Picente and the budget

[lioneljoe]

Recently, Mr. Picente implied that that the County sales tax will never be reduced and if it was it would have to be offset by a property tax increase. he also said the County's hands are tied because of mandated Medicare costs. I'm not defending Picente by any means but from what I understand there is some truth to what he says about the Medicare costs. Concerned Citizens did a great job listing some items that could be cut in NH for a substantial savings. Can anyone provide the same level of detail for the county that will clearly show that we can reduce the budget and cut the sales tax? Larry, do you have any insight to how much flexibility there is in the county budget? Thanks

[rodwilson]

GREAT topic. Why are our medicaid such a high percentage of our taxes? What is causing this? I've talked to several people who's points range from poor coverage of physicians so people tend to use more urgent care and emergency facilities. Do we have an additional burden due to some of the programs that we call "growth". What is the impact of the refugee population? Do we have a higher percentage rate of disabled and handicapped? What about the programs we support for recently released convicts? Does the local prison population factor in?

One thing we CAN do right now is to invest in real and aggressive community health education. People want to stop smoking, let's help them. Really help them, not sit on the money for those projects and call it fiscal and budgetary responsibility. Let's teach people about what they put in their bodies. Chronic, preventable disease waste millions.

We need to determine the causes and take action!

[concerned]

There is one aspect to Medicaid that I think we tend to forget. There are more and more advertizemenst and estate lawyers as guests on WKTV, etc. and the topic is how to handle all your assets when you are approaching the time to ge into a nursing home. The idea is to have Mediciad pick up the tab for many people who could afford to turn over there assets to pay susstancial protion on the cost of nursing home care. Something should be done about this. At the rate of nursing home care at $5,000 to $10,000 per month Medicaid is paying a lot for a lot of people in New York State.

Concerning the cost of stopping to smoke. On the local buses there are big signs that tell you that New York State will pay for you to get into a stop smoking plan( patches, gum, medication) Medicaid picks up the tab. Here is one abuse---you can get the patches for free as many times as one wants just by using a different phone number. Some people use more that one patch at a time as a means to get high.

[rodwilson]

Apr 23, 2009 9:44:50 GMT -5 @concerned said:

There is one aspect to Medicaid that I think we tend to forget. There are more and more advertizemenst and estate lawyers as guests on WKTV, etc. and the topic is how to handle all your assets when you are approaching the time to ge into a nursing home. The idea is to have Mediciad pick up the tab for many people who could afford to turn over there assets to pay susstancial protion on the cost of nursing home care. Something should be done about this. At the rate of nursing home care at $5,000 to $10,000 per month Medicaid is paying a lot for a lot of people in New York State.

Concerning the cost of stopping to smoke. On the local buses there are big signs that tell you that New York State will pay for you to get into a stop smoking plan( patches, gum, medication) Medicaid picks up the tab. Here is one abuse---you can get the patches for free as many times as one wants just by using a different phone number. Some people use more that one patch at a time as a means to get high.

GREAT piece. My idea for the Smoking cessation is community based. I quit smoking last year and couldn't find a program that was actually taking place, they were canceled due to lack of participants. My approach is recruit people who are willing to teach these classes (I already know some) and to participate in a patch or nicotine replacement "buy in". As a member of the community, I realize that it might be more effective to actually take these classes to the people. 70% of smokers want to stop and it contributes to more than 14% of medicaid costs. The people most likely to be in need are the people least likely to be able to get it. Church basements, wherever. I thought these programs were supposed to be funded by Tobacco Settlement $$$ that sits in our County "surplus" account. But your comments clearly demonstrate that I need to some more homework before throwing good money after bad but I am convinced that it's a worthy goal and can pay dividends.

The nursing home piece is huge. Now this is another example of our state and federal reps fail us. If these laws are handed "down" to us via mandates then they need to step up and either review and change the legislation or demand that the state take back some of the burden they're handing down to get us on par with other NY counties.

[concerned]

I thought the Tobacco Settlement money funded also. I have been using Chantrix for a year now and it is paid for through Medicaid . Actually through the Part D prescription drug program which is Medicare but I get extra help from New York State which is Oneida County. Either way when I get my monthly statement showing the medications I refilled Medicaid is listed.

[rodwilson]

Apr 23, 2009 10:27:39 GMT -5 @concerned said:

I thought the Tobacco Settlement money funded also. I have been using Chantrix for a year now and it is paid for through Medicaid . Actually through the Part D prescription drug program which is Medicare but I get extra help from New York State which is Oneida County. Either way when I get my monthly statement showing the medications I refilled Medicaid is listed.

So it would appear that instead of funding the programs with money that was actually disbursed for such programs and for health care related to smoking, we here in the OC use it to stop gap any real action on solving the medicaid issue?

[frankcor]

I have two concerns:

I'd like to see someone analyze the costs at the jail. Years ago we were told that Oneida County could save money by enlarging the jail and housing all our inmates here plus we could make money by charging other counties to house their inmates here as well.

But I have never seen anyone perform an audit of the costs and revenues at the jail. Would it be possible to reduce the staff at the jail by closing one or more of the units and stop housing out-of-county inmates.

My second concern is the fact that Oneida County has never done a zero-based budget. We always take the fact that we spent the money last year as justification for spending that much plus cost-of-living this year. I was stunned to hear Majority Leader Woods admit that the county has never justified any of the positions that they added last month. The jobs were on the books last year so that must mean we need them this year.

[dgriffin]

Frank, down here in Ulster County, the new jail turned from a supposed money maker ... for the reasons you mention regarding housing inmates from other counties ... into quite a debacle. While the major problems had to do with construction cost overruns, probable graft and corruption, it also turned out that housing inmates from outside the county has in recent years not been profitable.

RodW, welcome to the group. We're glad to have you here.
Regarding people moving money to relatives to save their estates from nursing homes fees ... I don't like subsidizing this through taxes to fund Medicaid, although it's exactly the arrangement I engineered for my parents some twenty years ago. And I recognize that folks are getting screwed when insurance companies throw them out of hospitals far sooner these days and then won't pay for their stay in a nursing home. This sucks an unbelievable amount of money out of the patient's pocket and can cause him or her to become destitute sooner than dead. (The trick being to have them coincide. )

PS, I assume you're aware that even after assets are moved, they remain a part of the patients assumed assets for some number of years. I don't know the length of time currently, but it increases often. It used to be 18 months, I think it's now 5 years.

[rodwilson]

Thank you Dave and points understood. It's a situation that def needs to be changed. I totally understand your rationale behind it. Neither the state or the insurance company care about breaking your bank.

[Clipper]

To be legally transferred, the transfer of assets has to take place 3 years prior to entering the nursing home.

When we put my Dad in the nursing home, he had to spend down to $2000 before medicaide would pick up and supplement his care. His pension was paid to the nursing home each month, with the exception of $40 that he was allowed to keep for haircuts and incedentals.

I was Dad's power of attorney, and when he died, he was under the impression that he was solvent and leaving us kids each a few thousand dollars. I never had the heart to tell him that he had spent all the proceeds from the sale of their home. He worried uneccesarily about money, even though he had no bills other than the nursing home, and his cable, which I paid with my own funds. I saw no reason to let him know that his finances were minimal and inconsequential. It would be devestating to me to find out that I had worked all my life, only to be restricted to a total of $2000 in assets, and $40 a month for haircuts and lunches out.

Once again, anything that has been transferred or spent in the last three years, has to be declared for medicaide.

[frankcor]

For some reason, some people don't have any problem with transferring assets to their children and then (3-years later) essentially "going on the dole" expecting the taxpayers to pay their terminal medical costs while their children reap the benefits of unethical lawyers.

[Clipper]

Exactly Frank. American's have come to believe that an inheritance is an "entitlement" in itself. Many seem to think that it is perfectly alright to transfer the house, and move most of their money to their children so that they can be cared for by the taxpayer.

In the case of my father, we learned from the unexpected decline in my mother's health, and her subsequent death, that preparation was necessary, and we pre-paid for my father's funeral and purchased the stone for their grave and graveside service.

When my dad passed away, we were left with his checking account, with the allowed $2000 to split 3 ways between myself and my siblings, and that is as it should be.

When I retired and moved here to care for Mom and Dad, I expected to spend some of MY money, to make their life easier, and more enjoyable, not conspire to get rid of theirs, or to hide it from the government. Trying to hide assets and to preplan the bilking of the average taxpayer, to pay for one's parent's care is despicable and criminal.

In most cases, our children are even more successful than our generation has been, and they in many cases are much more solvent and financially endowed than our generation. In most cases, they are certainly NOT in need of an entitlement to an inheritance.

It is my opinion that older folks should spend their money, enjoying life in their golden years, and when they need to be placed in a nursing facility, the proceeds from their home should be attached to pay for their care. If a husband dies, and the wife is surviving, a lien should be placed to recover the proceeds from the sale of their home when SHE passes on.

The younger and surviving generation has a lifetime to plan for their OWN retirement and the financing of such a venture. The older generation should be enjoying the fruits of a lifetime of work, and the proceeds from their home should insure that the government is partially reimbursed for their care should it become necessary.

I guess that it is the honesty that was instilled in me by my parents, but I would feel very guilty spending the proceeds that I might have hidden from the medicaide folks, had we hidden some. No good will come from ill gotten fortunes.

[frankcor]

Apr 24, 2009 10:05:14 GMT -5 Clipper said:

Trying to hide assets and to preplan the bilking of the average taxpayer, to pay for one's parent's care is despicable and criminal.

On the contrary, my friend. It's a growth industry.

Haven't you seen the new building occupied by the Estate Planning Law Center off the Parkway by the Zoo? The address is 1 Golden Place and they don't call it Golden Place for nothing.

Be sure to check out their handy calculator to see how much of your estate YOU can hide.

[dgriffin]

Now, wait a minute you guys. I am neither criminal nor despicable. I didn't write the Medicaid law. And I didn't break it. There is nothing dishonest or criminal about following Medicaid law to the letter, as is also true for IRS regulations. What we have here is a screwed up set of patchwork legal mandates, much of it NOT legislated, that everyone walks around in an artful manner, including the Department of Social Services. No state legislator ever sat and voted on very many of the Medicaid provisions, including the asset waiting period, reimbursement rates, etc. The RULES come from case law, but mostly from state attorneys who opine on matters brought to them by local DSS agencies. And each locality DOES INDEED interpret some matters differently. There were differences between Oneida and Ulster County DSS implementations. There are differences among the states.

When my parents both went into a nursing home in Oneida County, I went in and spoke with the Medicaid people in downtown Utica (1987) and asked their advice about the handling of my parents estate. They freely spoke about what others had done and I moved my parents money in a manner that was recommended by our family attorney. The Medicaid people were very nice and even offered suggestions, although they certainly did not give away the store. They acted truly honorable and upright, as though they appreciated both sides of the situation, the taxpayers' money and the family's ability to pay for care. At that time the asset waiting period was 18 months. On a visit to update DSS workers on my progress at 15 months, they surprised me by saying they were waiving the time period on that day, saving us 3 months of the ridiculously overpriced nursing home bills. I say ridiculously overpriced, because they in fact are just that, so that the nursing home can get as much money as possible up front, because they know most patients will be soon cleaned out and go on Medicaid, at which time the Home will have to accept it, plus Social Security.

I would estimate that at least HALF of the money my parents had to spend would have been covered by their hospitalization insurance before New York State's Insurance Commission folded up their integrity and began sucking on the teat of the insurance industry. Some of their care would have been provided with state money through subsidies to hospitals that have dried up.
This is not a black and white issue. It is complicated, for both the families of those who need the facilities of a nursing home and those government workers who try to administer the program. I even have a bit of sympathy for the nursing homes.

I will join you in saying we have a messed up system of medical care for the elderly, and I don't like lawyers who take advantage of it any more than you do. I also don't know your individual family situations, although Clipper has shared his somewhat.

All I know I did the best I could with what was available, listened to the advice of both the legal profession as well as the Medicaid workers, and I'm satisfied I did the right thing.

[dgriffin]

By the way, in case anyone is thinking of making their way to an Estate Planning group of ambulance chasers. I checked one out in Albany and found them not very creative. Nor ready to rock any boats. They are not about to do anything different and ruin their relationship with the local Medicaid office. Medicaid could throw a wrench into their works and keep them in court on a number of cases, ruining their business plan, which is to collect (back then) about $5,000 for doing nothing but signing their name to the work of the children after the heirs attend a couple of seminars taught by a kid who still has a law school parking lot sticker on her bumper.