and staffing. The number of caseworkers in County Assistance Offices, for example, has been reduced dramatically as a result of budget cuts.  There are currently more than 1,600 fewer staff at County Assistance Offices than there were in January 2003 – a 20% reduction.  Meanwhile, the number of households that rely on Medical Assistance has ballooned from 1.8 million individuals in 2006 to more than 2.2 million individuals today – an increase of over 22%.

The Auditor General’s recommendations (for example, that caseworkers verify income twice as frequently) would create an overwhelming administrative burden for caseworkers at a time when they are given insufficient resources to handle staggering caseloads.


Pennsylvania Medicare Beneficiaries Settle Case Against the Department of Public Welfare

May 3, 2010

Narcissa Garcia was struggling to live on her monthly disability payment of $695.00.  Her struggle was made more difficult by having her monthly benefit reduced by almost $100 to pay for the monthly Medicare Part B premium.  In November 2008, she applied and was approved for Medicaid benefits, part of which would have Pennsylvania pay her monthly Part B premium.  Because of delays, Ms. Garcia had to wait six months before Pennsylvania began paying the premium, while her monthly benefit was still being reduced.

On April 23, 2010, Ms. Garcia, the Center for Advocacy for the Rights and Interests of the Elderly (CARIE), and the Arc of Pennsylvania entered into a court settlement with the Pennsylvania Department of Public Welfare (DPW).  The case, Garcia, et  al. v.  Kathleen Sebelius, et al. was a class action lawsuit brought on behalf of all Pennsylvania residents who are eligible or  will become eligible for the Medicare Savings Program (MSP), the Medical Assistance program that pays the Medicare premiums for eligible Pennsylvania residents.  Advocates from Community Legal Services and the Center for Medicare Advocacy represented the  plaintiffs in the lawsuit.  You can go here to read a press release regarding the settlement. Read the rest of this entry »

The effect on home ownership when entering a nursing home.

February 1, 2010

The Aging & Disabilities Unit receives many calls from individuals and their families members about the effect that entering a nursing home has on the individual’s home ownership.  In the community rumors abound that in order to enter a nursing home and to have Medicaid pay for it, you will have to give your home to the state.

These rumors are wrong.  If someone owns a home and requires long-term skilled nursing home care to be paid for by Medicaid, she can preserve her home ownership for the entirety of her life.  This is true only for homes that the potential nursing home resident actually lives in, and not for non-residential property that an individual owns.  When evaluating financial eligibility for a Medicaid nursing home grant, the Pennsylvania Department of Public Welfare (DPW) will always exclude as a resource a home that the applicant lives in.  Again, to have Medicaid pay for long-term, skilled nursing care, an appplicant NEVER gives up the ownership of her home.

Unfortunately, these rumors can cause individuals to take steps that will ultimately affect a person’s eligibility for Medicaid to pay for a nursing home stay.  Sometimes, a home-owner will transfer their home to a family member thinking that this will protect their home from the state.  When this is done, it actually can prevent an individual from receiving Medicaid, unless they receive actual payment of fair market value for their home.  When an applicant applies for Medicaid, DPW will do an in depth review of an applicant’s financial history from the previous five years.  If DPW discovers that an applicant has transferred a home for less than fair market value, it will penalize the applicant by denying her Medicaid for a period of time.  If a homeowner anticipates a stay in a nursing home facility, she should contact an attorney before transacting any business regarding the ownership of her home.

The rumors of losing one’s home, we believe, have their origin in Pennsylvania’s Estate Recovery Program (ERP).  ERP is a program mandated by the federal government that requires all states to seek recovery from the estate of a deceased person the cost of long term nursing care paid for by Medicaid.  This law is only applicable to Medicaid recipients over 55 y.o.  Additionally, this law only takes effect after the person receiving nursing care has passed away.

Because Medicaid is a program for low-income individuals, often the only asset left in a person’s estate is the home.  Upon the death of the Medicaid recipient, DPW will send a letter to the family asking for an accounting of the deceased’s estate.  This will be followed by a claim from DPW for the cost of care provided while the individual was receiving a Medicaid grant.

However, there are many ways to avoid having to subject a home to estate recovery.  The law requires that DPW grant hardship waivers in certain circumstances (spouses, disabled children, care-givers who provided significant care prior to the entry of deceased into a nursing home).  CLS often works with family members to get these waivers.

Because of the rampant rumors about ERP, many people will not apply for Medicaid, and in turn, not receive the necessary medical care they require.  Individuals who need long-term, skilled-nursing care should know:

1)  You do not have to give up ownership of your home in order to receive a  Medicaid grant for long-term skilled nursing care.

2) Recovery from the individual’s estate after they decease is not inevitable, and many times avoidable.